In the days since the Arizona shooting, friends and acquaintances of Jared Loughner have painted a portrait of a social outcast who showed signs of a severe mental illness long before last weekend.
But the 22-year-old apparently slipped through the cracks in one of the worst states in the nation for mental health services.
It's an issue that is especially important in Texas as the state braces for $134 million in proposed budget cuts for mental health services. Insufficient state funding could put many of the estimated 1.5 million people with severe mental health disorders in jeopardy.
"It's an under-served population, and sadly, lately, we've seen all too tragically how improper treatment of those with chronic mental health problems can have a devastating effect on a community," said Texas Medical Association President Susan R. Bailey.
Still, spending more on mental health care is no guarantee that a similar tragedy can be averted, said Rep. Vicki Truitt, R-Keller. While the Arizona shootings have brought access to mental health services to the forefront, it's impossible to predict how the issue will play out in budget debates.
"I'm certain that any cuts will be carefully and strategically considered, kind of like a triage effect," she said. "Sadly, bad things have happened, even in the best of economic times."
Rep. Mark Shelton, R-Fort Worth, said the trend is toward lower-cost psychiatric emergency centers and other preventative measures.
"Add all those things together, and I think we can provide what we really need," said Shelton, a physician. He is following bills that could help those in the revolving door of state hospitals be more functional and relieve a shortage of psychiatrists.
For years, insufficient funding had eroded Texas' ability to care for the mentally ill. But in 2007, the Legislature funded crisis hotlines and expanded community-based programs that led to improvements in mental health care, Bailey said.
The changes reduced psychiatric emergency-room visits, hospitalizations and prison incarcerations, she said. Those very improvements are now being targeted.
The Center for Public Policy Priorities estimates that reductions to hotlines and medication stabilization services would mean 21.6 percent fewer people would get care in their communities.
"We know we get the best results when we have community-based support for mental health services," said Patsy Thomas, president of the Mental Health Connection, formed in Fort Worth after a mentally ill man killed seven in a 1999 shooting rampage at Wedgwood Baptist Church. The group has been contacted by officials in Tucson to offer advice for that community.
Texas, which ranks 49th in the nation for the amount it spends per person for mental health, is already at bare bones, Bailey said.
"Any further cuts will have potentially catastrophic effects," she said.
Experts say that the way to prevent tragedies such as the Tucson shooting is to treat the most severely mentally ill, and the earlier the better.
The data show that half of all lifetime cases of mental illness begin by age 14 and three-fourths by age 24, said Dr. Carolyn Robinowitz, past president of the American Psychiatric Association.
"For most people who have an acute severe mental illness, it doesn't come on or off like a light switch," she said.
But getting treatment against someone's will, without violating their civil rights, is tricky.
"You do have a right not to take care of yourself if you are ill," she said. "But where does that right end, if your behavior affects others?"
Jan Jarvis, 817-390-7664