When you hear news of another school shooting, what鈥檚 your first reaction? Shock? Disbelief?

Or, like many of us, have you become somewhat complacent when you hear about the latest attack at a school or university?

Regardless, there is a basic question that we should ask: What inspires someone to take a gun into school on a given day to shoot fellow students, teachers or both?

There have been 387 school shootings in the country since 1992, according to www.stoptheshootings.org. In the U.S., children aged 5-14 are 13 times more likely to be murdered with guns than in any other industrialized nation.

A Google image search on the term “school shooter” brings up plenty of infamous faces.

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So, what happens inside the shooter in the run-up to the spurt of violence?

Dr. Mark Stitham, a board-certified psychiatrist in child, adult and forensic psychiatry on Oahu, says,鈥 No one really knows for sure but there are common themes of extreme alienation, poor social skills and severe low esteem.聽After all, killing is the ultimate control over others, albeit in a horrific way.鈥

Well, what can be done about it? More precisely, can this type of behavior be recognized and addressed early enough to prevent another school shooting like one in Santa Barbara last month or like more recent campus shootings at Reynolds High School in east Multnomah County, Oregon, and Seattle Pacific University.

Dr. Stitham feels it鈥檚 difficult to prevent such attacks and maybe it is just luck that one hasn’t hit Hawaii yet.

There is often a debate about how to prevent such attacks. Is the answer gun control, better mental health responses, or both?

鈥淎s for prevention, dangerousness cannot be predicted and we cannot monitor every wild proclamation, but certainly we can all 鈥 especially school officials 鈥 focus more on these types of young men,鈥 Dr. Stitham said.

鈥淭he shooters are really committing suicide by cop or by themselves.鈥 鈥 Dr. Mark Stitham

鈥淎lso, of course, the size of ammunition clips should be minimized 鈥斅爊ote it’s the tremendous firepower guns these killers use, not a deer rifle.聽But of course the NRA will prohibit any sensible gun control.鈥

On the mental health front, experts highlight the need to avoid raising suspicions about broad groups of people when very few ever engage in such attacks.

While many of the shooters have mental health issues, Dr. Martin Johnson, the founder of the Hawaii Center for Psychology, says, 鈥淣ot all of those who suffer from mental health issues are violent. The key is to try to distinguish between the two.鈥

To that end, there are factors that help to predict which people with serious mental health issues might become violent. A history of violence, substance abuse 鈥 including drugs or alcohol 鈥 and certain severe mental illnesses, like schizophrenia, are risks factors for potential future violent behaviors.

Hostility, paranoia and other odd behaviors may offer clues too, but actually predicting who will become a first-time violent offender is very difficult.

One simple but radical idea, Dr. Johnson proposes, is for everyone to get a mental health checkup, a sort of physical for the mind.

鈥淕oing in for a checkup with a psychologist is similar to going to the dentist. You wouldn鈥檛 try to handle your own dental care at home; you would leave it to a professional.” Everyone should also get their mental health checked on periodically, he said.

The Mental Health Parity Act of 1996, signed by then-President Bill Clinton, required that health insurers provide equal coverage for medical as well as mental health services.

Unfortunately most people are not aware of such details in their mental health coverage. (A simple phone call to the insurance company can clear up questions about coverage.)

But what if the person you are concerned about is not yourself, but a friend, relative, neighbor or someone you hardly know but come into uncomfortable proximity with?

Directly encouraging such people to seek help that might be effective for them would likely fall on deaf ears.

(that is in the process of being updated) by the U.S. Secret Service and Department of Education has found that in 95 percent of the cases examined, the attacker planned to harm the target before the shooting occurred. More than two-thirds of the attackers obtained guns from their own home or from a relative’s. Prior to the targeted attack, more than 90 percent of the attackers behaved in a way that caused concern or indicated a need for help. In almost all of the cases studied, the attacker had told a friend, classmate or family member about the idea before taking action.

Such elements have largely found an echo in the recent flurry of attacks, suggesting that we need to find ways to head off such violence.

If there are students who feel like one of their own is making threats 鈥 and suggesting that they are going to bring guns, knives or other dangerous items to the school 鈥 then someone needs to notify the counselors, teachers, security or anyone in authority who might be able to help.

After many of the school shootings, investigations reveal that the shooter had some sort of manifesto 鈥 often a very long, obsessive one 鈥 or had posted hateful messages on social media, sometimes just days or even hours before their attack. Anyone who reads these posts might be in a position to help alert the local school or the police.

Many of these tragedies have also resulted in the death of the shooter.

Dr. Stitham says this is significant.

鈥淭he shooters are really committing suicide by cop or by themselves.”

After the shooting, it isn鈥檛 usually very constructive to ask why the horrific incident took place 鈥 at least not in terms of prevention. After all, the Centers for Disease Control and Prevention notes that nearly every school district has long had a comprehensive crisis preparedness plan and training for faculty and staff, but that doesn’t do much for places where a massacre has already taken place.

So it is crucial to identify warnings in social media posts or online video rants, or even to monitor people who exhibiting suicidal tendencies, in the hopes of preventing shootings.

Dr. Johnson also suggests that people who feel threatened notify the police if they have concerns about someone.

鈥淎ssault does not have to mean that someone has hit you. That鈥檚 considered battery. But if someone threatens you verbally or physically, this is a warning sign of potential future violence and it needs to be taken seriously.

Both doctors emphasize that although we have not yet endured a campus shooting in Hawaii, that doesn鈥檛 mean that it can鈥檛 鈥 or won鈥檛 鈥 happen here.

To help make sure that it doesn鈥檛, they say we should take preventative action by improving the availability of mental health services. Counseling services in schools, mandatory yearly mental health visits for all enrolled students and workshops for parents to know how to use social media well enough to recognize the warning signs would be a start.

None of these solutions guarantee we won鈥檛 ever have a campus shooter in Hawaii, or in other places where they haven鈥檛 yet occurred, but such actions might improve our odds.

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