As President Obama observed so effectively in Tucson last Wednesday, civil discussions of public policy at a time of great tragedy are an essential ingredient of democracy. While we may never know exactly what motivated last weekend's attack that resulted in six dead, "we cannot and will not be passive in the face of such violence."
One thing that has become clear is that the man accused of firing those shots in Tucson was seriously troubled and likely mentally ill. The warning signs surrounding Jared L. Loughner, from his bizarre behavior at Pima Community College to his disordered thinking revealed in notes and videos, seem glaring in retrospect.
Might the attack have been prevented? That investigators will never know. Some are already speculating that Mr. Loughner's lawyers will mount an insanity defense, although his meticulous planning prior to the crime would seem to work against it.
So as the nation considers such issues as whether the sale of oversize gun magazines should be restricted or members of Congress provided better security, there is a more fundamental question to be asked: Are we doing enough to help the mentally ill?
It's hard to believe that anyone knowledgeable about the state of this country's health care system would answer yes. It was only a matter of hours after the shooting that mental health advocates were recalling how Arizona had reduced spending on mental health just months earlier.
That would seem more shocking if Arizona were unique in this respect, but it isn't. Advocates say states have collectively cut out more than $2 billion from their mental health care budgets, the result of the economic recession and the gaping budget deficits it has caused. In turn, that's translating to fewer psychiatric hospital beds, longer waiting lists for housing the chronically ill, and less for emergency services.
That is not to suggest that if some Tucson clinic had longer hours or local social welfare agencies could invest more in outreach programs that Mr. Loughner would have been a patient in one or another program, his symptoms addressed, affordable treatment made available to him. At best, it might only have raised the probability.
Indeed, it appears his parents were wholly unprepared for his descent into darkness. While it's unusual for the mentally ill to commit acts of violence, it is sadly not uncommon for families to be confused, conflicted or simply in denial when a loved one develops symptoms of mental illness. Nor is it surprising for someone suffering from an illness to avoid treatment.
That suggests society needs to be doing more outreach, not less. Maryland has been relatively fortunate in recent years. The expansion of Medicaid eligibility in 2007 has allowed more money to be spent on mental health care, up 17 percent since 2008 and in the current fiscal year, it's expected to rise 8-10 percent more, according to Department of Health and Mental Hygiene officials.
Next year's proposed budget — scheduled to be offered by Gov. Martin O'Malley later this week — is expected to reduce mental health care spending by as much as 5 percent, however. With demand for services rising (12 percent in the last fiscal year), that could prove a formidable challenge to an already-strained system.
In the wake of Tucson, such policy decisions deserve a second look. One promising idea would be to invest more in a program called Mental Health First Aid, where average people are given a 12-hour course in mental illness and how to reach out to someone showing symptoms. It's not unlike training people in CPR; social workers, college counselors, teachers and others can help until professional aid is available. Sometimes all that is required is a calm conversation and a knowledge of how to find appropriate services.
Another would be for the new Congress to show support for at least one controversial provision from last year's health care reform — allowing parents to keep their children on health care insurance policies until age 26. Certain maladies, such as schizophrenia, don't start until the teen or college years or shortly thereafter.
To further quote the president's eulogy for Tucson's victims, "Let us use this occasion to expand our moral imaginations, to listen to each other more carefully, to sharpen our instincts for empathy." Certainly we can question whether we are doing right by our children and our community without that concern interpreted as a suggestion the perpetrator was not responsible for his behavior.
Meanwhile, we all deserve to learn more about the realities of mental illnesses that can attack any of us without regard to age, race, religion or income. Health care experts believe that four of the 10 leading causes of disability in the U.S. are mental disorders. Ensuring access to treatment (and reducing the stigma associated with it) can only reduce severity of such outbreaks and perhaps prevent other tragedies.