A 55-year-old man, Mr. N. presented to the UCLA emergency department (ED) reporting auditory hallucinations and thoughts of suicide. This was his sixth visit to the UCLA ED over a period of a few months; each visit was precipi-ed by his losing his medication and experiencing worsening psychotic symptoms and suicidal thoughts. During all but one of these visits, the examining physicians concluded that Mr. N. did not meet the criteria for psychiatric inpatient care. A typical note read, “He is only in the ER for od and shelter. . . . He has been homeless for many years. Given that he came to the ER to seek shelter, he has proven himself capable of making plans.”