Arthur Caplan

is the Emanuel & Robert Hart Professor of Bioethics, chair of the department of medical ethics, and director of the Center for Bioethics at the University of Pennsylvania

It is not just guns.

In all my life, I never thought I would write those words after a massacre involving a mass murder with a gun. But a week's worth of intense media coverage of the heinous murders of students and faculty at Virginia Tech and analyses focusing on guns by innumerable experts has left me furious.

I don't think the expert wisdom is even close to understanding what must be done to try to prevent this type of tragedy in the future.

It is not just guns. We need to fix a broken, abandoned and pathetic system of mental-health care.

In the same month that Seung-Hui Cho killed and injured scores of people at Virginia Tech, a researcher at the University of Washington was shot to death in her office by a former boyfriend, who then killed himself. Rebecca Griego had gotten a restraining order against Jonathan Rowan. When he showed up at her office, he fired five shots into Rebecca. A colleague at the university said it was a "psycho from her past."

In Mandeville, La., a man who had just had a restraining order issued against him by his estranged wife allegedly ambushed her and their three children. He had never gotten any help for previous violent outbursts.

And in Queens, N.Y., a man killed his mother, a wheelchair-bound man, and a home health-care worker before shooting himself dead - just minutes after the mother called 911 pleading for help. The mother's surviving sister blamed police for failing to protect her sister from the "mentally ill" son.

The murdered mother, Sonia Taylor, had called police twice Monday during fights with her son Wade Dawkins. The police had been called to the home eight times since last May. During an incident in October, Taylor told police that her son, a drug abuser with no rap sheet, was throwing things and acting violently. The police took him to a local hospital for an evaluation. He was quickly sent back to her house.

All of these killings involved not just guns, but killers who might have benefited from mental-health treatment. None got the help they needed.

The Virginia Tech murderer was - to be blunt - totally crazy. He fit the dreary profile all too familiar from the shootings at Columbine High School near Denver and the Nickel Mines School in Amish country near Lancaster. Cho was an angry outcast, preoccupied with thoughts of violence against those whom he saw as bullying, victimizing or just plain ignoring him. He had profound social withdrawal, suicidal thinking and destructive fantasies, and was a known stalker. He scared people. But he fell through the cracks of university bureaucracy and a hodgepodge mental-health system.

Report after report over the past decade has warned that most public mental-health systems have, to quote one, "all but disintegrated." Such systems, whether local, state or federal, are badly fragmented and ill-equipped to address our nation's mental health in a comprehensive manner.

States have been balancing their budgets on the backs of the mentally ill for years. A recent example is North Carolina, where 33 percent cuts in the state budget have been proposed.

But you don't really need to read the reports or look at the budgets. Look out your window.

Most of the homeless people wandering around America's cities are mentally ill. Try to get help for your anorexic daughter, alcoholic brother-in-law or suicidal spouse and see what happens. See what kind of police or mental-health response you get if someone threatens or harasses you repeatedly.

Serving in Iraq or Afghanistan with post-traumatic stress disorder or another mental illness? Good luck. The military's mental-health system is overwhelmed and understaffed. The services available to soldiers' families are just as bad.

I don't buy that "guns don't kill people, people kill people." Too many guns with too much firepower are too readily available. Politically, we lack the will to do anything about that problem.

But that is not the whole problem. It is time to start repairing a mental-health system that serves too few, costs too much, protects too little and cannot even find the means to help those who clearly are in desperate need. Maybe after Virginia Tech we can at least find the will to do that much.

The Web site address for the Center for Bioethics at the University of Pennsylvania is http://bioethics.upenn.edu.