Years ago, between appointments at my psychology practice, I got on the phone with a woman whom, for purposes of confidentiality, we will call Linda.
Linda was desperately trying to reach me to set up an emergency appointment. Calling from the home of a neighbor, she had just left her house during another screaming match with her 16-year-old son. When she came into my office an hour later, she collapsed into a chair and began to sob.
"I don't know what to do anymore," she said. "We are scared. My daughter hides in her room and locks the door. My husband has to cancel business trips to be home. I'm just so frightened my son might hurt us and I don't know what to do."
Following the tragedy at Sandy Hook, I've found myself wondering what would have happened to Linda's family if she hadn't connected with me, hadn't been able to get him to an emergency room and hadn't had the resources to get her son treatment for his mental illness.
The common factor in many mass tragedies is an underlying mental illness. The lesson for Americans from the horrifying tragedy in Connecticut is that we had better take off our blinders and deal with such illness or we are sure to face the same problem again. It is not only what's in a person's hands that makes his act violent, it's what is in his mind.
What we see over and over is a socially isolated individual with a mental illness living in a household where well-intended, concerned, good-meaning relatives -- often parents -- find themselves overwhelmed, scared or even in the dark about their family member's mental condition.
There is no simple fix. Yet I'm determined to make sure Congress takes appropriate action in a thoughtful, determined way -- not by jumping to conclusions -- in order to prevent this from happening again.
To start, we need more research in neural and behavioral sciences. According to the National Institute of Mental Health, we still are far from knowing how to predict who will lash out. We do know that the vast majority of those with mental illness never become violent. In fact, the mentally ill are 11 times more likely to be the victims of violence than the aggressor. If they do attack, it is most likely against themselves in the form of suicide.
But for those who act out against innocent victims, we need research to help us understand why. While the risk for aggressive behavior increases when drugs and alcohol are involved, there is so much more to learn to help us better understand the dynamics of violent behavior, the impact of obsessive use of realistic violent video games and other cultural influences. Increased research at NIMH will give us sound science to better identify the risks and to help us better identify those most likely to commit violent acts.
In many cases, the only way to detain a mentally ill person who may turn violent is if he -- it is usually a he -- commits a crime and can enter a juvenile detention facility or adult prison. These are not psychiatric treatment facilities. We must have better options than jail, the streets or a short stay in a hospital before someone acts out.
I know from my own experiences in practice that patients with mental illness can be cared for effectively with appropriate treatment. That is why in 2008 I worked to ensure that Congress passed the Mental Health Parity and Addiction Act to stop insurers from using financial barriers to discourage patients from seeking mental health care treatment. Yet more than four years later, federal agencies still have not finalized the guidelines, meaning patients across the country still have trouble gaining access to basic services and desperately needed emergency care.
Since the 1960s, spending has shifted from institutional care and toward community-based settings where the government has less direct operational oversight. Last year, taxpayers provided more than 60 percent of the $113 billion spent on mental health care in this country, but we haven't bothered to examine if the federal government or the states are effectively managing these programs. We don't even know with certainty if the money is being spent on patient care or on bureaucracy.
There are dozens of federal agencies responsible for direct care, public program grants, treatments and research. Each program has to be evaluated and audited, and as incoming chairman of the Energy and Commerce Oversight and Investigations subcommittee, which has jurisdiction over many of these programs, I intend to examine each one closely to build on our successes and address our failures.
Each one of us has someone in our immediate or extended family with a diagnosable mental illness. This can no longer be a source of shame. If we don't talk about it, we can't work on it. That is why I am motivated to turn this tragedy into an opportunity for meaningful reform.
Change won't happen overnight, but we should begin by having an honest discussion about how to address mental health in our communities and in public policy while the cries, laughter and smiles of the Sandy Hook children are still burning in our hearts.
Rep. Tim Murphy, a Republican from Upper St. Clair, will begin his sixth term in Congress in January, representing the South Hills of Allegheny County and portions of Greene, Washington and Westmoreland counties. Prior to serving in the House, he worked as a clinical child psychologist for three decades.