Psychiatric Annals

CME Article 

School Shootings Revisted for Clinicians

Eleanor Lastrapes, MD; Bailey Vasquez, BS; Heather Baker, LCSW; Julio I. Rojas, PhD, LADC; Britta K. Ostermeyer, MD, MBA

Abstract

School shootings are an unfortunate reality that have become more prevalent in recent years, impacting countless lives throughout the country, and the number of incidents continues to rise. Despite the increasing incidence of these shooting events and widespread media coverage, school shooters' characteristics and risk factors have not been well categorized. The aim of this article is to highlight these areas through a review of current literature pertaining to school shootings. Findings indicate that many school shooters are White adolescent males with personality and sociocultural characteristics who feel marginalized by society and without prosocial supports, and they are often exposed to additional risk factors such as substance abuse or trauma. Although the increase in these shooting events is troubling, schools are attempting to implement prevention strategies, including an interdisciplinary school team to assess threats. [Psychiatr Ann. 2020;50(9):376–381.]

Abstract

School shootings are an unfortunate reality that have become more prevalent in recent years, impacting countless lives throughout the country, and the number of incidents continues to rise. Despite the increasing incidence of these shooting events and widespread media coverage, school shooters' characteristics and risk factors have not been well categorized. The aim of this article is to highlight these areas through a review of current literature pertaining to school shootings. Findings indicate that many school shooters are White adolescent males with personality and sociocultural characteristics who feel marginalized by society and without prosocial supports, and they are often exposed to additional risk factors such as substance abuse or trauma. Although the increase in these shooting events is troubling, schools are attempting to implement prevention strategies, including an interdisciplinary school team to assess threats. [Psychiatr Ann. 2020;50(9):376–381.]

Varying definitions of school shooters exist in the current literature. Whether or not to include near misses and what constitutes “school grounds” are topics of debate and lead to challenges in creating a central database. The Naval Postgraduate School Center for Homeland Defense and Security (CHDS) published a school shooting database compiled from more than 25 different sources.1 CHDS defines school shooting as any event, including threats or near misses, during which a firearm is discharged on school infrastructure, campuses, or bus stops in the United States. Using this definition, there were more than than 1,300 shooting events from 1970 to 2018, and these numbers continue to rise.1

Typology

Effort has been dedicated to discovering characteristics of school shooters that could help predict future school shootings. Although some common findings observed in school shooters are provided in Table 1,2 there are no simple criteria to identify shooters.3 The profiles previously used to classify school shooters are broad, including criteria pertaining to large bodies of students, such as social withdrawal and poor coping mechanisms.4 These profiles run the risk of stigmatizing students who will never commit major acts of violence.

Common Findings About School Shooters

Table 1:

Common Findings About School Shooters

There are differences in school shootings based on school demographics.2,5 Whereas urban schools are commonly associated with higher crime rates and gang violence, serious school shootings with multiple fatalities occur more often in rural and suburban schools, especially in middle class areas. These shooters are mainly White males.2,5 Suburban and rural shootings may be characterized by social alienation, whereas urban shootings are more associated with interpersonal relationship violence.6

When examining all school shootings, including single victim events, there was a wider racial profile range among shooters.4 In regard to school performance, youth violence has generally been linked to lower academic scores, but most school shooters perform average or above.4

Shooters exhibit common psychological factors, such as a fragile self-image, paranoid dynamics, and narcissism, as well as retreat into violent and omnipotent revenge fantasies.6 Common social factors include rejection and ostracism by peers, dysfunctional family dynamics, and a lack of prosocial supports.

Illustrative Case

(This is a pseudonym and a fictionalized account to illustrate a point.) John is a 15-year-old sophomore at his local rural high school. He earns average grades and does not exhibit behavioral problems at school. He has experienced bullying at varied intensities since elementary school. He has minimal social connections and feels unliked by others. He lives with his parents and has a younger brother. His parents both work long hours outside the home to make ends meet, leaving them little time to spend with their children to provide supervision and guidance. Over the past year, his parents have had increasingly intense verbal arguments at home and have been threatening each other with divorce.

When he was in middle school, John began telling his mother that he did not feel as if he fit in and that the bullying he experienced worsened. His parents noticed him becoming increasingly sad, staying more to himself, not trying any sports or other activities. His father decided to get John involved with his favorite hobby, his gun collection. John was excited to spend extra time with his father, and his father was proud that he and John had developed this shared interest. John developed a sense that guns empower and make one feel important.

In high school, John developed an interest in a girl who shared a few classes with him. While passing a note to her, a peer intercepted it, read it aloud in class, and many of his classmates laughed. He continued to notice peers looking at him and whispering to others in the hallways. Also, he experienced more bullying by other students. John felt even more humiliated and became increasingly resentful toward students at school. John's self-esteem worsened, and he withdrew even further from others.

At home, John began spending more time caring for his father's gun collection because it helped him feel in control and powerful. John took a selfie proudly carrying his father's most powerful gun and became increasingly more preoccupied with omnipotent fantasies. He experienced a sense of importance and fantasized about going to school with his father's gun. Empowered by the gun, John envisioned that the bullying tormentors and others who laughed over the note he tried to pass on to the girl he liked would finally have to listen to him. In internet chats with other gun owners, he began to brag about how good he was at target practice with real guns and how much he would enjoy seeing his tormentors at school cower when he brought his gun to school. John also searched the media for information on prior school shooters.

After growing fantasies of finally becoming important and being respected by others, John increasingly desired to take his father's gun to school and shoot those who had hurt him. He mentioned to another student in passing, “They will all have to respect me when I come with my gun.”

A week later, John takes the gun from his father's basement and slips it into his backpack before school. He arrives on campus later that morning, turns on his cell phone video function connected to a live video-sharing feed, and begins firing into a crowd of students where some of his tormentors were gathered. When he is confronted by law enforcement, he aims at them and forces them to fire on him so that he will not survive the attack. He is killed at the scene. In his backpack, police find a note by John stating “They deserved to be punished. Everybody will forever know my name.”

Risk Factors

Risk factors relating to school shootings are complex and usually include a myriad of interactions of psychopathology and psychological factors, social issues, past trauma, and cultural factors.6 Many consider strained family dynamics a potential risk factor in the formation of school shooters, especially because family members are often victimized directly before a shooting.2 Households lacking discipline or a supportive childhood environment, including houses with a history of abuse or neglect, are at increased risk of youth violence.3,7 Access to firearms is another risk, as most school shooters obtain firearms from family members who own them legally. Studies have shown an increasing relationship between firearm youth homicides and number of households that legally own firearms.2 Locking guns in secure locations, such as a safe, has not stopped adolescents from gaining access to these firearms and using them.5

Children and adolescents with trauma and adverse life experiences are at even greater risk of mental illness, substance abuse, and other health or societal consequences than the general population.8 Although 1 in 5 children and adolescents in the United States have a diagnosable mental health condition or substance use disorder, and as many as 60% of these children and adolescents do not receive treatment for them,9 most perpetrators had no documented mental health diagnoses.2,10 However, many exhibited suicidal thoughts and difficulty coping with personal failures, as evidenced in perpetrators' writings.3,11

About 73% of school shootings between 1994 and 2018 were gang-related or interpersonal4 and were associated with repeated rejection by peer groups.2 According to the US Secret Service Analysis of school attacks, most perpetrators experienced some form of bullying, and almost all were experiencing a social stressor related to peers or romantic interests.3 Paolini12 noted 60% of school shooters acted out of revenge and 80% held a grievance toward another person at the time of their attack. About 80% communicated their plans to someone they knew,3,11 which provides an opportunity for intervention.

Prevention

Schools are faced with the dilemma of decreasing their vulnerability to an active shooter attack while maintaining a supportive and nourishing learning environment.13 A national survey of 349 school principals reported that 17% experienced a firearm incident at school in the past 5 years.14 Those surveyed reported perceived inadequate parental monitoring (70%), inadequate mental health services (64%), bullying (59%), and easy gun access (50%) as the main underlying causes, with many reporting uncertainty as to what measures should be implemented due to the lack of evidence of effective school violence prevention.14 Preventive school-based measures that have been discussed and/or implemented include (1) security measures (2) increased student access to mental health services, (3) threat assessments with interventions for students, and (4) preparation for crisis management.

Security Measures

Many schools have increased their security measures, including the installation of security surveillance cameras, limiting school building access, and hiring trained school security guards.15 Public schools have most frequently limited school building access and the use of school computers for social media, and often prohibit cellular telephone use. Table 2 provides a summary of school security measures that have been used.

School Security Prevention Measures

Table 2:

School Security Prevention Measures

Research on school firearm violence prevention shows no evidence indicating a reduction in firearm violence,16 and there is little to no support for security measures to prevent shootings or reduce school crime.4,13 Arming teachers also yielded no evidence for effectiveness in decreasing school homicides.11 To the contrary, the adoption of ineffective security measures may lull parents, teachers, and students into thinking they no longer have to be concerned about their safety.16 Although effective security measures can be experienced as appearing prison-like and as creating a negative school environment,13,15 crime prevention through environmental design is an architectural philosophy that aims to defer antisocial or criminal behavior through environmental design with a focus on natural surveillance, access control, and territorial reinforcement.13,17

Increased Student Access to Mental Health

The massive funding allocated to school building security measures unfortunately contrasts with the nationwide vast underfunding of school mental health services, which aim to help students before their problems escalate into violence.18

Of particular note, school shooters often function in the margins at school and society and usually are not enrolled in mental health treatment. Therefore, in most cases mental health professionals were not able to identify them prior to any shooting events.6 Although mental illness at large is far from significant in these deeply troubling school shooting events,6 students experiencing risk factors such as low self-esteem, social isolation, bullying, trauma, and/or family dysfunction could greatly benefit from mental health services.19,20

In addition, program funding cannot just be limited to care of existing mental health problems but should also include prevention.19 Education on substance abuse, mental illness, and trauma for school professionals seems vital. Some have argued for more school-based mental health services, which could offer benefits such as staff training, identifying red flags, earlier identification and treatment engagement, developing interventions, and an onsite presence for ongoing case consultation and management.21 A system review of interventions to reduce interpersonal violence at schools showed that cognitive-behavioral, social-emotional, and peer mentoring/mediation programs are effective in preventing peer violence. In addition, cognitive-behavioral and whole-school violence prevention programs show promise for preventing peer victimization.20

A standardized school-based prevention program in Germany called “Networks Against School Shootings” combines threat assessment (see below) with the general prevention of school emergency situations through (1) early intervention in student psychosocial crises, and (2) training of teachers to recognize warning signs of targeted violence.22 This program found that increases in teacher expertise and evaluation skills enhanced the identification of students with psychosocial crises, as well as promoted positive teacher-student interactions and positive feelings of perceived school safety.22 School counselors are in the unique position to conduct mental health screening to identify students with risk factors and to help the students better cope with their distress to prevent harm to themselves and others.12 Collaborative bridges between schools and mental health agencies can help ensure treatment resources for students in need.12

Threat Assessment and Intervention

Threat assessment by school teams represents a fundamental shift in risk assessment away from the pursuit of violence prediction toward proactive violence prevention or reduction.4 School authorities focus on identification, assessment, and individualized management of student threats.23 A threat assessment team would take an individual approach to evaluate student threats rather than a “zero tolerance” approach because the zero tolerance approach has proven ineffective. In fact, the zero tolerance approach of suspending and expelling students typically leads to worse societal outcomes.11 A multidisciplinary school-based threat assessment team typically consists of a school administrator, several mental health professionals, and a law enforcement representative, who is typically the school resource officer. Students at schools using a team threat-assessment approach report less bullying, greater willingness to seek help for bullying and threats of violence, and more positive perceptions of school staff members.4 Such schools also report significantly fewer long-term suspensions, more counseling services, more parent conferences, higher student reports of fair discipline, and a higher teacher perception of school safety. Fein et al.24 state that threat assessments are only effective in the context of a school “climate of safety.” Table 3 summarizes the highlights of a safe school climate. Bonnano and Levesnon15 reported that most school shooters shared their violent plans with peers prior to events and that a “code of silence” keeps this critical information undisclosed. In a safe school climate, however, students are comfortable and more willing to share concerns because they are not made to feel that they are “snitching.”15 Effective action can then be taken before violence occurs, resulting in decreased school violence.

School Climate of Safety

Table 3:

School Climate of Safety

It is also important to note that when a school shooting takes place the shooter's identity should not to be displayed in the media as this greatly rewards the grandiose narcissistic fame craved by the shooter and greatly entices future shooters (see the article by Kambam et al. 25 in this issue for more details).

Crisis Management

Key components to reducing fatalities in case of a crisis are (1) speedy medical treatment of living victims and (2) medical emergency interventions by nonmedical personnel.26 Therefore, teachers, administrators, and school staff must maintain basic life support and cardiopulmonary resuscitation skills. It is also important to have good coordination between law enforcement, medical providers, and school officials.3

Conclusion

School shootings resulting in fatalities and injuries have continued to increase since 1970. Characteristics and risk factors of such shooters are multifaceted and include an interplay between psychopathology, psychological distress, social stressors, trauma, and sociocultural issues. Many school shooters did not have a mental health history and performed these acts of violence out of revenge. Schools are faced with the dilemma of implementing strategies to protect students and staff against an active shooter attack while still providing students a supportive educational atmosphere. Although many schools have opted to increase security measures, research supports that an allocation of funding to psychological and mental health services for students might yield better results. Moving away from the pursuit of violence prediction, proactive risk assessment and risk mitigation by a multidisciplinary school-threat assessment team offers schools a proactive alternative for violence prevention through individually tailored interventions for students.

References

  1. Riedman D, O'Neill D. K-12 School shooting database: research methodology 2018. Accessed August 10, 2020. https://www.chds.us/ssdb/resources/uploads/2018/10/Intro-and-Methodology-K-12-SSDB.pdf
  2. Bushman BJ, Newman K, Calvert SL, et al. Youth violence: what we know and what we need to know. Am Psychol. 2016;71(1):17–39. doi:10.1037/a0039687 [CrossRef] PMID:26766763
  3. Alathari L. A U.S. Secret Service analysis of targeted school violence. Accessed August 10, 2020. https://www.secretservice.gov/protection/ntac/
  4. Cornell DG. Threat assessment as a school violence prevention strategy. Criminol Public Policy. 2020;19(1):235–252. doi:10.1111/1745-9133.12471 [CrossRef]
  5. Melvin DL, Matthew ER, Kelli SH. A Descriptive analysis of school and school shooter characteristics and the severity of school shootings in the United States, 1999–2018. J Adolesc Health. 2019;64(6):797–799 doi:10.1016/j.jadohealth.2018.12.006 [CrossRef] PMID:30833119
  6. Knoll JL, Annas GD. Mass shootings and mental illness. In: Gold LH, Simon RI, eds. Gun Violence and Mental Illness. American Psychiatric Publishing; 2016:81–104.
  7. Stoddard SA, Whiteside L, Zimmerman MA, et al. The relationship between cumulative risk and promotive factors and violent behavior among urban adolescents. Am J Community Psychol. 2013;51(1–2)57–65. doi:10.1007/s10464-012-9541-7 [CrossRef] PMID:22744013
  8. Rishel CW, Tabone JK, Hartnett HP, Szafran KF. Trauma-informed elementary schools: evaluation of school-based early intervention for young children. Child Schools. 2019;41(4):239–248. doi:10.1093/cs/cdz017 [CrossRef]
  9. Substance Abuse and Mental Health Services Administration. Identifying mental health and substance use problems of children and adolescents: a guide for child-serving organizations. Accessed August 10, 2020. https://store.samhsa.gov/system/files/sma12-4700.pdf
  10. Bindu K, Lagast K, Villarreal M, et al. School shootings during 2013-1015 in the USA. Inj Prev. 2017;23(5):321–327. doi:10.1136/injuryprev-2016-042162 [CrossRef] PMID:2792380011.
  11. Stubbe BDE. Engaging youths for accurate risk assessment in the context of school shootings. Focus Am Psychiatr Publ. 2019;17(4):387–390. doi:10.1176/appi.focus.20190033 [CrossRef] PMID:32047387
  12. Paolini A. School shootings and student mental health: Role of the school counselor in mitigating violence. Accessed August 10, 2020. https://www.counseling.org/docs/default-source/vistas/school-shootings-and-student-mental-health.pdf?sfvrsn=6
  13. Lamoreaux D, Sulkowski ML. An alternative to fortified schools: using crime prevention through environmental design (CPTED) to balance student safety and psychological well-being. Psychol Sch. 2020;57(1):152–165. doi:10.1002/pits.22301 [CrossRef]
  14. Price JH, Khubchandani J, Payton E, Thompson A. Reducing the risk of firearm violence in high schools: principles' perception and practices. J Community Health. 2016;41(2):234–243. doi:10.1007/s10900-015-0087-0 [CrossRef] PMID:26363918
  15. Bonanno CM, Levenson RL Jr, . School shooters: history, current theoretical and empirical findings, and strategies for prevention. SAGE Open. 2014;4(1):1–11. doi:10.1177/2158244014525425 [CrossRef]
  16. Price JH, Khubchandani J. School firearm violence prevention practices and policies: functional or folly?Violence Gend. 2019;6(3):154–167. doi:10.1089/vio.2018.0044 [CrossRef]
  17. Centers for Disease Control and Prevention. Using environmental design to prevent school violence. CDC National Center for Injury Prevention and Control, Division of Violence Prevention. Accessed August 10, 2020. https://www.cdc.gov/violenceprevention/youthviolence/cpted.html.
  18. Whitaker A, Torres-Guillen S, Morton M, et al. Cops and no counselors: how the lack of school mental health staff is harming students. American Civil Liberties Union. Accessed March 7, 2020. https://www.aclu.org/report/cops-and-no-counselors
  19. Leiner M, De la Vega I, Johansson B. Deadly mass shootings, mental health, and policies and regulations: what we are obligated to do!Front Pediatr. 2018;6:99. doi:10.3389/fped.2018.00099 [CrossRef] PMID:29713624
  20. Lester S, Lawrence C, Ward CL. What do we know about preventing school violence? A systematic review of systematic reviews. Psychol Health Med. 2017;22(suppl 1):187–223. doi:10.1080/13548506.2017.1282616 [CrossRef] PMID:28132514
  21. Teasley ML. School shootings and the need for more school-based mental health services. Child Schools. 2018;40(3):131–134. doi:10.1093/cs/cdy015 [CrossRef]
  22. Leuschner V, Fiedler N, Schultze M, et al. Prevention of targeted school violence by responding to student's psychosocial crisis: the NETWASS Program. Child Dev. 2017;88(1):68–82. doi:10.1111/cdev.12690 [CrossRef] PMID:28042899
  23. National Threat Assessment Center. Enhancing school safety using a threat assessment model: an operational guide for preventing targeted school violence. US Secret Service, Department of Homeland Security. Accessed August 10, 2020. https://www.cisa.gov/publication/enhancing-school-safety-using-threat-assessment-model-operational-guide-preventing.
  24. Fein RA, Vossekuil B, Pollack WS, et al. Threat assessment in schools: A guide to managing threatening situations and to create safe school climates. United States Secret Service and United States Department of Education; 2002..
  25. Kambam PR, Pozios VK, Bond KL, Ostermeyer BK. The influence of media related to mass shootings. Psychiatr Ann. 2020;50(9):393–398.
  26. Nagin DS, Koper CS, Lum C. Policy recommendations for encountering mass shootings in the United States. Criminol Public Policy. 2020;19(1):9–15. doi:10.1111/1745-9133.12484 [CrossRef]

Common Findings About School Shooters

<list-item>

Mostly White and male

</list-item><list-item>

Mostly from middle class families

</list-item><list-item>

Usually average or above average intelligence and academic achievement

</list-item><list-item>

Usually no history of discipline problems

</list-item><list-item>

Usually solo offenders

</list-item><list-item>

Usually not recidivist violent offenders

</list-item><list-item>

Usually no mental illness history, but same symptoms may be present

</list-item><list-item>

Often considered or attempted suicide

</list-item><list-item>

Usually no substance use history

</list-item><list-item>

Usually do not know anyone who has been killed before

</list-item><list-item>

More in rural towns and suburbs

</list-item><list-item>

Victims both male and female, often same race

</list-item><list-item>

Majority obtained gun from family members who purchased them legally

</list-item><list-item>

Often use multiple guns

</list-item><list-item>

Usually “leaked” their intentions to peers prior to the shooting

</list-item><list-item>

Often engage into concerning behavior prior to shooting (eg, weapon seeking, disturbing writings, pictures of themselves with gun)

</list-item><list-item>

May victimize family members prior to shooting

</list-item><list-item>

Commonly seek media attention for shootings

</list-item>

School Security Prevention Measures

Limit school building access <list-item>

Use of identification cards by active students and staff

</list-item><list-item>

Locked school entrances, including one-door access, visitor sign-in requirement

</list-item><list-item>

Gated campus

</list-item>
Weapon/gun prohibition <list-item>

Use of metal detectors

</list-item><list-item>

Lockless student lockers

</list-item><list-item>

Random sweeps for contraband

</list-item>
Increased surveillance <list-item>

Security cameras

</list-item><list-item>

School resource officers

</list-item><list-item>

Staff lockdown drills

</list-item>
Limited internet access from campus <list-item>

No social media access

</list-item><list-item>

Cell phone/texting devices prohibition

</list-item>
Crisis response <list-item>

Student drills

</list-item><list-item>

Duress alarms

</list-item><list-item>

Telephones, panic buttons in classrooms

</list-item>

School Climate of Safety

<list-item>

Adults and students have mutual respect, important to listen

</list-item><list-item>

Strong stand against “code of silence;” student reporting student to an adult is not a “snitch”

</list-item><list-item>

Students have a positive connection to at least one adult

</list-item><list-item>

Students can openly voice concerns without fear or reprisal

</list-item><list-item>

Concerns are raised and addressed before they became serious

</list-item><list-item>

Staff serves as positive role models

</list-item><list-item>

Teachers and administrators also address social-emotional student needs

</list-item><list-item>

“Shame-free” zones where teasing and bullying not accepted

</list-item><list-item>

Understanding that violence does not solve problems but only makes them worse

</list-item><list-item>

Conflicts are mediated

</list-item><list-item>

Diversity is respected

</list-item>
Authors

Eleanor Lastrapes, MD, is a second-year General Psychiatry Resident, University of Oklahoma Health Sciences Center. Bailey Vasquez, BS, is a third-year Medical Student, University of Oklahoma College of Medicine. Heather Baker, LCSW, is an Instructor, Child and Adolescent Psychiatry Division, University of Oklahoma Health Sciences Center. Julio I. Rojas, PhD, LADC, is an Associate Professor and the Director, ExecuCare Program, University of Oklahoma Health Sciences Center. Britta K. Ostermeyer, MD, MBA, is a Practicing Board-Certified Forensic Psychiatrist; the Paul and Ruth Jonas Chair in Mental Health; a Professor and the Chairman, Department of Psychiatry and Behavioral Sciences, University of Oklahoma College of Medicine; and the Chief of Psychiatry for OU Medicine and the Mental Health Authority of the Oklahoma County Detention Center, University of Oklahoma Health Sciences Center.

Address correspondence to Britta K. Ostermeyer, MD, MBA, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, PO Box 26901, WP3470, Oklahoma City, OK 73126-0901; email: Britta-Ostermeyer@ouhsc.edu.

Disclosure: The authors have no relevant financial relationships to disclose.

10.3928/00485713-20200810-01

Sign up to receive

Journal E-contents