As part of an investigation of the causes of increased use of Philadelphia's seven psychiatric emergency services, staff of the services were asked to identify the problems and changing conditions facing them. Difficulty securing inpatient beds for public patients and heavy use of services by a small number of patients fitting the description of young adult chronic patients were mentioned by staff at most of the services as among the most important problems or changes. The staffs' perceptions were confirmed in the second part of the study, which analyzed emergency service data for fiscal years 1979 through 1985. The data analyses also indicated that the heavy users continued to make extensive use of emergency services for several years following their first admission, causing their total number of visits to climb from 3,048 in 1980 to 14,839 in 1985. The authors suggest immediate strategies for responding to the emergence of these young, very disturbed patients.