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Previous studies suggest that patients use medical emergency departments for nonurgent care. However, relatively little has been published about the use of psychiatric emergency services. Eighty-two patients who visited the psychiatric emergency department in a free-standing psychiatric hospital during July 2003 participated in a self-report survey about patients' expectations. Almost all respondents had acute psychiatric needs on presentation to the psychiatric emergency department, and 45 (75 percent) had urgent needs that required inpatient or partial hospitalization. However, there was considerable mismatch between some patients' expectations and the types of services available. Patients' use of this psychiatric emergency department was generally consistent with the department's mission, but many respondents endorsed a need for a service that was not available, such as family therapy. These findings suggest the importance of efforts to educate the public about how to obtain mental health services.