Everyone in America has seen the latest results of another dangerously mentally ill loner with family members who were in denial about the severity of his condition or disconnected from him. The killer, Adam Lanza, shot shot his own mother in the face before slaughtering twenty elementary school children and the heroic teachers and their principal who had sought to protect them, belonged in an institutional setting. The same can be said for homicidal schizophrenic Jared Loughner who shot Congresswoman Gabby Giffords, James Holmes, the Colorado shooter, has a gag order on his murder trial but his defense lawyers have already disclosed that their client is mentally ill in blocking access to his diaries under physician-client privilege. Seung-Hui Cho, who committed the Virginia Tech massacre, had previously stalked women, made suicidal threats and been ruled “an imminent danger to himself and others” was set free and unwell to be treated on “an outpatient basis” that never happened.

Predictably, a debate about gun control has erupted in the aftermath of senseless deaths. However, other countries are as heavily armed as the United States (in a few cases, more so). These countries also have severely mentally ill people, yet they don’t have the mass shootings that have become a dark cultural phenomenon we see here in America.  Or when on the rare occasions they do, the shooter is likely not to be insane, but a professional terrorist.

There have also been calls for improved school security ( the Obama administration and Congress cut school security grant funds in 2010 and 2011), stationing policemen in schools and even arming teachers, citing the example of Israeli schools and the Pearl High School shooter who was stopped by an assistant principal with a .45.  While more security is a reasonable precaution and a good idea, short of turning our schools into windowless, prison-like, fortresses and giving the staff AK-47′s,  anybody utterly willing to die in order to kill someone else stands a pretty good chance of success. If all guns vanished tomorrow, the crazies will use car bombs and IEDs instead; mass shootings are a “motivated crazy person” (or terrorist) problem – criminals with economic motives do not carry out these kinds of attacks.

There is no perfect answer here, but here are a few suggestions:

• We need to revise our attitude toward mental illness with greater public education and access to mental health treatment, especially emergency treatment. Most mentally ill people are NOT dangerous but the warning signs of psychotic breakdown should become as widely recognized as the dangers of cigarette smoking.
• For the very few people who are mentally ill and violent, we need to have public heath authorities accept that some degree of active supervision is required to ensure they receive treatment and take their medication if they are to live independently, and if they refuse, to institutionalize them temporarily until they do so. The key variable here is *violence* not just mental illness and strong due process safeguards must be in place to protect the individual and ensure they receive appropriate treatment with dignity.
• Schools need much better training and planning for “active shooter” situations. At present, most schools have safety plans that emphasize locking students in enclosed rooms from which there seldom are any escape routes and the staff passively waiting for instructions from higher school authorities or police. While these plans may be good for unarmed intruders of unknown intent, they are dangerously counterproductive for heavily armed active shooters. Schools generally lack  enough secure rooms with doors that can delay such intruders for more than a few seconds and the standard emergency plan emphasis on “sitting tight” discourages the staff from engaging in reasonable risks to quickly evacuate students when the intruder is elsewhere in the building, or if possible, tactics to evade or if need be, resist, the shooter.