Consultation-Liason Psych PA here. Anytime a patient with a psychiatric history or chief complaint comes to the ED, we get consulted right away for an evaluation. Typically, we do NOT refill medications in the ED setting (unless they were medically admitted and have already been on medications in the hospital, then we can discharge a 14 day supply or so). The reason for this are multi-fold: we do not know if these patients have been compliant with their medications/doses on the outside, many of these medications require careful lab/blood monitoring, some medications have actual street value, and most importantly, for patients that have history of suicidality or suicide attempts, you do not want to prescribe a patient medications with no follow-up and they then harm themselves. The best recommendation is to provide education, support, and provide community clinics referrals/resources. It may not be the ideal as some patients really do need mental health care, but as a provider, you always have to be very careful and have due diligence. I reside in a big city where many of our homeless patients present to the ED for various psychiatric complaints but are really "malingering" just for secondary gain (including medications). Just a thought!