Recent rapid and significant changes in the utilization patterns of emergency psychiatric services have culminated in markedly different patient profiles and intervention needs than those for which these services were originally intended. The resultant overextension and inappropriate utilization of the emergency unit have served to seriously jeopardize treatment efficacy and efficiency and to exacerbate the stress and difficulties associated with providing mental health intervention in an emergency room setting. Study findings of the patient profiles and patterns of use of emergency psychiatric services of a large metropolitan hospital are reported and examined in relation to these issues. Implications for a restructuring of treatment orientation and of the use of facility resources are discussed.