Strategic Reform Series

National Position Papers

The National Shattering Silence Coalition provides evidence-based frameworks to address the most critical gaps in our mental health system. Our position papers serve as a strategic roadmap for policymakers, clinicians, and advocates, moving beyond rhetoric to offer concrete solutions for those living with the most severe brain illnesses.

70% Reduction in Arrests via AOT
$343B Annual Societal Cost of Neglect
10:1 SMI in Prisons vs. Hospitals

defining the path to systemic reform

The National Shattering Silence Coalition provides evidence-based frameworks to address the most critical gaps in our mental health system. Our position papers serve as a strategic roadmap for policymakers, clinicians, and advocates, moving beyond rhetoric to offer concrete solutions for those living with the most severe brain illnesses. By grounding our advocacy in medical necessity and human dignity, we define the standards of care required to save lives and prevent systemic neglect.

Assisted Outpatient Treatment (AOT):
​The Evidence for Early Intervention

Jails and prisons have become the default institutions for people with untreated serious mental illness—a clear policy failure. The NSSC advocates for Assisted Outpatient Treatment (AOT) as a humane, constitutional, and proven solution. AOT provides structured access to care for individuals who, often due to anosognosia, cannot recognize their need for treatment."

Decades of research show that when AOT is implemented, it creates a ‘Treatment Saves’ reality:
  • Reduces homelessness, arrest, and hospitalization by approximately 70%.
  • Cuts overall public costs by up to 50%.
  • Decreases crisis-driven police encounters and preventable deaths.
  • Improves long-term stability and treatment adherence.

​The 16-Bed Rule: Ending 60 Years of Discrimination

Why We Must Repeal the IMD Exclusion: The "Institutions for Mental Diseases" (IMD) exclusion is a discriminatory provision of the Social Security Act that has effectively turned our jails into the new asylums. Our Position Statement breaks down the urgent need for reform:
  • The "16-Bed Rule" Crisis: By denying funding to facilities with more than 16 beds, the government has decimated psychiatric hospital capacity, leaving only 12 beds per 100,000 people today (down from 337 in 1955).
  • The Cost of Neglect: New research shows the societal cost of schizophrenia has reached $366.8 Billion annually. Shockingly, only 10% of that is spent on healthcare—the rest is swallowed by jails, shelters, and lost productivity.
  • Criminalization of Disease: There are now ten times more people with SMI in prisons than in hospitals. The IMD exclusion is a "fail-first" policy that treats medical illness as a criminal justice issue.
  • Our Solution: NSSC urges Congress to pass H.R. 4022 and H.R. 3320 to permanently repeal this exclusion and treat brain diseases with the medical urgency they deserve.

WANT TO SEE THE HUMAN IMPACT OF THESE POLICIES?

​While position papers outline the "how," our peers on the front lines share the "why." Explore our collection of personal narratives to understand the life-and-death reality of living with no-fault brain diseases.

Turn This Evidence into Action. Information without advocacy is just data. Your voice can change the system.

The research and narratives you’ve read here are the tools we use to demand a more humane mental health system. But we cannot do it alone. Here is how you can help us scale our impact today:
  • Share the Truth: Email these position papers and peer perspectives directly to your local legislators and health officials.
  • Join the Movement: Become one of our 900+ members advocating for early intervention and medical necessity.