Tucson shootings: No lessons learned?

Even the most traumatic events fade with time. As the months pass since January 8, our attention is increasingly captured by the remarkable recuperation of U.S. Rep. Gabrielle Giffords and the approaching trial of accused shooter Jared Loughner. It's natural to want to let go of disturbing memories, both of the violence itself and of the troublesome questions that it raised.

But perhaps we shouldn't let go of these memories so quickly. Forgetting about questions is not the same as answering them. And just because no policy could have prevented this specific outbreak of violence doesn't mean that the probabilities of such outbreaks cannot be reduced.

The central question - one of enormous importance - clearly remains: Did Arizona's public behavioral health and law enforcement systems fail us in ways that can and should be addressed?

While law enforcement officials have largely remained silent on the question, state behavioral health officials and other industry leaders seem to have reached consensus. They have asserted that our behavioral health system is in good shape and, in this case, operated accordingly. Yet decisions made both years and months before January 8 suggest both critical lapses in official performance and a behavioral healthcare system weakened by legislative neglect.

Facts and informed opinion strongly suggest that Loughner is suffering from a mental illness. If officially diagnosed, this will surprise no one at Pima Community College, where students and teachers complained on numerous occasions about Loughner's odd and unnerving behavior.

Such a diagnosis will come as even less of a surprise to college officials, who clearly considered Loughner to be mentally ill and a danger to himself and others. This was evident in the October 7, 2010 letter from PCC to Loughner and his parents, banning him from the college's campuses, and instructing them to "...obtain a mental health clearance indicating, in the opinion of a mental health professional, his presence at the College does not present a danger to himself or others."

Although these instructions were not followed, PCC officials apparently felt that they had fully discharged their responsibilities by banning Loughner from campus. What more, after all, could have been done?

The answer to that question is, a lot. Arizona law (ARS 36-520) provides a mechanism by which individuals considered to be a danger to themselves or others as a result of a mental illness can be involuntarily placed into psychiatric treatment by a judicial process. It seems evident from the language in their October letter to Loughner that PCC officials were aware of these statutes. Equally evident is that these officials, who include sworn law enforcement officials, failed to seek the remedy these statutes afford, namely, to have Loughner examined and perhaps hospitalized against his will.

Why not? This remains unclear. But it is certainly not because past efforts haven't been made in Arizona to address exactly this sort of issue. Indeed, given the relatively high degree of criminal-justice involvement experienced by mentally ill persons, formal interagency agreements and cross-training programs are common in many communities across the country.

In the past, Arizona maintained the Arizona Council of Offenders with Mental Impairments (ACOMI), a statewide network of mental-health and law-enforcement agencies designed to promote better cross-system communications and coordination. Originally established by the Arizona Legislature, the enabling legislation establishing ACOMI was allowed to sunset, and the Arizona Department of Health Services disbanded the body.

More recently, communities in Arizona and throughout the country have adopted Crisis Intervention Training (CIT). This widely praised in-service training regimen is designed to teach law-enforcement officers how to assess and manage individuals with mental illness, including increasing officers' awareness of local mental-health resources and how to contact them.

In 2007, the Arizona Legislature enacted House Bill 2781, calling for a statewide training program to educate law enforcement and other first-responders to identify and manage individuals suffering from mental illness. Unfortunately, HB2817 fell victim to budget cutting by lawmakers and the Arizona Department of Health Services. It is not known if the PCC law enforcement officers who interacted with Loughner had received CIT, though language in the 2010 letter suggests that some college officials at least knew of it.

Also unknown is what working relationship, if any, exists between PCC police and the state-designated Regional Behavioral Health Authority for Pima County.

Hindsight is a wonderful thing, while scapegoating is an ugly and pointless practice. Yet responsible public policy demands that we seek lessons wherever we can find them. It is evident that significant breakdowns did occur in the public systems we have created and funded to protect us. These breakdowns, in turn, raise important questions about the knowledge and judgment of our public safety and public behavioral health officials, of our legislators, and of the educators, officers and clinicians who staff the front lines.

None of these individuals or institutions is responsible for what Jared Loughner stands accused of doing on January 8. Indeed, further psychiatric examination may conclude that even Loughner himself can't legally be blamed. But this is far from saying that lawmakers and governmental and industry officials bear no responsibility for the structure and function of a behavioral healthcare system that clearly failed to work. It is also far from saying there is no link between Arizona's years of drastic budget-cutting and the breakdown of a system that almost everybody agrees is underfunded.

Will we conclude that this should best be called a case of unintended consequences? Of collateral damage? Of the ineffable workings of fate? We owe it to ourselves to find out. We owe it to the victims of January 8 - and of other "January 8s" - before we, with great relief, allow the painful memories of that violent day fade into history.