Emergency responders face an increasing number of calls involving people with behavioral and mental crisis issue. The objective were study the situation, characteristics, issues, and accessibility to the emergency medical services (EMS) and appropriate treatment for emergency patients with a mental crisis in Thailand. The sample included 26 511 mental crisis patients accessing EMS from data base of the Information Technology for Emergency Medical System between 2014-2016 and stakeholder from four provinces distributed regionally using focus group and in-depth interview. The data were analyzed using descriptive statistics and content analysis. Results, the number of patients with mental crisis accessing EMS were increasing for the past 3 years. Most patients are male in working age group from the Northeastern during the raining and winter season, especially between September and October. During patients with maniacal attacks, assistance will be requested from the police and the emergency medical units. The response depends on the experience and community capability. The emergency responder teams had insufficient knowledge and skills. Emergency rooms in most hospitals lack specific caring unit. Psychiatric hospitals have different criteria for admitting patients. Most had not fast track system and even refuse admittance. In conclusion, mental crisis patients with EMS were rising. However, accessibility to appropriate service centers was still an issue. Most hospitals lack prioritized access and staffs had insufficient knowledge and skills. Cooperation among the police, emergency medical operation team and the rapid psychiatric emergency team is need to be reinforced.