When her daughter, Jessica, decided to drop out of college, Carolyn thought she might just need a break from the stress of school. But once Jessica moved back home, Carolyn became alarmed. Jessica barely left her room. She wasn’t eating—and never seemed to sleep. She was listless and hard to reach. After a few weeks, Carolyn worried that Jessica was suffering from depression. She decided it was time to get Jessica some help. But, to do so, should she take her to the emergency room?

Jeremy Finkelstein, Director of Emergency Services at Houston Methodist Hospital, says whether or not you should take someone you think is suffering from depression to the ER for treatment is a common question.

“What people don’t understand is that mental healthcare is a severely rationed service, for many reasons. So there is a dearth of facilities providing comprehensive inpatient care,” he says. “Even in large cities, there are often only a handful of psychiatric facilities. So there are some pretty specific criteria required to get admitted to a hospital for psychiatric care.”

But, that said, an emergency room is often the place that provides the medical screening exam that can help a patient gain admittance to a mental health facility for treatment when needed. It can be an important part of getting that inpatient care when it is merited.

So when should you go to the emergency department? In Carolyn’s case, Finkelstein says that Jessica’s depression would constitute a psychiatric emergency if she is obviously suicidal or homicidal, telling people she is planning to self-harm or harm others.

“Self-harm, suicidal or homicidal thoughts are very clear-cut cases where you should go to the emergency room. And if you are experiencing severe physical manifestations of a mental health condition, anything that is a threat to bodily function or well-being, that’s a good time to go, too,” he says. “Sometimes what looks like a mental health problem is actually a medical one. And we can help with that.”

If a person is showing signs of psychosis, with severely impaired thinking or disorganized speech, Finkelstein says the ER is the right place. And if someone has already been diagnosed with a psychiatric condition and is having serious issues with medications, that’s a time to head to the emergency department, too.

“Situations that are life or limb threatening, that’s when it’s appropriate to go to the ER,” he says. “A lot of folks come to the ER telling me they are suffering from different life stressors, maybe someone lost a job, or someone’s girlfriend left him, and they feel depressed. But the high risk elements just aren’t there. And they won’t end up as an inpatient. In those cases, you are better off trying to find someone you can see on an outpatient basis.”

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