Background: Pediatric mental health issues are increasing while access to care is decreasing. This is reflected in a growing number of patients seeking emergency psychiatric evaluations (EPEs) in the emergency department (ED). Methods: This was a retrospective review of patients seeking EPE in the ED of a children's hospital between September and December 2018, which compares patients referred from the community versus those from schools as well as patients from schools with and without school-based mental health services (SMH). Results: A total of 546 EPEs were analyzed, with 187 (34%) referred from schools. School referrals were younger, had a shorter length of stay and lower admission rates. When comparing those from schools with SMH, those referred from schools without SMH were younger and less acutely ill. Conclusions: Higher acuity children from schools with SMH suggest that SMH staff managed less severe situations on site. The role of SMH as a triaging tool and provider of mental health services should be studied as they may reduce the burden on EDs for EPEs.