My plan was to focus on the community reading of “Rough Sleepers” and how our community is taking care for those who experience homelessness. This book is about Dr. Jim O’Connell and his commitment to providing medical care for people who are unhoused in Boston — work that became the model for Oasis Free Clinics.

But then the 10th-largest mass shooting in United States history happened 20 miles from our clinic.

We all know someone touched by this devastating tragedy — a victim, a family member, a first responder. The “Maine is really a small town” feeling becomes apparent when something big like this happens.

In other Giving Voice articles, I have shared about growing up in Appalachia without access to medical and dental care and why it is a significant reason that I am committed to the work we do at Oasis. Something few people know is that as a teenager, I carried a gun to work every day when I worked alone at my family’s diner. That experience also shaped me professionally.

From 1997 to 2006, I worked for the U.S. Centers for Disease Control and Prevention, eight of those years assigned to work in Maine. For almost all of that time, I was focused on cancerrelated initiatives. However, for six months during my first year, I worked in the Division of Violence Prevention, and more specifically, on the Youth Violence Team. I read hundreds of articles about school shootings, learned about the Dickey Amendment which banned the CDC from studying gun violence (though it was reversed in 2019), and helped coordinate a national suicide prevention conference. One of the hardest things I’ve ever done was to ask and then listen to a principal to recount the day a gunman entered his school.

In 2005, it happened in my small-town high school in Tennessee.

My favorite teacher, my gym teacher, and the assistant principal were shot by a kid whose family owned the convenience store we all stopped by on the way to school. Everyone knew the family. They are good people — the first to let you“float” if you didn’t have enough cash, or to make sure a kid had something to eat.

In 2006, I left the CDC to work at Maine Medical Center on a mental health research grant.

We were studying whether the progression of a severe mental illness, like schizophrenia and bipolar disorder, could be stopped if you intervene early.

Study participants had experienced psychosis, including hallucinations, whether they were seeing or hearing things that weren’t there. Many had intrusive thoughts — ideas that came into their minds unbidden — or were experiencing paranoia. Our hope was to find a treatment that would prevent these things from continuing so young people could avoid the challenges that come with severe mental illness.

All this to say, I have been thinking about guns, violence, mental health, and the impact on communities for a long time.

Gun violence is a major public health issue. It is the leading cause of premature death in the United States with over 123,000 people killed or injured by guns annually. Just like most of us have connections to last week’s tragedy, many of us are only a few degrees separated from similar events around the country.

When I mentioned that there had been a shooting at my high school, an Oasis board member said there had been one at his. I just shrugged — no surprise.

Events like these are complex. There are rarely straightforward answers why something like this happens. Gun violence is a convergence of individual, family, school, peer, community and sociocultural risk factors. There are complicated and polarizing issues related to access to mental health care, gun control laws and individual versus collective rights. Yet in the wake of a tragedy like Lewiston, we want to know why this happened, what systems failed, and how it won’t happen again.

It is going to take individual and community level solutions to prevent things like this from happening. The American Psychological Association has developed recommendations, and I have adapted them below.

• We must invest in early childhood programs to help parents raise emotionally healthy children. Free pre-kindergarten, as well as parenting programs, such as the Families CAN! and Whole Families, are great examples that exist in our community.

• Although many youth “outgrow” aggressive behavior during late adolescence, others are disproportionately at risk for becoming involved in gun violence.

Having places like the Midcoast Youth Center and the Brunswick Area Teen Center are critical for providing connection to adults and social services to our young people.

• Overwhelmingly, violent acts are done by males. We have to change social norms about masculinity by providing healthy role models and opportunities for boys and men to express themselves. Boys to Men is doing great work in Maine and is a good resource to learn more.

• Most people who experience mental illness are not violent or dangerous. For the small percentage of people who are at risk for violence, mental health treatment can often prevent gun violence. Having access to mental health services is critical. Our colleagues at Mid Coast Hospital’s Behavioral Health Program play a vital role in addressing a wide range of mental health needs in our area.

• Having primary care services available and financially accessible in every community also makes a difference. This is why safety net providers, like Oasis, are critical to the health of our community.

• Keeping guns from people who are at high risk of using them for violent purposes has been shown to reduce violence.

To quote Sister Helen Prejean, “As a nun, I’m expected to offer thoughts and prayers, and indeed I do. But that’s not enough. We must rise up and take action together to stop this violence. This can’t keep happening.”

Who imagines they will be touched by the heartbreaking loss caused by a mass shooting? We will feel the ripples of what happened in Lewiston for years, maybe decades. No one wants another Maine community to go through this devastation.

It’s up to us to work together to make sure that doesn’t happen.

Anita Ruff is executive director of Oasis Free Clinics, a nonprofit, no-cost primary care medical practice and dental clinic, providing patient-centered care to uninsured adults living in Freeport, Durham, Harpswell, Brunswick and Sagadahoc County. For more information, visit Oasis- or call (207) 721-9277.