As we have explored this boarding trend, we have increasingly found that systemwide issues are at the root of boarding and the “subpar” care it generates. Shrinking inpatient psychiatric bed capacity is a national problem (2). In our state, there has been a 16% decrease in the number of inpatient beds since 2000, while the population has increased by 14% (3, 4). A similar shortage of detoxification beds for substance users, who often present to the psychiatric emergency service intoxicated and with suicidal ideation, contributes to the boarding problem. The vast majority of the boarding patients have been referred for involuntary detention. Our state laws dictate that patients transitioning from 14-day holds to 90-day holds are to be transferred to the state psychiatric hospital—but overcrowding at the state hospital, which has also experienced bed-count shrinkage, often means that there are no available beds there, so these patients must remain in community hospitals, essentially clogging the system. The involuntary commitment laws are enacted by the state legislature, and eight times over the past 15 years, lawmakers have voted to make it easier to commit patients, often in response to high-visibility acts of violence and pleas of families desperately wanting treatment of mentally ill relatives. Consequently, involuntary detentions have increased 27% over the past 2 years (5). Similarly, as law enforcement officers and jails increasingly encounter mentally ill offenders, laws have been implemented to ensure that these patients receive proper evaluation and treatment, creating another stream of patients to the psychiatric emergency service from the jail.