The boarding of Emergency Department (ED) patients due to a scarcity of inpatient beds is a widespread problem, and ED boarders have higher risks for poor outcomes. A small but increasing number of these patients have primary psychiatric diagnoses. With increasing challenges from state and federal budget cuts, inpatient capacity for psychiatric care has decreased sharply. Simultaneously, EDs have been seeing more patients with psychiatric illness and substance abuse.   These patients challenge ED staff, as they require intensive staff resources to prevent self-harm. In addition, the sometimes chaotic environment of the ED can increase patient agitation. One study found that psychiatric patients wait 3.2 times longer than non-psychiatric patients for an appropriate inpatient bed. While there are no simple solutions to this problem, the authors suggest improving medical home models that can improve psychiatric patient assessments, and care alternatives other than inpatient care.