Sixty families from three self-help, psychoeducational groups in western New York State were interviewed about their experiences during recent psychiatric emergencies involving their mentally ill relatives. Twenty-six hospital-based emergency mental health service providers were compared with the families on key attitudes toward emergency services. Families reported that emergencies were complicated and traumatic and that they involved contacts with numerous agencies, sometimes over several months. Satisfaction with the emergency service system was generally low among both families and hospital service providers. Service providers were less likely than families to believe that families' assessments of their ill relatives' need for treatment were credible. The author suggests that apparently "crazy" behavior of families may make sense in the context of serious patient pathology and a general lack of emergency assistance. Much effort is needed to develop coordinated emergency mental health treatment that is sensitive to families' needs.