Background: - Aim of this study was to give an overview of how patients were engaging tornthe service at the Hospital after first emergency visit to identify the gaps in the service andrnfactors associated with disengagement to care. Psychiatric service in Ethiopia has beenrnprovided by Amanuel Hospital for the entire country for many years and the service was notrnyet decentralized well. But there has not been systematic study conducted to see how patientsrnwere engaging to care after visit. We believe the findings will help to plan to improve thernservice and it will also raise questions for further research.rnObjective: - To describe the pattern of engagement to care after first emergency psychiatryrnvisit at Amanuel Specialized Mental Hospital.rnMethods: - A retrospective study was conducted involving those who visited emergencyrnoutpatient department unit at ASMH from December /2015 to November /2016. Datarnextraction sheet were used to collect information for the study. All cases who visitedrnemergency OPD of ASMH for the first time during the study period were included forrnstratified simple random sampling and 385 participants were included in the study. The datarnsheets were coded and data entry, cleaning and analysis was done using the StatisticalrnPackage for the Social Sciences (SPSS) version 20.bivariate and Multivariate logisticrnregression was done to see socio-demographic and other determinants of disengagement torncarernResults: -Three hundred and eighty five cases were included in the study. Of these, 57.4%rnwere males. The mean age of the participants was 31 years. In terms of region, majority ofrnthe participants (near to 71%) come from either from Oromia (47%) or Addis Ababarn(23.6%).In majority of the participants (83.1%) the main reason for emergency visit wasrneither aggression or other behavioral disturbance and near to 76% got diagnosis of nonaffectivernpsychotic spectrum disorder. Near to 81% of the participants have disengaged fromrncare and from those who were disengaged 44.5% had no re-visit to the hospital. Amongrnparticipants 90.3% of female and 77.4% of male who were included in the study disengagedrnfrom care. Majority of the participants (75.6%) were seen by Master or BSC psychiatryrnprescriberâ€™s and only 9.9% of the participants were seen by either psychiatrist or psychiatryrnresidents at first visit. Near to 95% of those participants seen by non-psychiatry professionalsrnwere disengaged from care.rnConclusion: - disengagement from care has deleterious effect on over all prognoses ofrnpatients and mental health care system in general. Proper emphasis should be given forrnpsychosocial interventions specially giving due emphasis on psycho-education about illness,rnlifestyle management, family intervention and support, relapse prevention strategies.rnRecommendation: - Giving proper psycho-education and patient centered care should bernthe rule than the exception. Improving the referral system, working in co-ordination andrncollaboration with other health institutions and religious leaders might help to improvernpatient care and engagement.