Facing the Challenges of Understanding and Managing Behavior and Psychiatric Issues

Dear Dr. Steve: When residents have behavioral disturbances that result in violent actions, one of my nursing homes sends the patient to the emergency room. In the emergency room, the ER doctors often do not see any acute need for psychiatric stabilization or admission, and I want to send the patient back with clearance from the ER doctor. The nursing home, however, insists that there be clearance specifically from a psychiatrist. Is such clearance necessary? How should my facility handle patients with behavioral and psychiatric issues?