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AIMS AND METHOD  To study the presentation, assessment and management of all patients attending St Thomas' accident and emergency (A&amp;E) department with overt mental health problems. The method included a pragmatic definition of ‘overt mental health problems' and a range of strategies to maximise case ascertainment.    RESULTS  The department saw 565 presentations in a 3-month period. Patients were predominantly young, male, single, unemployed, housed outside the area served by the local primary care group and presented outside normal working hours.    CLINICAL IMPLICATIONS  This study confirms that A&amp;E departments may be the most frequently used setting for urgent mental health assessments in central London. The patients attending differ from those using community mental health teams. It is argued that mental health liaison services based in inner-city A&amp;E departments should be developed.

Mental health presentations to an inner-city accident and emergency department