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A Portrait of a Disturbed Assailant

Saturday’s tragic shooting in Arizona still poses more questions than answers. But nearly all of the available reports paint a picture of the alleged gunman, Jared Loughner, as an individual who suffers from severe mental illness.

At a local community college, according to the New York Times, Loughner had a history of outbursts that frightened students and instructors so much that administrators called police—and, eventually, forced him to withdraw. One teacher later told USA Today, “I remember going home and thinking to myself, 'Is he going to bring a weapon to class?'” Meanwhile, multiple media outlets have described the confused rants on Loughner’s apparent websites and home-made videos, in which he talks about everything from reading Mein Kampf to resisting government control.

So far, most of the commentary on the shooting has focused on the role hateful, violence-laced political rhetoric on the right may have played in this incident—not in provoking the shooting but, perhaps, in creating an environment in which such violence seems not quite so out of bounds. There’s also been a lot of talk about the availability of firearms. The Washington Post reports that Loughner legally acquired a Glock 9mm semi-automatic pistol, complete with an extended magazine to hold extra bullets, from a local sporting goods store in November. It's the same gun that, police say, shot Representative Gabrielle Giffords and 17 others in front of the Tuscon Safeway store Saturday morning.

Count me among those who have been worried, for a while, about the violent undercurrent in political speech and, for much longer than that, about the easy availability of guns, particularly in states like Arizona that have notoriously lax gun control laws. Whatever role those factors actually played in this incident—and it’s really too soon to know—I have no problem decrying both. But the role mental health played in this shooting seems a lot clearer, even with the limited information already available. Almost by definition, somebody willing to open fire on a large, unsuspecting crowd has to be deeply disturbed.

Mental health, unfortunately, is probably the illness most likely to go untreated in the U.S. The stigma around mental illness isn’t what it once was, but it still exists. And notwithstanding laws, such as the 2008 Mental Parity and Addiction Equity Act, that have helped to provide more financial support for treatment, funds for care and support of the mentally ill remains woefully inadequate.

Private insurance rarely provides enough coverage for the seriously ill, overwhelming public systems to the point where people who could benefit from therapy, drugs, and community supports--frequently living totally normal, productive lives--instead end up without treatment and sometimes without homes. Inevitably some of these people end up committing crimes, overloading a criminal justice system ill-equipped to handle them. We don't warehouse the mentally ill in asylums anymore. Instead, we warehouse them in jails.

Arizona in this regard is fairly typical. Mental health services in Maricopa County, which includes Phoenix, has been the subject of litigation for more than twenty years. The state has tried contracting out services to two different private companies, but care seems to be getting worse, not better.

A 2009 survey by the National Alliance on Mental Illness reported that, statewide, mental health services  had actually improved over the previous three years, to the point where the organization bumped Arizona's grade from a “D+” to a “C.” But, NAMI noted, there are still enormous problems, from shortages of providers to long waits for services. “Having case managers with nearly 100 clients does not allow them to do anything but respond to emergencies,” one survey respondent told NAMI. “Until my family member has an emergency, there is no case management.” 

It should go without saying that most mentally ill people are not violent—and that those who are violent might not be if they received appropriate treatment. But, too often, they don't get it. And that's when tragedies occur.

Was this such an instance? Was the Arizona gunman among those the mental health system left out? If so, might a stable, coordinated care environment have offered effective treatment—the kind that might have changed his behavior and, in so doing, spared the victims of yesterday’s violence? If so, were there missed opportunities—and who or what missed them? 

After a major disaster, like an airliner crash or terrorist incident, we conduct thorough investigations to determine what caused the tragedy and how we might avoid another one like it. This occasion calls for a similar response. We may never know whether a better mental health care system would have averted this massacre. But we can be sure that it would avert some future ones. 

Update: I originally referred to NAMI incorrectly. The organization's title now appears as it should: the National Alliance on Mental Illness.