When an emergency physician or hospitalist places a psychiatric consult, you are the person who shows up the same day, performs the assessment at the bedside, and begins treatment in the room: medication management, long-acting injectable antipsychotics, medication for addiction treatment where indicated, and substantive therapeutic work — not a chart review and a medication reconciliation. A sound, evidence-based clinical assessment framework: a clear, defensible approach to deciding when a patient in the emergency department needs further observation, inpatient admission, or safe discharge to the community, with respect to suicide risk, ability to care for self, and risk of danger to others.