There's no way to legislate evil out of existence and mentally ill homicidal people are sometimes going to commit gruesome crimes. It has no cultural boundaries. The same day a mentally ill American attacked children in Connecticut a man in China did the same thing. While some are busy politicizing the issue to advance their agendas, society needs to take a renewed look at warning signs.

Banning things doesn't help, since violent crime in the UK is highest in the developed world but guns are illegal. And while an 'assault weapons' ban existed in the USA, the Columbine shootings still happened in Colorado. Connecticut has strict gun control laws and the guns in the Newtown, CT murder spree were owned by the murderer's single mother, who bought them for home defense, but the recent attack has renewed the volumes of opinion about what can be done to prevent the next tragedy. 

Can anything realistically be done to prevent these horrific crimes? An article in Current Psychiatry Reports reviews prior papers on the topic, focusing primarily on "targeted" and "rampage," or "spree," shootings. Targeted shootings are those where there is a specific target, individual group or institution, and rampage or spree shootings are those that involve multiple victims, either known or unknown to the assailant.

Unfortunately, while there are some characteristics shared by past shooters, such as narcissism, depression, low self-esteem and a fascination with violence, the authors conclude there are not enough similarities to create a profile of a potential mass murderer. 

But they argue that threat assessment may work, focusing on traits as: suicide risk, homicide risk, thought processes, reality testing, mood and behavior as well as relevant social and developmental histories. Any obsession with firearms or violence and the presence of writings or drawings with violent themes seems obvious but we've gone through a period in the last few decades where being mentally ill is regarded as the same as having a cold. Where the mentally ill used to be stereotyped and demonized, society may have gone too far to the other side and now be ignoring obvious problems. After a psychology grad student killed people in a theater in Colorado during a "Batman" movie, it was revealed that people in the department were concerned about him.  A local gun club turned him down for membership because he was too strange to be on their shooting range.

Mental health workers and adults - including parents of children - must be socialized to take threats of interpersonal violence seriously, just as recent efforts have been made to treat all threats of suicide as calls to action.

"School shootings are not all the same and may require different approaches to prevention and treatment, especially with respect to identifying risk factors at the individual, school or community levels, and particularly with regard to examining the role that mental health issues may play to increase risk for perpetration," the authors conclude. "Community mental health providers and professionals, particularly psychiatrists, are essential partners and must continue to seek avenues for working with schools to conduct thorough threat assessments, to identify young persons with significant mental health needs and to develop protocols for identification, prevention, and treatment that will effectively support the social and emotional needs of our most vulnerable youth and communities."