In Justice, Part 2: The Right to Be Well — Moving Past the Word "Mental" to Save Our Lives

In this piece: NSSC Senior VP Kerry Martin shares a raw, unfiltered look at surviving Bipolar I psychosis, exposing how the catastrophic division between mental and physical health has normalized the state-sanctioned abandonment of our most vulnerable. Backed by hard forensic data and personal survival, this essay issues a powerful call to shatter the current Standard of Neglect and replace it with a true National Standard of Care that treats no-fault brain disease with the dignity of any other medical emergency.

As my colleague Carmen Facciolo recently laid bare in the opening installment of our In Justice series, America does not possess a psychiatric treatment system for those with severe mental illness (SMI). We possess a crisis containment system. We have designed a bureaucratic system that intentionally waits for a human to be in crisis before it will offer a shred of medical help.
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But while policy experts, legislative committees, and institutional gatekeepers debate the philosophical nuances of civil liberties, my SMI brothers and sisters are paying for those theories with their lives. They are paying for them on freezing sidewalks, in overcrowded emergency rooms, and inside concrete jail cells.

I have sat before legislative committees and said what most in the advocacy space are too terrified to whisper: "Please, take away my rights if I ever lose my mind again—because I don’t want to die; I want to live."

Myth of Autonomy: Left Behind on the Street Corner

​I write these words not as an academic observer, but as a survivor of Bipolar I who has lived through the terrors of active psychosis. And I am going to tell you a raw, unfiltered truth that is incredibly difficult to disclose because of the crushing weight of societal stigma: My psychosis was triggered and accelerated by substance use.

Years ago, I was encountered by law enforcement while visibly psychotic, delusional, and intoxicated. Because I had not yet crossed the narrow imminent danger threshold required by our broken legal standards, the law barred those officers from intervening. The system forced them to leave me behind.

Think about the absolute absurdity of this design: we have mandated that police officers—who are not psychiatrists and are not trained in clinical diagnostics—must act as the frontline arbiters of a medical threshold. We have forced law enforcement to make complex neurobiological determinations that belong in a hospital, not on a street corner.

The state strictly demanded that we wait for a catastrophe. Because of that sanitized, legally mandated delay, I later tried to take my own life.

I survived that void through sheer, terrifying luck and the economic stamina of a middle-class family who acted as a human shield against a broken system. But survival should not be a genetic lottery. Navigating a medical crisis shouldn't demand that a family possess an elite educational background or a financial runway just to fight weaponized privacy walls.

When opponents fight structural legislative backstops like California’s SB 1016 or Massachusetts’ S.2973 (The Continuum of Care Act) under the banner of protecting civil liberties and self-determination, I am forced to demand an answer to the ultimate question: "Where is the liberty in an early grave? Where is the self-determination in a tent on Broadway or a cell in a county jail?"

To offer someone absolute "freedom" while their brain is suffering from a stage-four medical emergency isn't compassion. It is a sanitized, state-sanctioned form of abandonment. For decades, our nation has fiercely protected a Right to be Sick, while systematically ignoring the fundamental Right to be Well.

Co-Occurring Disorders: Institutional Game of Hot Potato

When co-occurring disorders surface, this broken system collapses entirely into a game of institutional passing-the-buck. It is deeply uncomfortable to admit to histories of alcohol and cannabis abuse. We live in a culture that weaponizes addiction, using it as an excuse to say, "Well, they did this to themselves." 

But breaking the silence is a non-negotiable part of the conversation if we ever want to fix our broken laws. If we don’t talk about co-occurring illness honestly, we are leaving the sickest among us behind.

Locked in the agonizing early stages of psychosis, I turned to alcohol and cannabis to quiet the noise and numb the pain. Like millions of others caught in a neurobiological crisis, I didn't know I was pouring gasoline on a biological fire.

America's psychiatric infrastructure completely refuses to treat co-occurring disorders simultaneously. We have drawn an imaginary, bureaucratic line between addiction and severe neurobiological illness. While an acute psychiatric ward will admit someone under the influence, they routinely discharge them the moment the immediate crisis drops below the legal hold threshold.

But when that individual tries to enter a substance use rehab or a detox facility to address the underlying addiction, the doors are slammed shut. Traditional rehab networks completely refuse to accept or accommodate individuals with Severe Mental Illness who are actively symptomatic or struggling with medication compliance.
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The system shuffles vulnerable human beings back and forth like cargo between networks that refuse to coordinate, leaving the sickest among us completely stranded in the gap.

Timeline of Systemic Failure

My perspective was forged by over thirty years of navigating a system that often feels explicitly engineered to fail the individual.

• 1992 (The Ivy League Void): While a graduate student at Harvard, I reached out for help during a crisis and poured my heart out to a resident clinician at the university’s mental health clinic. I walked back to my apartment, only to receive a phone call from her stating, "I don’t think I can help you." Following a suicide attempt born directly of that clinical abandonment, I woke up under the blinding emergency room lights of a Cambridge hospital. A nurse looked down at me and said, "Lay still, you did this to yourself."
• The California Cycle: Years later, after graduating, the cycle repeated. My sister found me soaking in backyard sprinklers following a suicide attempt during a profound psychotic break. This incident occurred exactly one month after local police had refused to detain me for clinical treatment because I wasn't dangerous enough yet under the imminent danger standard.
  
  

Following these crises, I became a permanent prisoner of medical bureaucracy. I was boarded on ER gurneys for days, only to be moved by ambulance like cargo at 4:00 AM because an administrator needed the bed. I eventually learned to expertly lie to psychiatric evaluators just to escape a process that offered nothing but a glossy brochure and a discharge paper.

From the ivy-covered walls of Harvard to the sterile tiles of the ER, the message from society has been unshakeable: Wait for tragedy, then blame the victim.

Anosognosia Pipeline: Off the Edge of the Neurological Cliff

When we honor treatment refusal during active psychosis as an exercise of "autonomy," we are participating in a structural illusion. The fundamental crisis of our advocacy movement is that we introduced the word "mental" and went straight off a physical cliff.

Severe Mental Illness is not a behavioral problem, a spiritual journey, or a collection of eccentric lifestyle choices. It is a physical, no-fault biological brain disease. But because the law treats it as a "mental" issue separate from physical health, we have created a standard of law that is literally killing us.

As board-certified forensic psychiatrist and NSSC Board Member Dr. David Hager recently laid bare in Psychiatric Times, poor illness insight is a ubiquitous neurological deficit known as anosognosia. An individual with schizophrenia and anosognosia has a reduced capacity to participate in informed consent. They are neurologically unable to recognize the need for treatment, yet our civil mental health system is built on informed consent and patient autonomy—a framework that presumes the very capacity their illness has taken from them [1].

Dr. Henry A. Nasrallah, Editor-in-Chief of Current Psychiatry, establishes that anosognosia is fundamentally a disorder of consciousness—a metacognitive deficit driven by structural abnormalities and localized gray matter loss within the brain's right hemisphere and bilateral insula [2]. This is not a rare clinical anomaly; it is a pervasive, defining baseline of severe brain disorders. Multi-site epidemiological data reveals that anosognosia is present in an overwhelming 57% to 98% of patients suffering from psychiatric psychoses [2].

​Beyond my own survival, I have stood on the front lines of this crisis as a Certified Peer Support Specialist on an Assertive Community Treatment (ACT) team in San Diego. I have walked our streets and looked into the eyes of my SMI brothers and sisters rotting with their boots on. I have been the one offering a clinical hand and the physical keys to free, permanent housing—only to have those life-saving offers flatly turned away.

Why would a human being choose a freezing concrete sidewalk over a warm, safe bed?
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It is not a lifestyle choice. It is a genuine neurological deficit in self-awareness located in the brain's right hemisphere [3]. When we grant unbridled autonomy to an individual in the depths of a psychotic break or a manic surge who lacks all insight into their condition, we are not giving them freedom. We are handing a blind person a map to a cliff and telling them it is their civil right to walk off the edge.

We would never take an individual suffering from advanced Alzheimer’s or dementia, stand them before a judge, and expect them to execute a complex social contract or accept voluntary medical care [4]. We universally recognize that their organ is failing them, and we step in with compassionate, surrogate, structure-driven decision-making.

The operational outcome of treating this neurological blindness as a mental choice is entirely predictable. Bound by voluntary, consent-based service models, the civil outpatient clinic simply closes the case file of a psychotic patient who misses an appointment and drops them from the caseload.

The system waits for blood to be shed.

An estimated 77,000 individuals with psychotic disorders are currently warehoused in American jails and prisons—nearly three times the number of individuals in state psychiatric hospitals [5]. Meanwhile, over half of our nation’s remaining state psychiatric beds are completely occupied by forensic patients because the civil safety net collapsed upstream. We have structurally mandated that a jail cell is the only waiting room left to see a doctor. 

Families are left asking the ultimate, haunting question: "Why does a loved one have to commit a felony just to get admission to a hospital?"

Checklist of Abandonment: The Injustices We Endure

When we strip away the sanitized legalese and look at the actual reality of our healthcare landscape, the current system enforces three foundational injustices against my SMI community. Like all human beings, we deserve to have this broken architecture dismantled and replaced with the unshakeable National Standard of Care our coalition champions:

Injustice 1: Linguistic Deception (Mental vs. Physical)

• The Reality: By labeling severe neurobiological brain disorders as mental issues rather than physical organ failures, the law has stepped off a dangerous cliff. This artificial division allows the state to protect a person's civil right to slowly die untreated on a public sidewalk.
• Our National Standard of Care: We must legally classify Severe Mental Illness as a physical, no-fault medical emergency. Psychosis must trigger the exact same mandatory, compassionate, and immediate diagnostic and treatment protocols given to a patient presenting with an acute stroke or advanced dementia.
  
  

Injustice 2: Autonomy Trap (Anosognosia as a Choice)

• The Reality: The civil outpatient system uses voluntary, consent-based service models for individuals who are actively blind to their own condition due to anosognosia. When a symptomatic individual fails to participate in a voluntary contract, the system simply closes their file and walks away.
• Our National Standard of Care: We must mandate clinical accountability. When an individual lacks the structural capacity to participate in informed consent, the healthcare system cannot be permitted to abandon them. The law must compel continuous, community-based clinical engagement and trauma-informed support

​Injustice 3: Forensic Waiting Room (Jails as Hospitals)

• The Reality: Because the criteria for civil medical intervention are kept impossibly high, the state has structurally mandated that a jail cell is the only waiting room left to see a doctor. We force families to watch their loved ones commit a felony before the state will grant them access to a psychiatric hospital bed.
• Our National Standard of Care: We must fund and build a proactive, community-based continuum of care that intervenes during the early, manageable stages of neurobiological deterioration, ensuring that a medical team—not a police officer or a correctional guard—is the arbiter of recovery.

This disparity reflects a deeper, more insidious cultural crime: the total erasure of our humanity. When a person’s heart begins to fail, society does not look at them and say, 'There goes a walking heart attack.' They do not define their entire moral character, their intellect, or their soul by their cardiac arrest. They see a human being fighting a failing organ, and they rush to offer medical grace.

Yet, when the failing organ is the brain, our humanity is instantly stripped away. We are no longer humans fighting an emergency; we are defined entirely by our illness. We become our diagnoses. I am not a walking case of Bipolar I. I am a policy professional, a strategist, a sister, a daughter, and a human being who survived a stage-four physical organ failure. We deserve the exact same medical grace, the exact same standard of care, and the exact same basic human dignity accorded to every other patient on this earth.

Claim Your Position: Join Our SMI Peer Alliance

Those of us who live with severe brain disorders are no longer content to have our lives debated by academic theorists or sidelined by legislative committees. True systemic transformation cannot happen about us without us. The time for passive observation is over.

My fellow peers, the most profound insights into the SMI crisis do not come from textbooks—they come from the scars of the front lines. It is time to stop screaming into the void alone. It is time to turn our ground-truth into unassailable systemic power.

The politicians are not coming to save us. The bureaucratic committees are not going to vote our suffering away. The power to shatter this Standard of Neglect belongs to us, and it begins when we stand together as one undeniable voice.

If you are living with an SMI diagnosis and you are fed up with watching our community warehoused in jail cells and left under public sidewalks, claim your position with us today. Bring your lived experience to the table, and let’s build the national movement our 22 million invisible brothers and sisters deserve. Together, we will move humanity forward.

Join us HERE.

REFERENCES AND FOOTNOTES

[1] Hager, D. (2026). Anosognosia and the Criminalization of Schizophrenia: Implications for Clinical Practice. Psychiatric Times. Available at: https://www.psychiatrictimes.com/view/anosognosia-and-the-criminalization-of-schizophrenia-implications-for-clinical-practice
[2] Nasrallah, H. A. (2022). From the Editor: Is anosognosia a delusion, a negative symptom, or a cognitive deficit? Current Psychiatry, 21(1), 7-8, 14. doi:10.12788/cp.0210; Judicial Council of California (2024-2025 CARE Act Quarterly Reports).
[3] Leach, R., Fisher, A. (2023). Anosognosia and Bipolar I: The Right Hemisphere Neurological Deficit. Treatment Advocacy Center.
[4] Medical News Today. (2024). Anosognosia: Symptoms, causes, and treatment.
[5] Fuller, D. A., et al. (2024). The Jail-to-Hospital Ratio: A National Crisis. Treatment Advocacy Center; National Alliance on Mental Illness (NAMI.org).

Author

Kerry Martin, MPP, NSSC Senior Vice President of Strategy & Impact, Board Member, Peer Support Specialist & Bipolar I Survivor