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Pete Finelli, who lives two blocks from the clinic and once worked there as a nursing assistant, said there are always security guards on the ground floor of the building, where the shooting occurred. That’s also the equivalent of an emergency room, and is where patients are admitted and discharged.

Shaun Lorentz’s wife, Melanie, works inside the clinic building. He said he’s seen patients in the lobby who get irate because the facility doesn’t have the resources to meet all their needs.

“A lot of mental facilities have closed” in the region, he said, and the remaining ones struggle to cope with the workload.

The psychiatric clinic has 292 beds but reported more than 372,000 outpatient visits and just over 11,000 emergency room visits in 2010, along with $79 million in research funding.

UPMC chief executive Jeffrey Romoff said the health network was “deeply, deeply saddened by today’s events” and expressed “deepest sympathy to the victims and their families.”

Associated Press writers Mike Rubinkam in Allentown and Kathy Matheson and JoAnn Loviglio in Philadelphia and news researcher Jennifer Farrar in New York contributed to this report.