Objective <p>Psychiatric emergencies represent acute disruptions in thought, mood, or behavior that carry a risk of harm to self or others. This study aimed to examine five-year trends (2019–2023) in psychiatric consultations requested from the emergency department of a tertiary hospital in Turkey, identifying predictors of high-risk presentations and factors associated with discontinuity of follow-up care.</p> Methods <p>This retrospective study included 1,100 adult patients referred for psychiatric consultation between 2019 and 2023. Inclusion criteria were age ≥ 18 years and availability of complete consultation records; exclusion criteria included incomplete data and duplicate consultations for the same cases. Diagnoses were established according to DSM-5 criteria. Sociodemographic, diagnostic, and clinical data were analyzed using descriptive and comparative statistics (Student’s t-test and Chi-square test).</p> Results <p>A 17-fold increase in consultation requests was observed from 2019 to 2023, with the most frequent diagnoses being schizophrenia and other psychotic disorders (19.4%) and bipolar disorder (17.5%). The leading reasons for consultation were agitation (18.8%), suicide attempt (14.5%), and forensic referral (10.8%). Among suicide attempters, 57.2% were male, and 71.1% failed to attend follow-up outpatient appointments within one month. Post-pandemic years showed a marked increase in both total consultations and suicide-related visits.</p> Conclusions <p>The substantial increase in psychiatric consultations reflects not only the psychosocial effects of the COVID-19 pandemic but also expanded service capacity, increased mental health awareness, and improved emergency–psychiatry collaboration. Low follow-up adherence among high-risk patients, particularly suicide attempters, underscores the need for integrated post-emergency monitoring and coordination between emergency, psychiatric, and crommunity-based services.</p>