From crisis to next step
Match the response to acuity, function, and available support
Emergency assessment is a focused clinical process that evolves as immediate risk is contained, collateral is obtained, and medical or substance-related contributors are evaluated. The disposition should reflect what the person needs to remain safe and continue treatment after the crisis encounter.
- Practice context
- Mobile and community crisis response, urgent outpatient care, emergency departments, crisis stabilization programs, partial hospital and intensive outpatient programs, and inpatient psychiatry
- Typical pace
- Immediate triage and stabilization followed by reassessment, disposition planning, and rapid follow-up during transitions between levels of care
- Who's involved
- People with acute changes in safety, behavior, cognition, judgment, functioning, substance use, or ability to meet basic needs, along with families and other supports
Common presentations
- Suicidal thoughts, self-harm, or recent suicide attempt
- Acute psychosis, mania, severe agitation, or aggression
- Intoxication, withdrawal, overdose, or substance-induced symptoms
- Delirium, catatonia, or abrupt change in cognition or behavior
- Severe depression, anxiety, panic, or trauma-related distress
- Inability to care for basic needs or marked functional decline
- Medication toxicity, adverse effects, or abrupt interruption
PMHNP priorities
- Address immediate threats and create a safe environment for assessment
- Evaluate suicide, violence, elopement, vulnerability, and ability to meet basic needs
- Assess for medical, neurologic, medication, and substance-related causes
- Use verbal de-escalation and trauma-informed approaches whenever feasible
- Reassess after stabilization, collateral, observation, or a change in clinical status
- Determine the least restrictive safe level of care and document the clinical rationale
- Build a specific transition plan with medication reconciliation, follow-up, communication, and contingency steps
Care team
Emergency clinicians, PMHNPs, psychiatrists, nurses, social workers, crisis clinicians, emergency medical services, pharmacists, security or public-safety staff, peer specialists, inpatient and outpatient teams, and family or other supports.