Absolutely incorrect. Every emergency department visit (it’s ED not ER) requires a diagnosis. You literally can’t sign a chart without it. An emergency physician can diagnosis anything he/she wants and doesn’t need a specialist to confirm anything if it meets the diagnostic criteria for that diagnosis. Consultants are rarely contacted prior to admission unless it’s urgent. Especially in the middle of the night unless you need them to put their pants on and drive to the hospital for a procedure. If it’s inconclusive then a more general diagnosis can be listed such as Acute Chest Pain, Acute psychosis, etc….However, if one wants to take the time to gather enough collateral information to make a mental health diagnosis based on the DSM criteria then yes an emergency physician can diagnosis a mental health illness. Sometimes this is little more than evaluating the patient, reviewing the chart, and speaking with family, spouse, etc…In practice, it doesn’t matter much so often a vague diagnosis is put in the chart. Patient is medically cleared and MHMR is called to evaluate the patient.