The call came in as they always do—brief, detached, clinical. Adult female, unresponsive, possible overdose. By the time she arrived in my bay, the paramedics had pushed multiple rounds of naloxone with no meaningful response. We moved fast. Airway, access, dextrose, flumazenil, a full tox screen. She was polypharmacy. We adjusted. She stabilized. By the time she was admitted to the intensive care unit, intubated and sedated, the acute crisis was over.

What came next was the part no one had a protocol for.

In 23 years of emergency medicine, I have stabilized thousands of patients in a mental health crisis. Overdoses, suicide attempts, acute psychotic breaks, the quiet deterioration that accumulates until someone finally calls 911. We are good at this work. Our protocols are sound. Our teams are trained. But once the patient is stable and the automatic doors close behind them, we hand them to a system that is not ready for what they actually need — and we move on to the next emergency.

That is the mental health discharge gap. It is not a new problem. But it is one our specialty has not dealt with well enough, in part because what happens after discharge often feels like someone else’s job. I think that needs to change. Emergency physicians have more influence at the point of discharge than we usually use.

The first 72 hours after a mental health crisis discharge are especially dangerous, and they are also the time when follow-up care most often falls apart.^1,2,5 Patients leave our departments with discharge paperwork, a list of referral numbers, and very little guidance for the days that follow. Families leave with the same. The system that stabilized the crisis is not built to carry the patient through what comes next.

The result is predictable. Appointments are missed. Medications are not filled. Shame sets in after the crisis itself has passed, and it can keep people from getting the help they need.³ We see them again, often in worse condition than before.⁴

We can still do more.

A few discharge questions matter a lot: Is the patient safe for the first 48 hours? Is there a real follow-up appointment? Have we talked through practical means restriction? Families leaving without clear answers to those questions are not set up to help. We should treat those questions the way we treat return precautions for chest pain.

The way we speak matters too. “You had a medical emergency and you’re going to need support” lands differently than “follow up with outpatient psychiatry.” The first sounds like care. The second can sound like a dismissal.

Our documentation matters as well. Mental health discharge summaries often leave out the kind of information the next clinician actually needs: family dynamics, barriers to follow-up, and the patient’s emotional state at discharge, not just the medical one. That does not require more time. It requires paying attention to what will matter later.

When it is available, a warm handoff helps. A social worker or care coordinator making the first call before discharge is better than handing someone a phone number and hoping for the best.² Not every department has that option. Many do, and do not use it often enough.

I also want to say this plainly: I am not writing this only as an emergency physician. I have lived through my own mental health crisis and recovery. I know what it feels like to be handed a discharge sheet and sent into a system with no map. I know what it feels like to leave with questions nobody asked.

That experience shapes how I see this issue, but it is not the basis of the argument. The argument is clinical. Our patients are at their most vulnerable in the hours after we discharge them, and we have more influence over those hours than we tend to admit.¹^,⁴ The discharge gap belongs to emergency medicine too.

The system will not fix itself between the stretcher and the parking lot. But we can do more than we do now.

Dr. Burnham is a board-certified emergency physician with 23 years of emergency medicine practice and the author of LIFELINE: What to Do After a Mental Health Crisis (Guidestone Publishing, 2026). He can be reached at burnham@live.com.

Disclaimer: Opinions in this piece do not represent the views of ACEP nor ACEP official policy.

References

1. Chung DT, Ryan CJ, Hadzi-Pavlovic D, et al. Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(7):694-702.
2. Vigod SN, Kurdyak PA, Dennis CL, et al. Transitional interventions to reduce early psychiatric readmissions in adults. Br J Psychiatry. 2013;202(3):187-194.
3. Corrigan PW. The impact of stigma on severe mental illness. Cogn Behav Pract. 1998;5(2):201-222.
4. Olfson M, Marcus SC, Bridge JA. Emergency treatment of deliberate self-harm. Arch Gen Psychiatry. 2012;69(1):80-88.
5. Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161-167.