These incidents are common in America today. Hospitals often provide extraordinary care for a variety of complex medical and surgical problems. Yet, they struggle to care for people with chronic psychiatric and medical ailments that result from environmental circumstances: homelessness, domestic and community violence, substance abuse, insecurity and loneliness. These problems are difficult to treat or manage especially when resources are insufficient. To meet these needs, hospitals will have to rethink their roles, particularly in the new health care landscape created by the Affordable Care Act.