Experts say that red flags that went unheeded before the Arizona shooting tragedy have exposed a gaping hole in the US mental health care system.
Dozens of witnesses, police officials, neighbors, friends, teachers and classmates of the accused gunman, Jared Loughner, pointed to warning signs that should have alerted authorities to the 22-year-old's descent into into mental illness.
AdvertisementThere were the alarming comments to students and teachers at the community college that eventually suspended him; the reported looks and comments at his local bank, where tellers routinely felt for the alarm button when he walked in; and behavior that Arizona authorities said showed Loughner hoped to acquire a firearm -- even after being rejected by the US Army for failing a drug test.
Despite what experts believe are clear signs of emerging schizophrenia in Loughner, there is no record of him undergoing a mental health evaluation, they said.
Loughner has been charged with shooting a US lawmaker and 19 others who had gathered to meet her in a supermarket parking on January 8, using a legally purchased Glock semi-automatic handgun.
Six people were killed and 14 were wounded, including US Representative Gabrielle Giffords who was shot in the head.
The tragedy has fueled intense debate on America's controversial gun laws and how such a troubled man could acquire a weapon.
But it has shone a more glaring spotlight on the US health care system, and in particular the country's inability to responsibly treat its mentally ill.
"I think the system failed miserably," said doctor Fuller Torrey, founder of the Treatment Advocacy Center (TAC) which advocates for stricter laws requiring treatment for the mentally ill.
"This is a psychiatric failure, it's not a political failure," he told CNN on Sunday. "It's a failure of our ability to provide basic care for people who have brain diseases that are seriously mentally ill."
Arizona, Torrey and other experts say, has among the worst mental health services in the United States, with only one state, Nevada, with fewer public beds for mentally ill patients.
"So even if someone tried to get treatment for this fellow, it may or may not have succeeded in Arizona, because they have cut many of their outpatient services."
The same could be said for virtually all 50 states.
"Nationwide, the mental health care system is broken," executive director Michael Fitzpatrick of the National Alliance on Mental Illness (NAMI) said in a stinging indictment after the tragedy.
According to a recent TAC report, the number of hospital beds for the mentally ill has plunged by 95 percent since 1955, and three times more people with mental illness are now in jail than in hospital.
Only a single state -- Mississippi -- has the recommended number of beds, the report said.
But who fills these beds, and under what conditions? The questions are crucial for a system that by its constitutional nature must balance the safety of its citizenry with individual rights.
The vast majority of people with diagnosed mental illness are not a violent threat to society. The challenge, many experts argue, is making that threat determination -- and acting on it to ensure the ill person is treated.
Rudy Giuliani, the former mayor of New York, spoke Sunday about the problem, blasting the nation's "inability to deal with mental illness and our inability to deal with it as a society."
"This man was crying out for someone who needed to be treated," he told CBS News. "You would think, at some point along the way, he'd have been evaluated."
Giuliani said he learned as mayor that many people diagnosed with mental illness get no follow-up treatment or prescribed medication.
"Maybe that follow-up is needed now. And that would probably be the most relevant response to this tragedy."
Expansion of the health care system is unlikely in the next few years, with Republicans this month taking control of the House of Representatives and vowing to slash billions of dollars from a bloated federal budget.
But Democrat Debbie Wasserman Schultz acknowledged that "we have a tremendous gap in coverage for mental health care," and that repealing President Barack Obama's signature health care reform law, as Republicans vow to try to do, would invalidate mandates for improved mental health coverage.
As for the warning signs that Loughner presented a threat to society, Pima County sheriff's department chief Rick Kastigar acknowledged there were many.
"But each one was relatively benign," he told ABC News.
"There are criticisms that say, "Why didn't cops arrest this guy before?'" he added.
"We're bound by the law, and the totality of those issues didn't rise to the level that would allow law enforcement to take action."