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How Mental Health Clinicians Can Help Prevent School Violence

October 06, 2019

ResnickSAN DIEGO—There is no single profile of a school shooter, and potential threats must be evaluated based on the behavior of the student instead, forensic psychiatrist Phillip J. Resnick, MD, said at a Psych Congress 2019 Featured Session on school shooters.

Dr. Resnick, Professor of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, discussed the characteristics of the people who have committed mass killings in schools, how mental health professionals can evaluate possible threats, and what interventions they can take when someone is believed to pose a threat.

Mass killings involving firearms occur approximately every 2 weeks in the United States, with school shootings occurring monthly, said Dr. Resnick, who has been a consultant on some of the school shooting cases.

See the session slides

A US Secret Service study of 37 school shootings found that revenge is the most common motive, and faculty were more often the target than students—a fact which Dr. Resnick said surprised him. Bullying is often, but not always, a significant factor, with some attackers saying they had felt severely bullied, almost as if they were being tortured.

Two-thirds of the school shooters studied came from 2-parent families, two-thirds had not been in trouble previously, and most did not have a criminal record.

More from Dr. Resnick: Stopping the Surge of School Shootings

In more than 98% of the cases, the shooter had suffered some significant losses, such as romantic rejection, and that was often combined with low self-esteem, an inability to cope, and feeling like there was no solution to their problems. Of the attackers studied, 78% had suicidal thoughts and many had attempted suicide.

“It’s when there is nothing to lose that the person is most likely to go ahead” with the crime, Dr. Resnick explained. “If they’re already willing to die, then to get even with people they feel have treated them unfairly becomes much more attractive.”

An Opportunity to Intervene

Adults who commit mass killings are usually lone actors, with no one else aware of their plans, Dr. Resnick said. But with teenage attackers, other students know about the plan 80% of the time, and in some cases have encouraged the violence, he noted. An adult may also know, but there are no known instances of a perpetrator’s parent being aware.

The killings are “detailed, planned experiences,” and it is a myth that the attackers “just snap.” In the 2012 Sandy Hook Elementary School case, the attack was planned for 2 years, Dr. Resnick noted.

“The fact that the planning is so lengthy means that we have more time to intervene than if it was a sudden event,” he said.

Dr. Resnick encouraged mental health professionals not to wait for a threat to be made before intervening. A student may pose a threat without making a threat, he said.

A threat assessment is different from a psychiatric assessment because investigating outside collateral is more important than the interview of the person, Dr. Resnick explained.

Warning signs that assessment teams can look for include weapon-seeking, weapons acquisition, practicing at gun ranges, he said. Criminal justice and school records should be reviewed, as well as the student’s phone and computer records and online activity.

“Any school shooter evaluation is incomplete without the cyberspace information,” he said, telling clinicians to look for signs of grievances and grudges in the student’s digital footprint.

Assessment teams should also be alert for paranoid personality traits, which Dr. Resnick said “are of special concern.” These traits include being overly sensitive to disrespect, having closed thinking that precludes corrective information, externalization of blame, disproportionate rage, and feeling devalued by an “in” group.

Clinicians should examine the subject’s perception of being bullying and others’ responses to it. “They don’t forgive and forget even small slights,” he said.

Assessment teams should interview the student’s family, Dr. Resnick said, but in a very discreet manner.

“If other students learn that one student is being evaluated as a potential school shooter, that child is going to be stigmatized and they are going to become more isolated and at greater risk,” he said.

Other Steps Toward Prevention

To further help prevent school shootings, schools should have anti-bullying programs and create a climate where students are not afraid to report concerns and do not feel like a “snitch,” he said. Following the Parkland, Florida school shooting, the state is creating a mobile app that students can use to report potential threats, he added.

When a student is deemed a threat, an integrated approach is needed to reduce their emotional pain, help them see they have a future, and help them find nonviolent ways to resolve their problems, Dr. Resnick said. Interventions could include a change in classroom assignment, evaluation for an Individualized Education Program (IEP), and increased supervision of the student.

—Terri Airov


“School shooters: tormented teens or cold-blooded killers?” Presented at Psych Congress 2019: San Diego, CA; Oct. 5, 2019.

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