Television programming is interrupted by a breaking news story unfolding someplace in the United States. A deranged shooter has opened fire on everyday Americans at a school, shopping mall or public meeting. We are at first dazed, then incredulous and finally grief-stricken. It just keeps happening - but why - and more importantly, what can be done to prevent tragedies like the one in Tucson, Ariz.?
On April 16, 2007, Seung-Hui Cho killed 32 people and wounded many more at Virginia Tech in the deadliest peacetime shooting incident by a single gunman in U.S. history. I was secretary of the U.S. Department of Health and Human Services at the time. Within days of the tragedy, the White House called and President George W. Bush directed me, with the assistance of Secretary of Education Margaret Spellings and Attorney General Alberto Gonzales, to find answers about what the federal government could do to prevent such tragedies.
In the 12 days that followed, we traveled to states where unthinkable events had unfolded - Columbine, Red Lake, the Bell Tower at the University of Texas and nine other cites where demoralizing moments in American history had occurred. At each location, we met with groups of educators, mental health experts, law enforcement personnel and state and local officials who had been participants in these events and their aftermath. Their reflections and observations proved valuable, and we catalogued them in a report to the president. (See Report to the President on Issues Raised by the Virginia Tech Tragedy, U.S. Department of Health and Human Services, June 13, 2007, hhs.gov/vtreport.html).
It has been nearly four years since then, and once again, we struggle to understand the social implications of a deranged gunman acting on his own to terrorize our nation. Feeling our national turmoil caused me to review the report to the president. Little has changed since it was issued, and I am inclined to think our observations may have even more meaning today.
We recommended a series of action items, but made clear we did not "see them individually or together as a panacea for the many complex issues our society confronts in trying to prevent another tragedy."
"Rather, they are an attempt to frame the issues and identify tangible steps we can take over time to help prevent events like the Virginia Tech tragedy." I offer them again in the same spirit.
We offered five still relevant and important suggestions:
c First, people misuse the Health Insurance Portability and Accountability Act, commonly known as HIPAA, and neglect to share information that could be helpful. Many of the obstacles to sharing information are only perceived, as opposed to real, HIPAA restrictions. The fact is there are methods of sharing information on persons who are likely to be a danger to themselves or others.
c Second, accurate and complete information on individuals prohibited from possessing firearms is essential to keep guns out of the wrong hands. The report says: "State laws and practices do not uniformly ensure that information on persons restricted from possessing firearms is appropriately captured and available to the National Instant Criminal Background Check System." Four years later, some progress has been made on this problem, but progress is slow among the states.
c Third, awareness and communication are key to prevention. Early reports from Tucson make clear that many in the community saw warning signs in the behavior of the suspect, but failed to act.It is important that parents, students and teachers learn to recognize warning signs and encourage those who need help to seek it, so that people receive the care they need and our communities are kept safe.
c Fourth, it is critical to get people with mental illness the services they need.Meeting the challenge of adequate and appropriate community integration of people with mental illness requires effective coordination of community service providers who are sensitive to the interests of safety, privacy and provision of care.
There is a hard truth in this one. In recent decades, mental health has gone through a welcome deinstitutionalization as we moved away from housing mentally ill persons in mental hospitals. Social liberals and fiscal conservatives supported this change. However, too little was put in place to replace it. We have neglected our mental health infrastructure, relying too much on prisons and universities rather than more effective community resources.
c Fifth, we need to continually improve our prevention and emergency-preparedness programs. States and communities have made progress, but there is more to do. We must fully implement these programs through practice and effective communication. In the past four years, there are indications universities and other institutions are working to improve their preparedness. Now is a time to redouble our efforts.
The hard work of creating a more perfect union never stops. Finding the balance between freedom and security is hard work and requires ongoing and concentrated effort. Learning from the past is an important part of the process.
Michael O. Leavitt was the secretary of the U.S. Department of Health and Human Services from 2005 to 2009 and a three-term governor of Utah.
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