Clinical experience suggests that accident and emergency departments are increasingly adopting the role of primary health care providers, particularly those departments situated within the inner cities. Previous studies have shown that there is a high rate of psychiatric morbidity contained within the group of patients attending accident and emergency departments. The question arises as to how adequate provision for serving such patients can be made. Traditionally these patients have been referred to a duty psychiatrist for assessment or have been discharged from the department without a specialist psychiatric opinion having been sought. This approach has its drawbacks as an inappropriate emergency referral creates unnecessary work for an already busy duty psychiatrist. On the other hand no referral at all may result in serious psychiatric disorder remaining undetected and untreated with possible tragic consequences.