Introduction

The accident and emergency (A & E) department of the general hospital differs from other settings for emergency intervention as patients with acute psychiatric problems will present here whether or not a specific service for their management is provided. Whatever their treatment history and familiarity with local health services, most people know where to find their local general hospital A & E department, and know that it is a source of urgent help available day and night. Further, it has been observed that some patients and their carers continue to come to the A & E department even if they are aware of other, sometimes more appropriate, services which they may contact in crisis (Bartolucci & Drayer, 1973).

However, whilst the A & E department figures prominently in the minds of the public as a source of help, it has not always been so central in discussion and research on psychiatric emergencies, or in the development of innovative services. In the 1960s and 1970s, at least in North America, the general hospital emergency room was for a time a major focus for research and service development, as numbers of patients presenting here increased and as psychiatric services began to shift from the large mental hospital to general hospital units. More recently, the assessment and management of self-poisoning has received considerable attention in Britain.