Gun violence has created a large-scale cycle of trauma and fear that’s damaging Americans’ mental health, making children fearful of going to school and adults of going to public places, Surgeon General Vivek Murthy said in announcing a public health crisis Tuesday.

Murthy’s report cites the mental health toll beyond direct victims in making the case to Congress to pass legislation to stop gun violence. Murthy pointed to the Bipartisan Safer Communities Act, the 2022 law Congress passed after mass shootings in Buffalo, New York, and Uvalde, Texas, as evidence that lawmakers can work together on the issue. The law, signed by President Joe Biden, strengthened background checks and provided federal funding for mental health interventions.

Even so, “a deep sense of fear” now pervades American society, Murthy told POLITICO, tying it to high-profile mass shootings. “We think about where many of these mass shootings are taking place — in schools, at parades, at concerts, in houses of worship — these are part of the fundamental components of our day-to-day life.”

While mass-shooting deaths account for just 1 percent of firearm fatalities, they play an outsize role in how safe Americans are feeling, Murthy said.