The article by Boudreaux et al. [1] in the current issue regarding the prevalence and interest in treatment for mood disorders among ED patients raises several important concerns for acute care providers and for the health care system as a whole. Hospital emergency departments (EDs) have increasingly become a location in which mental illness first presents [2]. The result is that identification, diagnosis and referral for mental health symptoms rests, not infrequently, with ED physicians. However, neither the training of emergency physicians nor the needed support infrastructure of psychiatric and social services has kept up with national trends, leaving ED providers poorly prepared and under-resourced for the task.