Serious Mental Illness Not a Factor in Most Mass School Shootings

Megan Brooks

May 24, 2023

Mass shootings, often on school campuses, have become a regular and sad reality in the United States.

The statistics are grim. Every day 12 children die from gun violence in America and another 32 are shot and injured. Since the Columbine High School shooting in 1999, more than 338,000 students in the US have experienced school gun violence, according to the nonprofit organization Sandy Hook Promise.

A new analysis from the Columbia Mass Murder Database (CMMD) sheds fresh light on the debate over whether mental illness or easy access to guns is the key driver of mass shootings.

The findings, which are published in the Journal of Forensic Sciences, show that most perpetrators of mass school shootings are young, White men without serious mental illness.

A 'Straw Man'

Mental health is often used as a "straw man" in debates about mass shootings, lead investigator Ragy Girgis, MD, told Medscape Medical News.

"There are many factors that contribute to the mass shooting epidemic, including gun access, criminality, substance use and misuse, and many others. Mental illness is incidental in the vast majority of cases," said Girgis, with Columbia University Irving Medical Center, New York City, and the New York State Psychiatric Institute (NYSPI).

"People with serious mental illness constitute only a small portion of the perpetrators of gun violence in this country," co-investigator Paul Appelbaum, MD, professor of psychiatry, medicine, and law at Columbia University in New York City, told Medscape Medical News.

Using the CMMD, the researchers examined 82 incidents of mass murder perpetrated in academic settings including schools, colleges, and universities. The average number of victims of these incidents was eight. More than half (60%) of mass school shootings involved at least one semi- or fully automatic firearm.

All 82 incidents were initiated by men (mean age 28), and 67% were Caucasian. About two thirds (63%) involved guns.

More than three-quarters (77%) of all perpetrators of mass murders in academic settings had no recorded history of psychotic symptoms.

Despite the absence of serious mental illness, almost half (46%) of the mass school shooters took their own lives at the scene, suggesting that they viewed themselves as engaging in some form of "final act," the researchers note.

"The major difference between mass shooters in school settings and elsewhere is the higher rate of suicide by the perpetrators in school settings. That suggests that the shootings are often part of a preexisting intent to die on the part of the shooter," said Appelbaum.

Epidemic of Emptiness

He noted that the typical profile of a mass school shooter is that of "a young male with anger problems, often as a result of bullying or abuse, frequently described as a loner, who has signalled a desire to kill other people."

"If we only focus on mental illness, we will miss the warning signs in the majority of cases associated with victimization (such as bullying) and consequent anger," Appelbaum said.

Girgis said there is a need to deal with the "epidemic of emptiness, narcissism, anger, and societal rejection felt by many young men/boys who, when combined with a desire to take their own lives and a great need for notoriety, feel that perpetrating a mass school shooting is their only option."

"We also need to understand why it is so easy for so many mass school shooters to obtain firearms that are not theirs — either illegally or from someone else who themselves may have obtained the firearm legally," Girgis said.

"All countries have people with mental illness," Appelbaum said, "but among developed countries the US is unique in the easy availability of weapons and in our disproportionate rate of murders."

He also noted that school shootings are not a problem that clinicians are going to solve.

"Although they can be alert to signals from their patients of an intent to harm people in a school (or other) setting, the vast majority of shooters are not receiving treatment for a mental disorder," Appelbaum said.

"This is a problem that can only be substantially diminished by reducing access to firearms, which includes requirements for safe storage, universal background checks, waiting periods to purchase firearms, and similar means-oriented interventions," he added.

Need for Regular Mental Health Checks

Thea Gallagher, PsyD, who was not involved in the study, noted that mass school shooters may not have a psychotic illness, but with mental health there is a "spectrum, and obviously, that individual is struggling to some extent, most likely, mentally, if they are at a place where they are willing to take the lives of others and themselves."

"We need to understand more about how people get to this place and the issues people are struggling with. We need to push for yearly mental health checks just like the yearly physical," Gallagher, with the Department of Psychiatry at NYU Grossman School of Medicine in New York City, told Medscape Medical News.

"The more that we create conversation and moments to talk about how people are feeling internally, the better chance we have to give people who are struggling healthy coping strategies and the opportunity to process their emotions and not bury them," Gallagher said.

Support for the study was provided in part by the New York State Office of Mental Hygiene, and the Elizabeth K. Dollard Charitable Trust. Girgis has received royalties and/or advances from books on mental health published by Wipf and Stock and Routledge/Taylor and Francis. He has consulted for Noble Insights, IMS Expert Services, and Fowler White Burnett. Appelbaum and Gallagher report no relevant financial relationships.

J Forensic Sci. Published online October 27, 2023. Full text.

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