Speaking as a frontline clinician with 20 years of experience in the psychiatric emergency room at San Francisco General Hospital, Dr. Paul Linde believes that people with chronic and serious psychiatric illness, politically powerless and voiceless, are being further marginalized by our society. As President Obama’s health care reform package is due to roll out in 2014, will the changes in it further abandon the care of the seriously mentally ill? Already, cuts to public health budgets have adversely impacted this population. And, with organized psychiatry casting an even wider diagnostic net with the publication of DSM-5, the focus on treating the sickest psychiatric patients becomes even more diluted. Dr. Paul Linde’s clinical work in a busy urban psych ER will inform this discussion and put a human face on this public health problem.