Since the mass shooting in Uvalde, TX, rapidly after that in Buffalo, NY, I have read and heard several simplistic public media pieces suggesting easy means of preventing these acts. They unanimously indicated that mass shooters (MS), especially those who are younger, can be detected before their fatal actions by their statements or writings online or on paper. If these raise concerns, they can be reported to authorities, and this will result in the individual receiving therapy and medication that will alleviate his (92 percent of MS are males) maladaptive thoughts and possible behaviors.

Of course, potential MS do not often leave their paper writings in the open for parents or teachers to see, and those online may be in hidden files that only trusted peers may enter. Even in therapy, they often do not reveal their intent to their therapist. Potential MS often discontinue outpatient therapy a month or more before their fatal action. I would be more concerned about violence committed against family or neighborhood pets, the books they read, the music they play, new peers, changes in appearance (e.g., haircut, tattoos), and the items they collect.

I do not know if these articles are written to assuage public fear by giving them something to do or in the honest belief that a public version of “I Spy” will decrease violent occurrences. However,  regardless of the underlying intent, I find several difficulties in this approach, which may well render it unworkable.

Initially, many individuals will see far too many potential MS and flood the police with phone calls. This over-reaction might be in accord with outlier formulations of utilitarianism as it protects the many at the expense of the few, but it would also echo fascism of the 1930s and communism under Stalin where children were encouraged to spy on their parents and adults on their neighbors.

Brain development, perhaps especially of the amygdalae, is immature in children and does not fully develop until young adulthood; utterances made in anger to peers, family, school, and the public are most often simply that and do not indicate real threats. The same could be said for pretending to shoot someone. Should each require a call to law enforcement and a mental health evaluation?

In discussing the current crisis of mass shootings, some senators have downplayed the role that easy access to assault rifles might play in these murders but place full blame on mental illness and offer an expansion of mental health services as the solution to MS. Undoubtedly, we need expansion of these services, but they are not the panacea these politicians think they will be.

First, we would need to develop the process and infrastructure through which suspected mass murderers, regardless of age, would be assessed in a manner that is ethical and protective of their individual rights. Secondly, we would need to establish similar processes and structures for those who are determined to be potential future threats that would protect society, for an indeterminate sentence, once again regardless of age, but still in a manner that is ethical and protective of their rights. We would have to be this extreme, as treating them as outpatients would not control their behaviors or medication adherence. At the least, this would necessitate modifying several laws, redefining personal rights, and incarcerating people, possibly for life, without the benefit of trial, based on a possibility of some future action. In essence, we would have to become, at least in part, a police state.

Another set of problems would entail a redefinition of mental illness that would be broader than currently used by the American Psychiatric Association (APA). Can we assume that every MS is mentally ill, as do these senators? Current estimates are that only 18 to 25 percent of these individuals are severely mentally ill; depending on the researcher, this is either an overestimate or an underestimate. The mental illnesses commonly associated with these shooters are major unipolar depression, bipolar mania, schizophrenia, some personality disorders, or psychotic disorder. But, what about the ± 79 percent of MS who are not mentally ill under current guidelines?

What about those who are misdiagnosed as a potential threat and mistakenly separated from society, are they the price of vigilance? Or will they be reevaluated at some point and released if found to be sane? Would this apply to all those who are kept confined? Too, what about those underdiagnosed as was the Buffalo shooter, who purportedly only received a 15-minute evaluation (a ridiculously brief amount of time), at age 16, who admittedly lied to the evaluator, and who was determined not to be a threat. And, to the evaluator’s credit, at 16, he may have been joking and not have been a credible threat.

In sum, despite the beliefs of some senators that only addressing mental health will solve the issue of mass shootings, the too-easy availability of assault rifles must be addressed. Too, though they are dramatic, we need to put these murders in perspective. More people are murdered in mass killings not involving a firearm, and a far greater number of people are killed annually by handguns in one’s and two’s than by either form of mass murder. Perhaps, non-legal handgun availability must be curbed as well.

M. Bennet Broner is a medical ethicist.

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