Te ideas in this chapter are my own experiences and opinions on different topics within the arena of emergency psychiatry. My frst experience working in an emergency department (ED) in America was a claustrophobic one. Te ED that I frst worked in by New York City standards was small, and therefore by every other standard was tiny. Te psychiatric ED was simply a small room flled with nurses, psychiatry residents, medical students, psychiatric technicians, and a few attending psychiatrists. Te space was so small that we only had one square yard to walk around in. In the middle of this small room was an ominous and intimidating secretary who yelled at anyone who asked her for something. Calling her “scary” would be an understatement. Over time, as I became used to the smallness of the psychiatric ED, psychologically it felt larger. Tere appeared to be more room to move around than I initially thought, and I was not afraid to respond when the phone was ringing. Ultimately, even the scary secretary became less terrifying and we became a functional team that worked well together. Before I knew it, my frst year of psychiatry residency training had come to an end. Years passed, and toward the middle of my third year of residency, I was asked to be the chief of the psychiatric ED. At that hospital, it was called the psychiatric observation suite (POS). I accepted the offer of that position, mostly because no one had offered me any other position. I also happened to look up to the director of the ED, as he is one of the best ED psychiatrists I have ever known.