In 2016, the National Action Alliance for Suicide Prevention published “Crisis Now: Transforming Care is Within Our Reach.” Alignment with these practices cuts cost of care substantially, reduces the need for psychiatric hospital bed usage, ED visits and law enforcement overuse; resulting in better health and declines in suicide rate, justice system involvement/ incarcerations and psychiatric boarding. These challenges are simply greater than previously acknowledged, but the Washington State supreme court ruling on the unconstitutionality of boarding, the suicide death of Virginia State Senator Creigh Deeds’ son, the insistence of hospitals nationwide about the costs and safety and the series of violent incidents from Columbine forward are changing the expectations. These innovative approaches pioneered under the leadership of Arizona Medicaid are now being replicated throughout the US.