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Mentally ill people, including those with high intelligence (and there are many) can not necessarily take for granted that our full mental capacity will always be available. There are numerous factors that may affect our faculties. 

Being delusional, being manic, or being depressed, are all things that will probably limit or distort cognitive capacities. If delusional, our minds are subject to gross errors in thought. In that case, mental capacity is working against us. If manic, thoughts are also distorted--we may have delusions of grandeur, or we may have incomplete reasoning. I am not an expert on mania, since my primary diagnosis is currently "schizoaffective." However, I have seen the behavior of people in an acute phase of mania, and their reasoning isn't realistic. 

Being severely depressed could mean that a large part of consciousness is bogged down with negative, pessimistic, self-rejecting thoughts. Also, parts of the mind could be slowed down. 

When medicated and stabilized, effects of medication on cognitive capacity vary, depending on which medications a person is taking, the dosages, and individual differences in people's brains. Generally speaking, taking medications will allow more of the mind to be usable, if the alternative is untreated symptoms of mental illness. 

An old antidepressant called "Trazodone" had the worst effect on my mental capacity of any drug. It is not an antipsychotic. It is extremely sedating, and it shuts down the higher functions of the mind, much more so than any antipsychotic I have taken. That is my experience--it may be different for other people. I've met people who think Trazodone is great. 

Insight into one's condition and insight that we need treatment are dependent on having enough mental capacity available. When fully psychotic, mental capacity for anything useful is absent. At that point, we will not have any mental capacity available to have the insight that we've become psychotic. 

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In situations where we are inundated with stimuli, the ability to think clearly will be compromised. I've been in situations of "warfare" against criminals, in a previous housing situation. They were blasting horrible "goth" music that created continuous upset. They were dealing drugs. They were doing a number of other things with the intent of letting me know that I should live elsewhere. After I moved, my electricity bill went way down. I think they were tapping into my electricity through the wall. Also, I had depression after moving that took about a year to go away. I suspect that they were manufacturing methamphetamine and that I was being exposed to the fumes. 

If you have neighbors who are criminals, you cannot live in peace, and your mental capacity will be significantly compromised. 

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Some therapists, in their ability to feel superior, are able to take advantage of mental gaps introduced by medication. The techniques used are, in some instances, manipulative, and sometimes damaging. This is a style of therapy that I detest. The therapist by asking a series of questions, and by asking sub-questions, is able to psychologically dissect a patient's mind, and when that is done, the control they have established is used to neutralize the patient's ability to function, or, this control is used to do other damage. 

This is a particular style of therapy that some practitioners use. Not all therapy practitioners do this. When the therapist asks a question, they exert pressure to speak. When we reply, the therapist wants specific examples of why we feel the way we do. Then, we go into sub questions. The therapist asks what happened to us in our past that made a thing objectionable. Then, they've got us reliving our past, and they ask questions about that. It eliminates accountability of the therapist, and the focus becomes that of probing into past trauma, ready or not. 

This style of therapy is disabling. In the name of helping a person, disassembly is done, and we are disempowered. (To use a term that might be sexist: emotional castration.) You might have to see a therapist employ this style of interaction to know what I am talking about. 

When in full use of our faculties, the above is less likely to happen. Additionally, something about taking psychiatric medication may make therapists able to do this to us. Or, possibly, the therapists have had a lot of practice and could do the same damage to anyone. 

Good therapy can help, and bad therapy can do damage. Ram Dass: "…therapy is as high as the therapist is."