The authors compare patient characteristics in a psychiatric emergency setting in the United States with a similar service in the United Kingdom. They found that despite many significant differences in nonclinical variables, the severity of clinical symptoms did not differentiate between the two groups. In both countries, it was not the degree of psychopathology but the lack of an available support network, an inability to engage the patient in the system, and a history of serious chronic maladjustment that led to the majority of "emergency" visits. The authors conclude that use of an emergency service sensitivity mirrors the gaps in health care delivery.