The purpose of this study was to describe the experiences of individuals with intellectual disabilities (ID) and their families in the emergency department (ED). Hospital chart audits were conducted on a sample of 20 individuals with ID living with family who had visited the ED for a psychiatric crisis. Individuals had a combined total of 44 ED visits. Seven (35%) individuals made more than 1 ED visit, with 15% visiting the ED more than 5 times over a 1-year period. Patients received psychiatric consults 64% of the time. Nineteen (43%) visits resulted in inpatient admission, but 32% of the time ED staff sent patients home with no recorded follow-up plans. The key difference between hospitalized and nonhospitalized visits in terms of client characteristics or crisis severity was a greater likelihood of physical aggression in visits resulting in admission. Implications for training of ED staff and a need for community resources are discussed. (Contains 3 tables and 1 figure.)