The times I've been to the ER have varied from being manic to depressed and also mixed. Each time they wanted to either admit me or send me to a psych hospital (60 to 120 miles away). One time I refused to be admitted, twice I was transferred to a psych hospital. This is in the past year. I can't remember how they did it years ago. As has been previously said, the ER first clears me medically. The staff have been friendly enough.