Tony Mantor: Why Not Me ? - Dr Aaron Meyer and Ann Marie Council part 2: Breaking the Cycle: Why Serious Mental Illness Deserves Better Than Jail or the Streets

Episode Date: June 24, 2026

Send us Fan MailShow NotesWhat happens when the systems designed to help people with serious mental illness become the very barriers preventing care?In Part 2 of this important conversation, Tony Mantor welcomes Dr. Aaron Meyer and Anne Marie Council for a candid discussion about the failures and possibilities within America's mental health system. Together, they explore why so many individuals spend years cycling through emergency rooms, jails, homelessness, and crisis without ever receiving the long-term treatment they truly need.The conversation examines the gap between policy and practice, the importance of housing with wraparound support, and why accountability—not simply creating more laws—may be the key to meaningful change.This episode challenges listeners to rethink assumptions about involuntary treatment, homelessness, public safety, and compassion while offering practical ways communities can advocate for a better behavioral health system.If you've ever wondered why so many people fall through the cracks, this conversation provides insight, hope, and a call to action. In This EpisodeWhy the "10-year loop" delays treatment for countless people living with serious mental illnessHow emergency rooms and jails have become default mental health providersThe importance of continuous support instead of one-time stabilizationWhy existing mental health laws are often not fully implementedThe need for more psychiatric beds and comprehensive treatment optionsHow housing combined with wraparound services can change livesThe role families and caregivers play in advocating for better careWhy stigma continues to prevent people from receiving helpThe importance of investigative journalism and public accountabilityPractical ways listeners can become advocates for change in their own communitiesWhy empathy and person-centered care must become the foundation of mental health policyKey TakeawaySerious mental illness is not a moral failing or a criminal issue—it is a healthcare issue. Until communities invest in accessible treatment, supportive housing, and systems that prioritize people over bureaucracy, too many individuals will continue cycling through crisis instead of recovery.Connect with Why Not Me?If this conversation resonated with you, please follow, rate, and share the podcast. Every listener helps expand understanding, reduce stigma, and create meaningful conversations about autism and mental health around the world.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)

What if everything you thought you knew about autism and mental health wasn't the full story? Today's conversation might change the way you see it. This is why not me, embracing autism and mental health worldwide. Real conversations about autism, mental health, and the stories that shape our lives. I'm Tony Mantor. This is where understanding begins. If this kind of conversation matters to you, follow the show, so you don't miss what comes next. Joining us today for part two of our two-part series, are Dr. Aaron Meyer and Anne-Marie Council.

Last week's conversation was so insightful and meaningful, we decided it needed more time. Today, we continue that discussion. It has been said that the L.A. County Jail is the largest psychological hospital in the country. How do we correct that? Preaching to the choir, I completely agree. Could you imagine?

I've actually heard someone say, what if we could take the men's prison in L.A. and convert it into actually holistic, secured placement treatment and not have it be a jail. But it's the same people. Yeah, I think you're on to something. Well, I haven't been doing this a long time. One story I hear over and over again from those that are in the autistic community and from those that deal with serious mental illness.

It is what I call the 10-year loop. It can take nearly a decade from the time someone realized something. something is wrong to the point where they finally get the right support and feel stable and safe in their lives. Why does that process take so long? And more importantly, what steps do we need to take in order to break that 10-year cycle? I cannot agree more. I think 10 years is not a conservative estimate. I think that is really, well, it is a conservative estimate because it can take more. It's very true. The one thing I will say is I want to, I'm hoping people can change the whole idea of people getting stabilized. And when I say that, it's kind of like the cycle of grief.

I don't know if you've ever lost somebody. You go through all these stages, but then it doesn't mean your emotions aren't going to well up later and you have to relive it. When someone is stable, it doesn't mean they're going to be stable next month. So we need accountability and help for them outreach. So when they do start to destabilize, we can then give them that intensive treatment to keep them stable. I think that's necessary. I think that's part of housing that heals. I don't know if you're familiar with that by Teresa Pascuini. I have heard of it. To be honest, I'm not completely familiar with it.

The idea is that some people do need wraparound services, and that's the only way that they're going to be able to live in this society, be productive and not have crisis after crisis. I totally agree. Now, this question is for the both of you. If there's one thing you wish the public could understand about serious mental illness, What would that be? If there's one thing that I think should change and should be and people should be familiar with,

I think not all access should have to come through a hospital. I think oftentimes the only way someone can get to a skilled nursing facility is through a hospital, and it's difficult to do community placement. In California, it's difficult when the majority of counties limit access to conservatorship to only a hospital setting. And if the person is chronically unable to live safely in the community, and they may end up repeatedly cycling through the emergency department, through the jail, and never make it to an inpatient psychiatric unit. This happens with people who are connected to AOT. It happens to people who are connected to assertive community treatment, wrap around mental health teams, and they're never able to get to the right level of care because access to a higher level of care has been restricted to an inpatient psychiatric unit. I wish that people would focus on how government can place hospitals as a barrier between the person who needs help the most and the governmental entity that's mandated to provide them that care.

I think it unfairly places hospitals and burdens hospitals and leaves the person cycling through the system. Well, I think that was a drop-the-mike moment because, I mean, that's just it. Hospitals are there, especially emergency departments, to help us in emergencies. How many times do we go to an emergency room and some of the delay is because there's people there who clearly have chronic problems and they're going every day, but they're not getting better. A wise man I know, Dr. Aaron Meyer always says that these are the people that are seen the most, but treated the least. So if we could get, that was supposed to be just a shout out to my partner, obviously, but if we could get access for chronic disability issues through a different avenue

than the hospital, I think it would be life-changing. And in fact, that's what our paper on 5200 was basically talking about. When you think about the future of those dealing with serious mental illness across the U.S., and of course in your state, with all the discussions that are going on now, what gives you the most hope? I think what gives me the most hope is that people are getting sick and tired and they're speaking up. The pendulum is swinging away from neglect towards an awareness that there is a population that's not getting served adequately or at all by our current systems and that we need to course correct away from a system that has been only designed for people who are willing and able to access it. And I think people are starting to recognize

the need to also care for a population of people who lack awareness into the severity of their diagnosis due to antisagnosia. Well, as usually, I agree with all that. And I would just chime in and say that the advocates that have been born from tragedy, I think, are going to be the people who move this forward the strongest. We have parents who lost a loved one and instead of just worrying about themselves, they don't want their child to die in vain. They don't want their loved one to die in vain. They want it to be a message, a message that the system is broken and that there's a better way. And I have just so much respect and admiration for those that do that. Take their pain and turn it into something good, good message. If you had the

attention of every single policymaker, health care leader, community care leader, for just one minute. What would you tell them needs to change right now? And I would say we need access. We need beds. We need places for people to go. And we need need not only new laws, but we need our current laws to work. And we need to make sure that there's effective oversight to make sure that they work. Well, I'm glad you brought that up. I hate to, I just want to say, did you talk about the 5200 issue earlier in the podcast? Not in depth. Did you want to take that? Because I think you made a really good point, but I'm not sure the listeners know the depth of it. Yes. In California, we have, court-ordered mental health evaluations where any person can request to the county that there's a

person who may be a danger to themselves or others or gravely disabled, so unable to live safely in the community. This is in addition to the process where anyone can call 911 and request mental health support. The problem with calling 911 for mental health support is that it can be limited to a point in time assessment where it's linked to an emergency. And when someone is chronically living in such a state that they can't live safely in the community. Sometimes this can be dismissed as, well, this is the person's baseline. And so for these court ordered mental health evaluations, the county is required to do the evaluation and have a more thorough review than just a moment in time assessment. And if there's a reason to believe that the person is a danger or

gravely disabled, they can petition to the court. And if the judge hears the evidence and believes that there's probable cause can make an order where the person either voluntarily or involuntarily comes for a mental health evaluation. We submitted 58 Public Record Act requests and no county has an active process for this code section until we recently found one county in California has been doing it. And so I don't think there has been hardly enough oversight by the state into why this code section isn't being used. And if we had more oversight and the state had ensured that this code section was being followed, would we need other laws? So before creating other laws sometimes, let's make sure the ones that we have worked. Yeah. Let's go into the future. 20 years from now, when people

look back at what we've done and how we helped and handle those with serious mental illness, what do you think they'll find that we did right? Then, what is it that you wish that we will finally fix. I think what we did right, and it's funny, we did it right and we did it wrong. And when I say we, it was well before any of us were born. When John F. Kennedy first wanted community treatment as opposed to asylums, and then Ronald Reagan approved the LPS Act and closed a lot of the mental hospitals in favor of this community treatment, letting people live within the community rather than in these large facilities. Absolutely fantastic idea. The problem that we'd had was when they closed the facilities, the money went somewhere else. The money didn't go into those community treatment options.

So we had the right idea, but the ball got dropped. So now what I hope in 20 years is that we have a population in jail that's reduced by at least 26%. Because I know that some of the conservative estimates of those in jail with serious mental illness is about 26%. If we can reduce our law enforcement needs, our jail needs, our court needs, and put it into preventative, holistic, compassionate care, I think then we can be proud of ourselves. I'm not sure in the county systems that design public behavioral health care. I'm not sure there's even 5% of the people who have spent time in an inpatient psychiatric unit and really know what it's like to evaluate and treat someone with severe mental illness, people who are unable to care for themselves. And I think

If our systems were more preferentially directed towards the population who can't care for themselves, I think we'd see a lot less neglect and incarceration. Earlier in our conversation, we spoke about community and, of course, grassroots efforts to help those with serious mental illness. If one of our listeners today decides they want to take and make one effort to help those in their community with serious mental illness, what would you tell them to do first? That's actually a hard one. I would say first change your mindset because mindset, really, that's the only thing we can control, truly. And I think there is, you know, I didn't bring it up earlier, but if somebody wants to see the paper that Dr. Meyer and I are talking about on this other access point 5200, if you go on quarter turn strategies.com, you can get a free copy of that and just download it.

And the reason I bring it up is quarter turn, the reason I called the company that was because I don't want the pendulum to swing. to the other side, it's not one or the other. It's not all voluntary or all involuntary. I want to turn the system just thoughtfully and a little bit so we have that balance. So that's what I would say is let's change our mental mindset to say involuntary care is sometimes the compassionate and right thing to do as long as due process is still maintained. I think we need to listen to parents more. I think we need to listen to the experience of parents. And we also need to listen to people experience who have been through inpatient psychiatric units have been through involuntary treatment because I think you would see that not only is access an issue, quality can also be an issue.

And we have, for instance, for people who are on conservatorships, we have individualized treatment plans. And sometimes the oversight of these individualized treatment plans is non-existent. The whole purpose of getting onto a conservatorship besides the support is to get off the conservatorship. And so if we focused on people's experience within treatment settings and caregivers and families' experience of trying to navigate the system and get high quality care, I think we can learn a lot. I would hope that our policymakers and also the people who are in charge of implementing and designing these systems would pay attention. One day you decide to have a reflection. That reflection can be a week. It can be a month. It can be

a year. It can be any time frame that is relevant to this question. What is one story or experience that fundamentally changed the way you look at serious mental illness and the health care that we give today? I know exactly the story. It's obviously a sad one. We had a patient that the first responders were really trying to help. They love all their patients in their own way. They care about them. They see them as human beings. And that is what helps them build rapport, make that connection and the goal is to save lives. I know a lot of energy went into getting an LPS conservatorship or a chronic alcoholic. He'd been an alcoholic for, I want to say, over 20 years. I worked with Dr. Meyer on this case, so I know he knows who I'm talking about. We thought it was,

it was just enormous effort to get this LPS conservatorship, finally got him in the hospital. He was cared for. He improved. He looked terrific. The problem, there was nowhere to transfer him. There was no secured placement treatment program bed for someone who was a chronic alcoholic. This was about five years ago. So he was in the hospital warehouse for like eight months and then released from the ITP, the individualized treatment plan. What did he do? 24 hours later, he was back in the ER already drinking too much and he died six weeks later. That's a system failure. We had a problem getting access, but once we get the access, what Dr. Meyer was talking about about those individual treatment plans is critical. If we're going to put someone in involuntary care, we better have resources to give them,

the programming to give them, and the care that's going to help improve their lives rather than hurt it. So my case situation would be somewhat similar. There's a person who we cared for in the hospital who also had severe alcohol use disorder. And we had our city teams bring him a PlayStation because he also had a long period of time waiting for the next step. He eventually got to a mental Health Rehabilitation Center where he did very well. And we would visit him, a colleague and I would visit him, bring him Legos, things that he liked to do to keep his mind active. And when he was transitioned to a board and care, a different type of residential facility, he quickly left and resumed drinking and was transitioned then not to a more therapeutic setting, but to a skilled

nursing facility as a 40-year-old. When we have gaps in the behavioral health continuum of care, where you're going to go straight from an intensive mental health rehabilitation center to an unlocked board and care facility, there needs to be somewhere in between. It's painful and ethically brought for me when I'm considering what's the best situation for this person for him to be repeatedly through the ER head trauma after head trauma, intoxication after intoxication versus in a skilled nursing facility where he's probably not cognitively engaged. and it's situations like that where the system failures lead to, I think, me feeling haunted by that situation.

Let's say a listener happens to come into this conversation a little later than we anticipated. What is one important thing that you think they need to take away that could be so very important to the surroundings that they may be dealing with today? Well, I think on a broader level, mental health touches us all. And I think that if the stigma stays and people don't talk about it, you know, my son has a problem, but we can't talk about it or my, you know, wife has a problem. We can't talk about it. Then that obviously pushes the stigma. Medical insurance, which Dr. Meyer is more the expert on that than I am, but we don't have parity of treatment. If you come in with a heart condition, there is a treatment for you and you're going to get that. If you come in with the severe mental health condition, maybe you'll get released. Maybe you'll get care. It's not treated the same way. It's not understood in the same way. I am so glad you brought that up. I had this one conversation with a gentleman about his son, who was going through some serious mental illness. He was walking down the street completely naked and thought he was invisible. Luckily, he had two really good policemen that came across him.

They put him in the back seat. They did not handcuff him. They turned on his favorite music, got him really comfortable. They took him to a hospital, and the hospital said, I'm sorry. We can't treat this person. Yeah. As luck would have it. Again, he had a great first responder. And he asked the doctor what his address was.

The doctor replied, what does that have to do with anything? He said, since he's not a problem, we're going to drop him off at your house. Wow. Then things changed. They treated him. How do we get past that? That kid needed help. He wasn't a danger to anyone else.

There was no clear danger to himself. but it definitely showed he needed help. If it wasn't for that good policeman doing what he did, he would not have received help. How do we change that scenario? Yeah. I mean, what you're asking is how do we get people to wake up? You are 100% correct.

How do we get people to pay attention and think about themselves in that situation to have a little bit of empathy and to, I think if empathy led our systems, we'd have more person-centered systems versus system-centered care where looking at how someone can be excluded versus how we can include someone. And I think we need to have a much more inclusive behavioral health system that doesn't discriminate against people who are unable to engage or doesn't exclude people with physical health diagnoses. We need an integrated system.

And so I would encourage your listeners to help wake people up. You know, a funny thing about that story, and there's nothing funny about that story, a good argument could be made that he was obviously a danger to himself because he is so vulnerable walking around naked, walk into traffic, the attack. I mean, so the idea that he wasn't a danger to himself, I do take cause with. However, I think everybody seems to think you need an emergency to get help. And that is the practice, isn't it? Because an emergency department like we talked about earlier is there for emergencies, but that's not how the code is written. The code says danger to self or danger to others. That's half of it. But the other half is or gravely disabled. And someone with

grave disability is not in an acute crisis, except for the fact that they're in acute crisis every day for their entire life. They're in a chronic state of being not able to manage their basic needs. It can be because of mental health problems or substance use disorder problems or both. But until we actually follow the rules that we have, we can't hope to change. Just like Dr. Meyer said, it's not even about new laws. It's why aren't we following the ones we have? That person should not have been released. And we need to get to a point where you talk about destigmatized. But we need to stigmatize physician responses like that. We need to stigmatize behavioral health systems that exclude people who are unable to access them due to the severity of their diagnosis.

So we need a lot more intolerance of systems that have lack of access, of responses that don't acknowledge the reality of a situation. And until we have situations where people are automatically peer-reviewed for not prescribing or recommending substance use disorder treatment, where people are automatically peer-reviewed for inappropriately dismissing people who are clearly unable to live safely in the community. I think until we can get to a point of both governmental accountability and healthcare accountability, we're still going to see problems. Unfortunately, we are a country of it's not a problem until it affects our family. In some way, we need to change this dynamic. They will hear things on the news and not do their research, only to be totally misinformed. Before I started this podcast,

I knew nothing about autism or serious mental illness. Absolutely zero. I would hear the bad things that would happen on TV, and I thought, like everybody else, put them in jail, throw away the key. Now, after doing this for a while, my first reaction is not that. I want more information. Are they really bad people that just do bad things because they are out there, or are they a product of a system failure? How do we get people to change their view? Not only just people in society, but within the system, because if the system doesn't change, nothing changes. How do we get them to realize that we have to make sure the system does not fail those that are in dire need of our help? So we need a lot more, we need a lot more people who do podcasts. We need a lot more investigative journalists who are holding

people accountable and asking questions to the government and publishing it because I think people want accountability. People want to know that their systems are addressing the problems they see before their eyes. And I think journalism is one of the main ways that can cause change. I also want to do a call out to the incredible hospital emergency physicians that are having to battle this. I cannot tell you how many calls I've gotten because I've been working with doctors for several years and they'll say, I have someone, where does he go? What's available? What placement options do I have? And I feel like if those were available, I think they would be a lot quicker to say, okay, this meets the burden. We can transfer them to get help. But if we have blocked access and nowhere to put them, that's pretty hard to

fix. So I think we definitely need to fix where people can get the treatment. And then I think access will also improve. When you really look at the homelessness situation, a lot of people on the streets aren't there by choice. Many are dealing with severe mental illness and simply have nowhere else to go. When the only options become the streets or a jail cell, something in the system is clearly broken. How do we start building real places for people to go before it ever gets to that point? So much of that, I mean, obviously the number one cause of homelessness is lack of housing. And housing is health care in many instances. Right.

And also housing alone often isn't enough for some people with the most severe mental health diagnoses, the most severe addictions. And so we need a continuum of housing support. And I think we need to be a lot more flexible about what people need and what is provided in localities. I just want to say that that is just so spot on with needing. the continuum of housing. And I don't think I understood that as much until I got into this work. But if you imagine, there's so many different reasons that someone is homeless. If someone lost their

job, had no family, maybe they immigrated from another country, maybe they just need that housing and they can get back on their feet. But if someone has severe substance use disorder, they are at the point where all they want is their next fix and they may not care about themselves. So how are they going to care about anything else? So they get a brand new apartment and what do they do? well, they destroy it because they don't have respect for themselves. Why would they care about their surroundings? It makes the apartment look like they feel inside. But if we give housing that heals where we have treatment and we have housing and we have

opportunity, then I think that's the only thing that's going to work. Housing first cannot work with the severely mentally ill. This conversation has been so great, great insight and conversation. I could go on forever with conversations about these topics. In closing, what is one big? of information that our listeners need to hear that you think is important. Hopefully this way they can do more research on the positions and not just the ones that you've been talking about, the ones they need to hear to better understand what needs to be done. I would say when you hear

something, question it. In other words, just because Dr. Meyer and I are explaining what our experiences, question it, research it. Make sure that you're making your own decision. One thing that I have really hard time with is information coming out that is just not true. I remember when Dr. Meyer was talking as a subject matter expert on LPS and the opposite side of the conversation who was against involuntary treatment said, oh my gosh, this is Britney Spears all over again. Well, someone in the audience might think, oh, Britney Spears, that was a terrible situation. What they don't realize is it has nothing to do with LPS. That was probate. But if we don't question what we hear and make our own informed decisions, we're going to go by headlines and then we're going to believe nonsense. So I would

say take the time to educate yourself and you'd be shocked there's a lot of like-minded people out there who are seeking the truth. And I would say get involved. So in San Diego County, for instance, we have a behavioral health advisory board. Every county has behavioral health advisory boards where the public is invited to attend and is able to make public comment. I think there are opportunities for voices to be heard. And one of my hobbies is reading the law, reading the code at night. So I would encourage people to take a look at your state's laws, find out more about why the system might be failing, attend, you know, board of supervisors meetings, look at laws. And I think don't accept the status quo and don't adopt a fatalistic mindset. Well, this has been tremendous information

and great conversation. I really appreciate you taking the time to join us today. Oh, yes. Pleasure. Thanks for the invitation. It's been my pleasure. Thanks again. A sincere thank you to our guests for sharing their journey. If today's conversation helped you see the world a little differently than we're doing exactly what we hope to do. Until next time, keep believing, keep learning, and most importantly, keep asking yourself, why not me?