Triaging Psychosis in the ED
Purpose and scope
This section gives a practical, evidence‑based approach to triaging patients presenting with psychosis in the ED. It integrates UK guidance (NICE NG225, NG10), the RCEM Mental Health Toolkit and GOV.UK/DHSC advice on information‑sharing, using the Australian Mental Health Triage Scale as a widely used five‑level exemplar.
The goals are rapid identification of acuity and immediate risk, assignment of an appropriate observation level, timely liaison psychiatry involvement, exclusion of organic illness and clear documentation and escalation.
Why mental‑health triage matters
Psychotic presentations range from low immediate risk to life‑threatening agitation or severe self‑harm risk and may reflect primary psychiatric illness or an acute organic process (intoxication, withdrawal, delirium, metabolic or neurological disease). Structured mental‑health triage performed alongside physical triage:
- Identifies patients needing immediate resuscitation, urgent medical assessment or rapid psychiatric intervention.
- Determines observation level and staff allocation to keep patients, staff and public safe.
- Triggers safeguarding, proportionate information‑sharing and liaison psychiatry referral where needed.
- Meets NICE expectations for mental‑health triage in EDs and timely access to liaison psychiatry when high acuity is identified (NICE NG225; NG10).
- RCEM provides practical templates and operational advice for implementation.