To The Editor:

When will we stop allowing our children to be murdered? The question is asked repeatedly after every massacre — not to mention the individuals killed daily in our country — and there is a flurry of, “We have to do something about it!” What happens then? Nothing. We hear “guns don’t kill people, people kill people,” and “now isn’t the time to consider gun control,” this from politicians as well as the NRA which funds their campaigns.

The reality is that ours is a “gun culture,” and that the use of guns for murder is only a small percentage of those used for hunting, or by collectors. But who needs assault-type weapons? I’m frankly surprised that fully automatic weapons are not legal by this time — I have no doubt that they will be eventually unless citizens, not politicians, not the NRA, become actively involved.

Some sort of gun control is only part of what we urgently need to do to protect our children. Increased security in the schools is a major need, but we must approach it without making them armed camps. The suggestion of arming teachers is, to me, insane. Having armed security officers seems to be a logical alternative, and they are present in some schools now. But — they are expensive. How much are we willing to spend now to (perhaps) avoid the unspeakable losses we’ve seen so often in the past several years?

Now considering the costs of a new, sane approach to this issue, we come to a topic with which I’m very familiar: the almost universal lack of funding for mental health evaluation and treatment. In my 45-plus years in psychiatry, I’ve never seen it any different. I’ve worked in hospitals, clinics, my private practice, and it is — has always been — the same. Managed care and insurance companies do not support adequate mental health care, and the question of “parity” of psychiatric services with coverage for other medical conditions has turned out to be just a promise. I’ve thought about this issue a lot, and I have yet to come up with answers. Perhaps it’s related to the centuries-old stigma of mental illness — some of my patients parked behind my office instead of in the lot in front — or perhaps mental illnesses aren’t seen as “real diseases,” much as psychiatrists are sometimes seen as “not real doctors.” Or maybe it’s easier to ignore someone who’s depressed than someone with a heart attack or cancer or an acute surgical illness. In reality, all are potentially fatal.

I must point out here that increased access to mental health care is not a magical answer. The majority of my patients, probably 95 percent, are not a danger to themselves or others. The risk of a patient committing suicide is much greater than homicide. It is easier — although that’s a relative term — to assess suicidality than it is to assess the risk that a patient may be homicidal. In my practice, I have probably seen 100 times as many suicidal patients as I have those whom I was concerned about homicide, although obviously these two frequently go together, as in many of the mass shootings that we have seen over the last several years. Therefore, a background check to see if an individual has been treated for a psychiatric illness will, most of the time, not be helpful. A background check for a history of violence might be.

Our country appears to be confronting a new, horrendous era of mass violence, and it’s frightening, to say the least. Leaving it to the government or the politicians to try to cope with it is not an answer. A grassroots movement of concerned, frightened parents just may be.