Four Months Later: The Legacy of the Tucson Shooting

Tucson, Ariz., has regained a semblance of normalcy four months after the crime that drew worldwide attention. Last week, it was business as usual at the Safeway supermarket where Jared Lee Loughner was arrested on Jan. 8 after shooting 19 people — killing six and leaving Congresswoman Gabrielle Giffords severely injured. A pair of tables set up for a used-book sale in the exact spot where the assault took place was piled high with titles like Divine Secrets of the Ya-Ya Sisterhood, Dan Quayle's memoir Standing Firm and, eerily, a novel called The Murderer Next Door, by Rafael Yglesias. A couple of miles away at Pima Community College, the school Loughner was expelled from last fall, clusters of students ate lunch on a patio and others smoked cigarettes in the parking lot. One pair took a between-class nap.

Even at the Loughner home on nearby North Soledad Avenue, where his parents have rarely been seen outside their house since January, his father Randy stepped out into the Arizona sunshine. As the wind rustled through the mesquite tree out front, Randy walked across his roof wearing a sleeveless shirt, shorts and work boots and doing what appeared to be work on the house.

But the close-knit city has become quietly sensitive to the underlying issue of the Jan. 8 shooting — the intersection of mental health and violence — and whether anything could have been done to prevent it. The exact details of Loughner's mental health are still unknown, and it wasn't until April 21, when court documents were filed showing that Loughner received treatment at Tucson's Sonora Behavioral Health Hospital at age 17, that any information about his treatment history emerged. Unlike the aftermath of similar acts of violence in recent years — notably the shooting on the Virginia Tech campus — there's been relatively little finger-pointing.

Instead, local behavioral-health agencies have been careful to stress that most people with mental illness are nonviolent and that early treatment is key. They've also continued the public discourse on mental health and violence, including a symposium at the University of Arizona last week that was carefully titled, "A Delicate Balance: Creating a Better Post-January 8 System to Protect the Public and Help Persons with Serious Mental Illness."

The message seems to be getting out. Some Tucson behavioral-health programs are reporting a spike in the use of their services and a boost in private donations since Jan. 8. Epicenter, a program created last year by the University of Arizona (UA) Department of Psychiatry to identify and treat individuals exhibiting early signs of psychosis, has seen a drastic increase in referrals. "We were getting one referral a week, and since the shooting it's closer to one a day," UA assistant professor of psychiatry Nicholas Breitborde tells TIME. The Southern Arizona chapter of the National Alliance of Mental Illness (NAMI) had record participation at its annual fundraising walk in March and pulled in $146,000 — 40% more than last year's figure.

Other agencies have redoubled efforts to educate and train community members in mental-health assessment and intervention — even in the face of state budget cuts to mental-health services. The Community Partnership of Southern Arizona is ramping up a program called Mental Health First Aid, which trains people in how to recognize mental-illness risk factors, implement interventions when necessary and connect those in need of help with professional care. "In the next six months we'll be training thousands of people from the faith-based community, teachers, parents and business people," says Neal Cash, the president of the organization.

One new initiative was launched by a survivor of the shooting. Giffords' district director Ron Barber came up with the idea to create the Fund for Civility, Respect and Understanding while he was still in the hospital recuperating from gunshot wounds to the cheek and left groin. One of the fund's main goals is to raise public awareness about mental illness and treatment.

Loughner's name wasn't invoked until three hours into the UA community discussion last week, and even then it was quickly followed by an emphasis on community healing. "What happened that morning at 10 minutes after 10 was an aberration," Barber said to the 200 or so assembled at the UA community discussion. "What happened immediately afterwards was the true face of our community." It's a sentiment that's widely embraced in Tucson. "What's interesting about this community is that we're not defining ourselves by what happened on January 8," Cash says. "We're talking about the good that can come of a tragic event."

Indeed, there seems to be some voluntary monitoring of worrisome behavior by some institutions. According to Lieutenant Lisa Sacco of the Pima County Sheriff's Department, since the January shooting, Pima Community College has voluntarily stepped up its efforts to communicate with law enforcement when students are expelled from the school. "They now send a letter to the sheriff's department," Sacco says. "We assess the information and check our databases to see if the person has had contact with law enforcement and whether there have been any threats associated or if there's a pattern of behavior."

There may come a day when Arizona schools and government agencies are legally required to report behavior that results in expulsions, firings or suspensions to a behavioral-health hotline — the intent of a piece of post–Jan. 8 legislation that Dr. Matt Heinz, a Democratic state representative who's also a physician and a friend of Giffords, is working on. Heinz was hoping to introduce the legislation in the most recent legislative session, but he couldn't get the behavioral-health community's support. "There was concern about the shifting of responsibility to a behavioral-health system with a lack of resources," Neal Cash of Community Partnership of Southern Arizona tells TIME, referring to recent state budget cuts. "If you build awareness in the community and ramp up demand, you have to have the resources to meet that demand." Cash, who wasn't directly involved in meetings regarding the legislation, is on board with Heinz's efforts, which include plans to reintroduce a bill in the next session. "We would love to work with him to craft [a bill] to potentially meet his needs and our needs," Cash says. "That door is wide open."