The days go by, and I, like you, struggle to make meaning out of literal madness.

Every day, with every funeral, these children call out to be remembered. I think now of the empty spaces in the homes of their families and friends, where the innocent best of our humanity played and planned and imagined and loved – and were loved and treasured in return.

And I do what so many of you are doing – asking myself what I can do to help, how I can fill that empty space, asking what comfort I might provide, for myself I suppose as much anyone else.

For the moment, I have no other choice but to sit with my sorrow and embrace not knowing, not understanding. I have to sit for the moment in discomfort, waiting for the veil to lift and the mind-numbing reality to set in.

This terrible thing has indeed happened.

These people, these children, were slaughtered and we are left now with an obligation to help those left behind.

While I am personally paralyzed with a grief that cannot yet find words, as a mental health professional I do have a perspective that you might find compelling. Many of you by now may have read ‘I Am Adam Lanza’s Mother’: A Mom’s Perspective On The Mental Illness Conversation In America, by Liza Long. It is a personal account of a mother living with her son’s frightening mental illness. While there may be controversy surrounding whether or not she should have written it, and what her motives may have been, the piece brings into sharp focus our collective inability to deal with mental illness in general, and potentially violent mental illness in particular (whether that violence is directed at one’s self or others).

I know this woman’s story. And you should too. It is a world all too familiar to those of us in the profession.

I sit in rooms with adults who are either suffering from varying degrees of mental illness themselves, or coping with children who are struggling with it. A vast majority of those seeking help are not a danger to themselves, or to anyone else. They come for help with depression, or anxiety or grief. They come in order to make sense of their lives, or to feel more connected to people or to free themselves from the shackles of a difficult past.

We also meet people who are struggling with much more challenging mental illnesses, with symptoms that make it difficult to maintain relationships or jobs, or to establish the many micro-connections the rest of us make every day and take for granted. These are people wrestling with something they cannot understand – terrifying and confusing, a darkness resulting in fear and rage – the exhibition of which often surprises and frightens them as much as the people it becomes directed against.

They know they need help. And too often they can’t get it as readily as they should. And I can’t give it to the extent I would like.

When mental illness takes a dangerous turn, psychiatric care with medication (however imperfect it may be), is the first line of defense. And yet, for those most in need, getting those services requires an emotional skill set they do not have due to the very nature of their disease.

In South Florida, where I currently practice, without fail, each time I have called a private psychiatrist to make a referral on a client’s behalf, I am given wait-list dates and an insistence on cash payments for the first visit. And while our community does what it can to support reduced fee clinics, they are completely overwhelmed with staff limitations and budget cuts.

Picture yourself being told that your only option to get the help you need is to first navigate a bleak phone system underworld where your call is passed from one voice mail to another. When you finally get the addresses of potential service providers, you wander from clinic to clinic, filling out forms and sit in waiting rooms with no guarantee of being seen that day. For anyone, the task is herculean, frightening and overwhelming.

Now picture someone already struggling with a mental illness doing it.

And then having to do it again, and then again, on a regular basis.

Many collapse under the weight of fear and frustration and simply do not go, or go once and do not follow up. They hunker down, staying at home, trying to quiet the voices and stifle the rage. They wait. The shame and anger building. We wait – until they become violent enough to themselves or someone else so that we can have them committed to a hospital. Once there, the meter begins to run and those without health insurance play beat-the-clock with providers to get enough meds and cursory psychiatric care to get released. The hospital staff, overwhelmed and under-funded, can only triage and move on.

By this point, social relationships are usually deeply damaged – the very nature of severe mental illness results in dangerous isolation. Even families attempting to help loved ones often find themselves left to their own devices, cut off from a world that would rather not see them.

Because mental illness is unattractive.
Because mental illness is unpredictable.
Because mental illness is everything we fear.

We need a system of care that educates the public about mental illness, its signs and symptoms so we can engage it full on.

We need to rethink limitations on which health care providers can be authorized to write the necessary prescriptions. At this point, most states limit this to psychiatrists and medical doctors (even PhD Psychologists are prohibited from prescribing). Yet the first person most likely to have ongoing contact with someone struggling with a debilitating mental illness is someone like me – a Master’s level mental health professional, usually with sliding fee scales, the majority of whom also do pro bono work or show up on insurance provider panels. We are trained in establishing a deep level of communication, and in interpreting nuanced behaviors that medical doctors and psychiatrists (for the most part) are not. We meet with our clients and ascertain their current levels of connection, of anger, of paranoia. Yet when those levels begin to become alarming, and medication or hospitalization need to be considered, our only option is to put our patients into a system that, unless they are already high functioning with good health insurance, is very difficult to navigate and nearly impossible to sustain.

I graduated from NYU, one of the best universities in the country. Surely standards could be put in place that would train those of us in the field to become certified in psychopharmacology, which could augment the benefits of the psychotherapeutic relationship for more severe mental illness. I am not an advocate for medicating without reason. But medication should be considered as one of a constellation of services for those clients who are spiraling out of control.

We need humane institutions to care for those who have been diagnosed with mental disorders and exhibit behaviors that make them likely to harm themselves or others – before they inflict that harm. Not as punitive outposts for our discarded ill, but compassionate, secure spaces where treatment can be implemented and progress and state-of-mind monitored.

And we certainly need more mental health care professionals in our schools to identify at-risk youth and get them services before they become risky adults. We know what the signs are. And once we know what the signs are, and we identify at risk youth, we should work with parents, the school system, and medical professionals to track their progress and insure that they do not simply fall off the radar screen – becoming damaged ghosts skittering around the edges of our communities but never part of them.

Never truly seen, never truly heard.

Until their screams become Columbine, or Virginia Tech or Aurora or Tucson or Newtown.

Or your town.

Let’s make mental health services – education, screening, prevention and treatment – a major health priority.