ObjectivesThe ability of nursing homes to manage the mental health needs of their residents is crucial to providing high quality care. An important element is preventing exacerbations of psychiatric conditions that trigger discharge from the nursing home (NH) because of an emergency commitment (EC) for an involuntary psychiatric examination. The objective of this study was to examine the relationship between resident and facility characteristics and the risk of EC for involuntary psychiatric examination among Medicaid‐enrolled NH residents in Florida.DesignThis retrospective cohort study employed 2.5 years (31 December 2002 through 30 June 2005) of Medicaid enrollment and fee‐for‐service, pharmacy, and involuntary commitment data to examine resident characteristics. NH characteristics were obtained from the Online Survey Certification and Reporting database.SettingMedicaid‐certified NHs in Florida (N = 584).ParticipantsMedicaid‐enrolled NH residents (N = 32,604).ResultsYounger age, male gender, having dementia, having a serious mental illness (SMI), and residing in a for‐profit facility were all independently associated with the greater risk of EC. Although most residents with EC were prescribed psychotropic medication, less than half received non‐pharmacological behavioral health outpatient services before or after their involuntary psychiatric examination.ConclusionOur findings highlight the salience of resident and facility characteristics to prevalence rates of EC for involuntary psychiatric examinations among NH residents and underscore a need for increased education, communication, and future research on the predictive factors as well as the consequences of these adverse events. Copyright © 2011 John Wiley & Sons, Ltd.