Is the crisis a psychiatric emergency?

Psychiatric emergencies and life crises are at opposite ends of a broad scale of stages requiring emergency care: Emergencies require immediate medical attention to avert life-threatening danger.

For the same reason, immediate hospitalization and additional treatment of internal disease risks must be provided if necessary. Crises often have not only mental but also social aspects.

The urgency of treatment is determined by psychiatric (suicidal) or physical risk.

Emergency cases and severe crises require 24-hour medical care. Social aspects cannot be dealt with at night, even if they are urgent.

Therefore, emergency and crisis intervention services with a multidisciplinary staff assign different roles to physicians, nurses, and social workers.

Since 1976, the Central Institute for Mental Health has provided a 24-hour crisis intervention and emergency service both at the institute itself and in the emergency department of the University Hospital Mannheim.

Within a few years, the number of treated episodes increased to 1,800-1,900 per year. Distance between places of work or residence is a critical factor in the use of services. More than 50% of emergency and crisis intervention service users are mentally ill. Only a small proportion seek crisis services without a psychiatric disorder.

Suicide attempts or intentions account for about 30% of service users, marital crises for about 25%, and alcohol problems also for about 25%. The development of complementary care in Mannheim has led to a parallel increase in the proportion of chronically mentally ill people living in complementary institutions.

This clearly indicates that a 24-hour emergency and crisis intervention service is a prerequisite for the implementation of an effective system of additional care for the mentally ill.