Raleigh, N.C. — No one knows what caused Adam Lanza to open fire on Sandy Hook Elementary School in Newtown, Conn., last week.
Many think he had to be mentally ill to do what he did, but he was never clinically diagnosed.
Falling through the cracks, mental health advocates say, is easier when state funding for mental health is on the decline.
"Unfortunately, I think our safety net has really come unraveled over the last 10 years," said Ann Akland, past president of the Wake County chapter of the National Alliance on Mental Illness.
She points to state psychiatric hospitals closing, reducing 50 percent of the beds available for stays to allow people to become stable and then re-integrate them back into the community.
"What’s happening now is our crisis services are very overextended," Akland said. "So, people are going to the emergency room, and some are there for weeks trying to find a bed in a hospital. Patients might be sent home without treatment they need."
Rep. Verla Insko, D-Orange, a proponent of mental health services in the state, says most people in North Carolina with mental health issues don't have any health insurance, and they don't qualify for Medicaid.
That's why, she says, many are in and out of jail and crowding emergency rooms to get help.
Insko says lawmakers need to allocate funding for mental health services. She says the state has cut $80 million from the mental health budget since 1991.
Akland says that, right now, communities are left to fill the void, but money isn't there.
"It's just the resources aren't there," she said. "The services aren't there, and we have a long way to go to get everything in place."
Alliance Behavioral Healthcare oversees mental health services, for people on Medicaid or with no insurance.
Last year in Durham and Wake counties, the company managed or referred services for 30,000 people.
"If people need to be seen immediately, we have walk-in facilities open that are open 24/7, staffed by psychologists, psychiatrists and other licensed professionals," said Alliance's director of clinical operations, Sean Schreiber.
Schreiber calls the mental health services in the Triangle "robust."
Akland says she hopes the Connecticut school shooting opens the dialogue to strengthen the state's system.
"The main thing is getting people the help that they need and keeping them safe and keeping the communities safe," she said.
Akland also wants to stress that mental illness does not always lead to violence. She says 5 percent of homicides in the United States are committed by people with mental illnesses.
"If your grandmother has Alzheimer's disease, it really changes her personality and who she is as a person," Akland said. "That's similar to what happens, in some cases, with mental illness. It's a brain disease, and so what we want to do is protect and help our family members."