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Another school shooting has everyone asking “Why,” but also “What can we do about these awful assaults on children and their teachers?”   The answer is complex.

The CDC’s ACE’s study has shown the connection between trauma in childhood and various negative outcomes throughout the life span. These include behavior problems, mental illness, addictions, negative health behaviors, physical health problems. Additional research shows that the negative outcomes can include  aggression and violence throughout one’s life unless there is someone to stop the traumatic event and provide good care to the child.

The second debate that arises each time there is a mass shooting is whether to implement “common sense” gun control laws, such as more thorough background checks.  This is a great place to start our dialogue on guns, however, there is much more that we, as a society, can do to prevent these tragic events.

Should the mentally ill have access to guns?  Here is where we are missing part of the picture.   Symptoms of mental illness are NOT the same as the risk factors for violence toward others, nor is it measured or treated with the same methods as in Mental Health.  Mental illness may or may not be a factor for risk of violence.  There are very well researched risk factors for violence and we see these factors over and over again when the media begins to autopsy the histories of these shooters.    Not all mentally ill persons are dangerous and not all dangerous people are mentally ill.

Risk factors for violence include, but are not limited to:

• Socially awkward
• Rejected by their peer group
• Narcissistic traits
• Poor angermanagement
• Active, untreated, severe mental illness or autism spectrum disorder
• Severe school or job difficulties
• Violent communications
• Low frustration tolerance
• Strong interest in weapons and/or the “darker” side of society
• A severe loss that disturbs the ego or sense of self

I propose that anyone that has either committed a violent act in the past and/or has several risk factors for violence should have a full risk assessment and a risk reduction plan generated.  Additionally, research indicates that the risk factors vary by age, gender and type of violence subgroup.  There are 2 sub-groups of those than are violent, 1, those that are criminally involved, and 2. Those that are severely mentally ill (erupters) and have risk factors for violence. Mass murderers are often of the Erupter type.

There are less than 4 validated violence risk assessment tools for youth used in the US.  These include the SAVRY (Dr. Randy Borum, 1999), LS-CMI (Andrews & Bonta. 1995), PCL-YV (Dr. Hare, 2008), and the CARE-2 (Dr. K. Seifert, 2007).  All of the validated risk tools use similar risk factors.  These tools are found in criminal justice more often that in mental health systems.  Assessments are a good start but not sufficient.  One must know how to best intervene when there is a risk of dangerousness.  

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The assessments and treatment interventions for risk of violence are different than those used for mental health issues.  The provider, counselor, teacher, principal, doctor, hospital or law enforcement officer needs to know when and how to refer someone for a full risk assessment and risk reduction plan.  Additionally, all of the above disciplines must work together as a team to stop these tragedies from occurring because these youth at high risk are often  involved with multiple public agencies.  Every emergency room should have a quick and easy risk tool, as well.

Many on the track to become a mass murderer have not yet violated the law. They may, however, come to the attention of a medical, substance abuse, or mental health provider.  It is up to those in the behavioral health and medical services to become trained to identify those at risk with a quick, valid screener and know how to implement or refer a youth for a risk reduction plan.  If treatment is effective, it can prevent a tragedy such as the recent school shooting.

Every school in the country potentially has access to Federal funds for putting risk assessment tools in their schools.  The key is to use a validated tool rather than create one of their own, use one on the CDC Compendium, or use one with no validation.

School based mental health services are essential to provide assessment and interventions for potential youthful offenders where most of them are: in the schools. Expulsion from school without the requirement of a risk assessment and risk reduction plan in order to return to school is really not effective and unacceptable.

Assessment and treatment for this group is very specialized and requires training in forensic methods and approaches to treatment. It is also necessary that all school-based therapists be trained to provide these services.   However, mandatory treatment for those at risk for dangerousness is still a very controversial topic. The questions that arise from this are “Can we violate a person’s rights before they have committed a crime?  Maybe not, but we can require assessment and treatment to return to school or work. We must debate these questions widely and publicly. 

Where is the “line” between high, medium or low risk for dangerousness?  Only research can tell us that. Canada provides grant money for this research and we need to do the same in the US.

Additionally, youth violence is often a result of child abuse or neglect or domestic violence in the home or neighborhood during early childhood.  The trauma of having been brutalized as a child, leaves a youth vulnerable to repeat the violence he saw at home and direct it toward others.

In conclusion, there are a variety of strategies to help prevent terrible acts of violence by youth.  We must increase our capacity to provide these services in every community.