Down the Rabbit Hole Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies Veronica Tucci, MD, JD a, *, Kaylin Siever, MD a , Anu Matorin, MD b , Nidal Moukaddam, MD, PhD b INTRODUCTION “But I don’t want to go among mad people,” Alice remarked. “Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.” “How do you know I’m mad?” said Alice. “You must be,” said the Cat, “or you wouldn’t have come here.” —Lewis Carroll, Alice in Wonderland Disclosure: The authors have nothing to disclose. a Section of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA; b Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1502 Taub Loop, NPC Building 2nd Floor, Houston, TX 77030, USA * Corresponding author. E-mail addresses: Tucci@bcm.edu; vtuccimd@gmail.com KEYWORDS  Medical clearance  Medical screening  Medical stability  Psychiatric and behavioral emergencies KEY POINTS  Patients with primary mental health complaints comprise a substantial proportion of all emergency department visits.  The medical clearance process for patients with behavioral and psychiatric emergencies consists of several elements, including medically stabilizing patients and meeting criteria for various inpatient psychiatric hospitals with limited medical resources.  There are no uniformly accepted interdisciplinary guidelines or algorithms that constitute medical clearance between psychiatry and emergency medicine.  The breadth of ancillary testing, including laboratory examinations and radiographic eval- uations, is often hotly debated among EPs, emergency psychiatrists, and inpatient psychi- atry teams. Emerg Med Clin N Am 33 (2015) 721–737 http://dx.doi.org/10.1016/j.emc.2015.07.002 emed.theclinics.com 0733-8627/15/$ – see front matter Ó 2015 Elsevier Inc. All rights reserved.