Sparse data are available on service utilization, pattern and profile of mental and behavioural emergencies in India. We explored the pattern and clinical profile of consecutively referred psychiatric emergencies at a premier tertiary healthcare centre in India.We reviewed the consecutive referrals for acute mental and behavioural problems made by the emergency department and recorded in an emergency psychiatry register between January 2015 and January 2016.Over a 1 3-month period, 666 patients were assessed; of whom 473 (71 %) had no prior/known psychiatric history and 84 (12.6%) had a comorbid medical condition. Nearly one-third of patients had potential legal issues associated with their emergency. The most common reasons for presentation were: an attempt at self-harm (130; 19.5%), aggression/agitation ( 122; 18.3%) and psychoactive substance use-related problems (69; 10.3%). Schizophrenia and other psychotic disorders (89; 13.4%) and mood disorders (87; 1 3.1%) formed the 2 most common diagnostic groups seen in emergency. Most commonly prescribed medications were benzodiazepines (296; 44.4%) followed by antipsychotics (187; 28.1%) and antidepressants (90; 13.5%). Notably, 11% of patients (76) were advised immediate admission under psychiatry, half of whom could be admitted directly from the emergency.Our findings suggest that there is a need to optimize emergency mental healthcare and develop service delivery models for common psychiatric emergencies in India.