Another dark, scary, shocking but "good" poem - if I can say that. There are things in your poem that I can relate to, which I will come to in a minute. I was wondering, however, whether you find writing poetry as a release of negative emotions? That once written and out there, you feel a little (even if 0.25%) better about yourself? Rather than using a journal you use poetry? But again Wow!
(You don't need to answer the above questions unless you want to.)
Here is how I relate to your poem (even though it relates to a 'she')... Outwardly I appear normal. That might be the mask we are all wearing. As you might recall, I started anti-depressants recently and this resulted in suicidal thoughts (which I did bring up with the GP) initially in dreams. These thoughts have very much dissipated, but the dream are still vividly etched in my mind. My wife and family know "of" the dreams (or nightmares) but I won't go into the detail. Too much information there for them to cope with and/or worry over. And so we play this game. At the same time we are both healthy, and yet unhealthy. Outwardly looking we are healthy. Inwardly, we are not.Out of genuine concern for our loved ones, we play this game.
I trust the 2nd last stanza is more of a symbolic action, if only because another verse follows. As I think there is a small element of hope in the final stanza through a cry for help in looking past the disguise.
I just had a thought, and you don't have to take me up on this... earlier in your story, you had a post about reasons to live etc. Could you write a poem based on that? And if not, no big deal. I have a work search game in visual hope box. The words that I have to find are only positive words, like yes, whole, nurture, truth, amity. It takes about 3 (or 4) puzzles for me to get out of that really low space, by doing a activity with only positive words. You have a knack and style of the writing i can appreciate. And this is only a suggestion, and nothing more.