Updated July 2022

 This update is taking place a few days after 7 people were killed and 40 injured in a mass shooting in Highland Park, IL at a 4^th of July parade.  In the previous two months, two other high profile mass shootings took place in a Buffalo, NY grocery store and an elementary school in Uvalde, TX.  The current rate of mass shootings in the United States, generally defined as affecting 4 or more victims, is 11 per week.  Add to this the thousands of suicide deaths and injuries, homicides, and accidents inflicted by guns and we are on track to meet or exceed the record 45,000 gun deaths that occurred in 2021. 

 The pandemic has seen record gun sales.  It is estimated that there are 120.5 guns in circulation for every 100 American citizens.  Military style semi automatic rifles have increased in popularity as the weapon of choice for mass shooters because their ready availability, the availability of high capacity magazines, rapid firing capability, and degree of tissue damage generated by the higher velocity ammunition.  There is no reason to expect that this pattern will change in the near future.  In fact, gun violence is expected to increase, because of the ubiquity of firearms and generally escalating social unrest.

 This is a major Public Health issue.  However, political solutions have not been forthcoming.  In the wake of the Uvalde shootings, Congress enacted minor enhancements to background checks for gun purchases, support for state-enacted “Red Flag Laws” that enable law enforcement to temporarily confiscate guns from individuals deemed at risk of enacting gun violence, and increased financing for “mental health” and “school hardening.” The Red Flag exemption for domestic violence perpetrators who were not legally married was rescinded.  In the same week, the US Supreme Court issued an opinion vacating a 100 year old law prohibiting concealed carrying of firearms in public without an individual demonstrating a compelling reason for being armed in public. 

 From a Public Health perspective, the United States is primarily taking a tertiary prevention approach to gun violence which is to treat the results of gun violence by trying to save lives or reduce disability in victims of gun violence.  The Red Flag Laws and increased background checks are examples of Secondary Prevention that aims to reduce the incidence of gun violence episodes.  Primary prevention, which would be the reduction in the number of guns in circulation is currently not an option. 

 In April 2018, following mass shootings at a Pittsburgh Synagogue and a Louisville school and grocery store, the NCPA Board of directors voted to establish a Taskforce to develop a position statement on prevention and coping with gun violence in North Carolina and nationally.  The charge to the Taskforce was to develop a statement and support materials that are research-based where possible and practical.  The Taskforce was chaired by Dr. Chuck Burnett, NCPFs Public Education Coordinator.  Taskforce members were Drs. Bill Barley, Nicole Jones, Nancy Laney, Matthew McNally, Susan Ornstein, Adeirdre Stribling Riley, and Ms Roxanne Pearson. The members of the Taskforce brought a wealth of experience from work in corrections, juvenile justice, mental health policy, research, and practice to our efforts to better understand the extent, causes, and effects of gun violence and distill possible action and advocacy options for Psychologists. 

 Literature reviews, analyses, and policy considerations were developed to address the extent of gun violence in the United States, active shooter characteristics and threat assessment, and potential advocacy activities for members of the North Carolina Psychological Association.  Fundamental to this report is the resolute rejection of the discrimination, bigotry, and hate embodied by active shooter gun violence.  The findings from available literature on the antecedents and consequences of gun violence have not changed appreciably since 2018, but the prevalence of guns and gun violence have increased dramatically since this report was drafted. 

Firearms, Active Shooters, Mass Shootings, and Mass School Shootings

 Background information about firearms

• There’s a massive amount of information out there about guns and gun violence, easily accessed via the Internet.  The following is a summary of data by an interested non-specialist from prominent primary and secondary sources, especially regarding mass shootings and mass school shootings. 

• Definitions of and understandings about firearms differ meaningfully among members of the media and the public.

• The term “assault weapons” is used confusingly. It sometimes refers only to semiautomatic firearms, including certain rifles, shotguns, and handguns, that shoot one but only one round per pull of the trigger.  Sometimes it refers to both semiautomatic and automatic (usually military or police weapons; see below) firearms, and there is contentious political debate about its definition and usefulness.

• Assault weapons that are rifles have a detachable magazine and a pistol grip.  They sometimes have a forward vertical grip, flash suppressor, large magazine capacity (e.g., more than 10 rounds), barrel shroud, and ability to accept a barrel extender.  The AR-15 (“AR” stands for “Armalite,” its original manufacturer, not “assault rifle” or “automatic rifle”) is such a semiautomatic firearm.  Images of these weapons and ammunition magazines an easily be found on the Internet. 

• A federal “assault weapons” ban was in effect from 2004 to 2014, and a bill to resume that ban by federal legislation was introduced in Congress in 2015. It is not yet law.  It would have banned particular firearms and ammunition-magazine sizes.  Some states and localities already did and still ban some “assault weapons,” some by name, including AR-15s.

• “Assault rifles” are not simply assault weapons that are rifles.  They are military or police rifles that are able to fire selectively, including fully automatically (in that mode, shooting multiple rounds per pull of the trigger, in which case they are essentially machine guns.  They have a much higher rate of fire than semiautomatic weapons. 

• It has long been illegal under federal and some state laws for private citizens to own weapons that are capable of being fired fully automatically, manufactured after May 19, 1986, or to manufacture replacement parts for pre-1986 fully automatic weapons.

• Americans own more than 300 million (393 million as of June 2022) guns of all kinds.  Ownership of multiple firearms is common (the average number of guns owned is 5).  A minority of gun owners own most of them.

• The United States has the highest rate of civilian gun ownership in the world.  Approximately one third of adults own at least one gun. Hunting and target shooting, and imagining, making, and maintaining firearms are part of the lives of millions of Americans.

• There were over 45,000 people killed by guns and over 40,000 people were injured by guns in 2021 . About 1.5% of annual deaths in the U.S. were by guns of all types.  About 54% of those gun-related deaths were suicides; about 42% of them were murders; a little over 4% of them were accidents.  Guns of all types are used in about 70% of murders, 50% of suicides, 40% of robberies, and 20% of aggravated assaults. 

Background information about mass shootings (including mass school shootings)

• The stem for the varying definitions of what are here generically called “mass shootings” is shooting of multiple people in a single incident and location, in a public place (including schools and colleges or universities), usually but not always by a single shooter.  Shootings related to other crimes and military shootings are excluded.

• Different specific definitions of mass shootings and databases about them are used by different analysts, sometimes resulting in meaningful differences of interpretation of data.

• One definition, three or more murders, governs when the U.S.  Attorney General can assist state and local authorities in investigations of violent acts in public places. 

• Less than 1% of the approximately 45,000 people killed annually in the U.S. by guns of all types die in mass shootings, in schools or elsewhere.  Mass school-shooting incidents are very uncommon and cause a minority of all mass-shooting deaths. 

• Shootings in general have occurred more frequently over the last few decades, and analyses using some databases show that ascending trend for frequency and deadliness of mass, including school, shootings, though “it depends on how you count,” in the words of one analyst.

• The FBI’s tracking of “active shooter incidents” in the U.S. (one or more shooters killing or trying to kill one or more people, with the potential for citizens’ behavior or that of the police to affect the outcome) for 2018 counted 27 of them in 16 states, 10 of them mass killings. In 2021, there were 67 active shooter incidents in 30 states, 12 of them mass killings.  This represented a 52% increase from 2020 which was a 33% increase from 2019.

• FBI data for 2016 and 2017 showed 20 and 30 such active shooter incidents, respectively, in 21 states, and for 2014 and 2015 a total of 40 in 26 states.  Of the 50 incidents in 2016 and 2017, 20 were “mass killings” (three or more murders in a public place), the same as in 2014 and 2015.  See also Mass Shooting Tracker, another database, with a different definition of mass shootings.

• Another database, Gun Violence Archive, detailed 15 mass shootings (four or more victims injured or killed) in North Carolina in 2018 and 2019 (as of September 5, 2019), at a nursing home, a high-school graduation party, homes, a gas station, bars, possibly on the street, and at the University of North Carolina--Charlotte.

• Handguns have been used far more often than long guns (rifles or shotguns) in shootings in the U.S., including in mass shootings.  For example, the FBI found that handguns were used in 65% of all murders in the U.S. in 2016, many times the frequency of murders known to the FBI to be with rifles and about twice the total of murders with rifles and unspecified firearms (some of which might have been rifles). 

• Particularly regarding firearms used in mass shootings, a non-FBI analysis of FBI data for a 34-year period ending in 2013 indicated that handguns were used in about half and semiautomatic weapons in about a quarter of them.  Other research about homicides between 2007 and 2017 concurred regarding the two-to-one ratio of mass shooting deaths by other firearms vs. assault weapons.

• Whether the U.S. is a particularly dangerous place regarding mass shootings is a matter of contention, though some analyses conclude that it compares badly among many high-income nations.

• There is evidence of a contagion effect of mass shootings, defined as their clustering together in time, and of the role of publicity in inspiring copycats.

Background information about “active shooters,” including mass shooters 

• Mass (and other) shooters at schools and elsewhere are preponderantly white males.  Their average age is in the 30s, and they range from teenagers to the 80s, though school shooters are almost all adolescents.  However, they can’t be identified on the basis of demographics alone.

• Most shooters, mass and otherwise, were not diagnosed as mentally ill, and very few mentally ill people are physically dangerous, except for some who are truly psychopathic or acutely psychotic (especially around the time of psychiatric hospitalization or of a first psychotic episode).  Truly psychopathic children are very rare.  However, at least some adolescent school mass shooters are described by authorities as actually psychopathic or psychotic.  Their behavior as children is often so off putting and scary that they’re shunned.  Mass shooters diagnosed as psychotic are very rare.  They’re feared as potentially dangerous, and their violence is usually not a surprise. Mass shooters diagnosed with a psychotic illness are very rare.

• Many other school mass shooters have been described as “sane but dangerous.” Most come from stable, two-parent, middle-class backgrounds and have no arrest records, aren’t gang members, aren’t habitually violent, and have no history of mental illness.  Some of them are bullied and aren’t originally aggressors.  It is the very rare shooter of any kind who doesn’t have some social relationship with another person. 

• The predictive value of suspicions about them as mass shooters is limited by the base rate of foolish, frightening behaviors among adolescent boys, including alcohol and drug abuse (which are strong predictors of violence in general).  The extreme exceptions aside, because of the ubiquity of mass shooters’ characteristics their profile isn’t thought to be useful.

• Motives that have been suggested include revenge, escape from pain and hopelessness, and motives inherent in psychopathy and acute psychosis.  Religion or politics is thought to a much less frequent motive of mass shooters.  On average, shooters of all kinds experienced multiple stressors in the year before the shootings.  Their most common grievances were about adverse interpersonal or employment actions against them.  In one view, many school mass shooters were in terrible adolescent crises, unable to handle them, and depressed and immature, and they saw no way out. 

• Shooters of all kinds planned their attacks, for up to two years, though they prepared for them much closer to the time of the attack, usually within a month of it.  They usually had a specific person or persons in mind.  Most had a personal connection to the sites they attacked.  Generalization of a grievance to an institution or to the community is thought to represent increased threat of violence.

• Shooters of all kinds, especially adolescents, very often “leak.” For example, the Parkland school shooter gave many warnings.  Shooters have talked to family members, friends, and coworkers, written about, or made videos about their intent, plans and preparations.   Some have revealed that they were in profoundly troubled, distressed states.

• Suicidality (serious suicidal ideation or behavior) is common among all shooters and is thought by some to be typical of school shooters.  Some of them live without much regard for their wellbeing day to day, and some vacillate between wanting to kill themselves and wanting to kill others.               

Background information about prevention of mass shootings in particular                     

• Correct diagnosis and treatment, including psychotropic medication, of mental illness such as bipolar disorder and acute psychosis, are important, though psychotic illness has been infrequent among shooters. 

• Among active shooters between 2003 and 2013, the FBI identified observable “concerning behaviors,” an average of four to five of which were shown by shooters, including mass shooters, up to two years in advance. 

• The most frequently observed were related to mental health (behaviors potentially indicative of psychiatric disorder), problematic social interactions, leakage of violent intent, and remarkable features of thinking or communication.  Among adolescent shooters, concerning behaviors related to school performance, anger and aggression, impulsivity, firearms, violent media usage, and substance abuse were known to have been present only about 20% of the time.

• The most common responses to such behaviors were to communicate directly with the potential shooter or to do nothing.  Fewer than half of such behaviors were reported to law enforcement.

• At the level of public policy, the most common suggestion for decreasing the incidence of shootings in general is greater regulation of firearms.  Most shooters got their guns legally or already owned them.  Strong correlational data exist regarding the direct relationship of rates of gun ownership and gun-related deaths in countries and in American states.  Reduced access to semiautomatic weapons is correlated in these data with fewer fatalities if not number of incidents. 

• Other suggested restrictions have included banning sales and manufacture of semiautomatic weapons; obtaining “background” information about more or all buyers and sellers in firearm sales and purchases; forbidding teenagers access to guns;  prohibiting purchases or ownership by people who present evidence-based, criminal-history risk factors for violence; permanently disqualifying some people who have been involuntarily committed to treatment because of mental illness; and setting a high bar for restoration of lost gun rights, among others.

• Regarding gun-control policy, a 2018 RAND review of thousands of studies of outcomes of government gun policies concluded that there is “little persuasive evidence” of effectiveness of most policies regarding most gun-use outcomes.

• Regarding effects on mass shootings, evidence was said to be inconclusive” regarding usefulness of background checks, bans on sale of assault weapons and large magazines, child-access prevention laws, ”concealed-carry”  laws, licensing and permitting requirements, minimum-age requirements, and waiting periods.  No acceptable studies were found regarding effects on mass shootings of gun-sales reporting requirements, gun-free zones, lost- or stolen-gun reporting requirements, prohibitions associated with mental illness, “stand-your-ground” laws, and surrender of guns by prohibited possessors.  (Various of the policies studied did have the preponderance of at least limited evidence supporting their effects on some gun-use outcomes, but not mass shootings.)

• Firearms (and large-capacity magazines for semiautomatic firearms) can be obtained or manufactured, with some effort, legally or illegally, and there are more than 300 million guns and the technology to manufacture guns and high-capacity magazines in private hands already.

• As of August 12, 2019, 17 states and the District of Columbia have “red flag” laws, which permit confiscation and ban the sale of guns to people who meet a state’s criteria as at risk of violent behavior in the near future, after a court proceeding and issuance of a “gun-violence restraining order” or “extreme-risk protection order.”  The number of such state laws has increased especially following the Parkland, Florida school shooting in 2018.  They have been proposed in another six state legislatures, including North Carolina’s.  Family members, household members, teachers, health professionals, law-enforcement officers, and/or states’ attorneys may petition for application of these laws, with variation from state to state.

• If there is clear evidence of a threat of great bodily harm or death by one person to another, the police can arrest, and evaluation for mental illness and involuntary commitment can be ordered by a judge.

• Many gun-control laws at various levels of government are probably already not enforced, and mass shootings have occurred in the most restrictive gun-control jurisdictions in the U.S.

• The first line of defense against shootings by adolescents, parents can emotionally deny or ignore their sons’ dangerousness. If parents act, child protective services may not be helpful; parents may fear loss of custody and accusations of child abuse.  In North Carolina, parents have the right to seek hospitalization of their minor children on their own, without working through the legal system.  Even so, arrangement of involuntary psychiatric hospitalization can be time consuming, expensive, complicated, and otherwise difficult to arrange, if beds are available at all. 

• Parents might have to press criminal charges against their own child. The duration of detention is limited.  The minimum age is usually 15.  Parents can petition to commit a younger child, but that usually lasts no more than three days.

• Schools are another line of defense.  There’s skepticism in general about the usefulness of security measures at schools, seen as locking the door after the shooter is inside.  There are suggestions about making schools “harder targets,” including stationing more police on school campuses (increased by a factor of four in 10 years after the Columbine, Colorado high-school shootings in 1999), training and arming school personal, and installing metal detectors at entrances and exits.  Others are about “access control”: screening students and visitors and their book bags and handbags, requiring them to sign in, using transparent bags, limiting the number of entrances and exits, locking doors, requiring ID badges, etc.

• Metal detectors have some empirical evidence of their ability to detect and deter, but some access-control measures haven’t been studied much if at all.  Some have been circumvented or overpowered.  Many, perhaps most school shooters have been students or others who had access to the school grounds. Two of the deadliest school shootings occurred at Columbine and at Virginia Tech in Blacksburg in 2007, with armed officers on campus.  How many school shootings have been deterred by security measures is understandably unclear.

• Some school districts have relevant programs and response protocols in place.  Adolescent bluster is triaged and distinguished from real danger with regard to access, planning, and specificity.  In North Carolina, a parent, the school, a mental-health professional, or others may petition for involuntary psychiatric hospitalization for the student, on grounds of dysfunction related to mental illness or substance use, or of dangerousness to self or others.

• The school can look at a student’s court records, search for weapons at school, and keep tabs on his behavior and behavioral changes at school.  The school and parents can talk to each other; different concerning behaviors and signs of dangerousness may occur in different settings and be observed by different people. The big picture may not be available to everyone.

• “Threat assessment” is a developing intervention, the systematization of procedures for identification of students or others who’ve threatened violence, assessment of the reality and urgency of the threat, and responses on a continuum from counseling to arrest.  Schools have mental-health services to offer.  They can sometimes divert a student to alternative schools.

• The effectiveness of tools available to schools can deteriorate over time.  Sense of urgency, funding, and availability of crucial institutional knowledge aren’t permanent.

Suggestions for Action

• Efforts to reduce gun violence have been going on for decades, and there’s a lot of pessimism about prevention, a sense that gun violence, including mass shootings, will not stop: There are too many “broken,” desperate, alienated people out there who are influenced to see mass murder as a way out.  It’s said that guns are easily obtainable and handguns, at least, readily concealable.  It’s seen as impossible to stop every dangerous adolescent or adult.

• However, consider these ideas related to the previous information:

• Implement laws, rules, and procedures. 
• Maintain their edge as time passes.
• Become familiar with terminology about mass shootings and firearms so you can understand the data and the claims being made.
• Maintain the difficult perspective about mass shootings and mass school shootings:  They’re unimaginably horrible, and they’re rare. 
• Learn to assess risk of violence empirically.
• Take seriously the leaking and other validated behavioral, verbal, and diagnostic signs, current and historical, of potential for violence.  Bring them to the attention of those who can act, and encourage them to investigate.  Help them talk to each other.
• Assist and support family members to respond to their relatives’ warnings of violence. 
• Learn involuntary psychiatric-hospitalization procedures.
• Consider advocating that shooters’ identities not be publicized.
• Follow developments in technology and procedures for reducing gun violence, and find out what’s being done in public places, for example, local schools.

References and Resources

 ALERRT Center at Texas State University and Federal Bureau of Investigation. (2018). Active shooter incidents in the United States in 2016 and 2017.              Washington, D.C.: U.S. Department of Justice.

ALERRT Center at Texas State University and Federal Bureau of Investigation.  (2019). Active shooter incidents in the United States in 2018.                              Washington, D.C.: U.S. Department of Justice.

American Psychological Association. (2013, Jan.). Gun violence: Prediction, prevention, and policy.  APA Panel of Experts Report. Washington, D.C.,                  Author.

 American Psychological Association.  (2014). Resolution on firearms violence research and prevention. Washington, D.C., Author.

 Aneja, A., Donohue, J.J. III, & Zhang, A. (2014, Sept.).  The impact of right to carry laws and the NRC Report: The latest lessons for the                                     empirical  evaluation of law and policy. Stanford Law & Economics Olin

Working Paper No. 461. Bedard, P. (2014. Jan. 14).  Crime study: Handguns, not “assault rifles,” used in most mass shootings.  Washington Examiner.

Bonner, L.  (2019, March 26.)  More states are passing ‘red flag’ laws for guns. A bill would have North Carolina join them.  Raleigh News & Observer.

 Campbell, S. & Yablon, A., Red Flag laws: Where the bills stand in each state.  (2018, Sept. 11).  the trace.org.

 Campbell, S. & Yablon, A.  (2019, Feb. 28).  Red flag laws: Where the bills stand in each state. The Trace.

 Casselman, B., Conlen, M., & Fischer, R. (2016, Nov. 22). Gun deaths in America. Five Thirty Eight online.

 C.D.C. & P., National vital Statistics Reports, 66(6), 1-75.

 Cohen, A.P., Azrael, D., & Miller, M. (2014, Oct. 15). Rate of mass shootings has tripled since 2011, Harvard research shows.  Mother Jones.

 Davis, S. (2017, Oct. 2). Here are the actual federal laws regulating machine guns in the U.S. The Federalist.

 DuJardin, P. (2018, March 21). Assault rifles vs. handguns: which are the bigger problem?  Daily Press.

 Federal Bureau of Investigation. (2013, Sept. 16). A study of active shooters in the United States Between 2000 and 2013.  Washington, D.C.:                           Washington Navy Yard.

 Federal Bureau of Investigation. (2016). Active shooter Incidents in the United States in 2014 and 2015.  Washington D.C.: U.S. Department of Justice.

https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2021-052422.pdf/view

Flesher, D. & O’Matz, M. (2018, Nov. 7). Who made key mistakes in Parkland school shooting? Nine months later, no one held accountable.  South                   Florida Sun Sentinel.

 Foundation for Economic Education. (2019, August 17).  Studies find no evidence that assault weapons bans reduce homicide rates. 

            fee.org/articles/studies-find-no evidence that….

 Fox, J.A. & Fridel, E.E. (2018). The menace of school shootings in America Panic and overresponse. In H. Shapiro (Ed.), The Wiley handbook on                     violence in education: Forms, factors, and preventions, 15-36.  Hoboken, N.J.: Wiley.

 French, D. (2018, Feb. 16). A gun-control measure conservatives should consider. National Review.

 French, D. (2018, Nov. 8). We don’t know how to sop mass shootings.National Review.

 Greenberg, J., Jacobson, L., & Valverde M. (2018, Feb. 14). What we know about mass shootings.  Politifact.

 Gregoire, C. (2015, Jan. 3). Here’s what we know about the contagion effect of mass shootings. HuffPost Science.gunviolencearchive.org.

 Hagerty, B.B. (208, May 21). The futility of trying to prevent more school shootings in America.  The Atlantic.

 Hemenway, D. & Miller, M. (2000).  Firearm availability and homicide rates across 26 high income countries. J. Trauma, 49, 985-988.

 Hepburn, L. & Hemenway, D. (2004). Aggression & Violent Behavior: A Review J., 9, 417-440.

 Katsiyannis, A., Whitford, D.K., & Ennis, R.P. (2018). Historical examination of United States intentional mass school shootings in the 20th and 21^st                   centuries. J. Child & Family Studies, 10(8), 2562-2573.

 Kelly, G. (2015, Oct. 1). Donald Trump is right: Mass shootings have become more frequent. The New Republic online newsletter.

 Kelly, G. (2015, Oct. 3).  Here’s why no one can agree on the number of mass shootings.  The New Republic online newsletter.

 Kerwin, M.E., Kirby, K.C., Speziali, D., et al. (2015). What can parents do?

 A review of state laws regarding decision making for adolescent drug abuse  and mental health treatment.  J. Child & Adolescent Substance Abuse,                24(3), 166-176.

 Kiely, E., Gore, D., Robertson, L., et al. (2018, March 5). The gun debate: Facts on background checks, concealed-carry laws, U.S. gun homicide

            rate, stolen guns. FactCheck.org.

 Koerth-Baker, M. (2018, Mar. 14). These researchers have been trying to stop school shootings for 2 years.  Five ThirtyEight online.

 Lankford, A. (2016). Public mass shootings and firearms: A cross-nation study of 171 countries.  Violence & Victims, 31(2), 187-199.

 Lott, J.R. (2018, Aug. 30). How a botched study fooled the world about the U.S. share of mass public shootings: U.S. rate is lower than global

            average.  https://ssrn.com/abstract=3238736.

 Lott, J.R.  (2018, Oct. 31). Few public mass killers have obvious political or religious reasons for doing their shootings, vehicle attacks, or bombings.                  Crime Prevention Research Center.

Lott, J.R. & Landes, W.M. (1999, Apr. 21).  Multiple victim public shootings, bombings, and right-to-carry concealed handgun laws: Contrasting                            private and public law enforcement.  Chicago: John M.

Olin Law and Economics Working Paper #73, 2^nd Series.      SchoolShooters.Info. massshootingtracker.org.

 Matthews, D. (2014, Oct. 21).  Are mass shootings really on the rise?  It depends on how you count.  Vox.

 Miller, M, Azrael, D., & Hemenway, D. (2002). Household firearm ownership Levels and homicide rates across U.S. regions and states,

            1988-1997. American J. Public Health, 92, 1988-1993.

 Murphy, S.L., Xu, J., Kochanek, K.D., et al.  (2017). Deaths: Final data for 2015.

National Reseach Council. (2004). Firearms and violence: A critical review.

 Washington D.C.: National Academies Press.

 Q & A: Sherry Towson on the contagion effect of mass shootings. (2015,Oct. 5). Arizona State University.

 RAND Corporation. (2018). Strength of evidence for relationships between gun policies and gun use outcomes.  Gun Policy Research Review.

 RAND Corporation. (2019). The effects of concealed-carry laws.  Guns in America.

Silver, J., Simons, A., & Craun, S. (2018, June).  A study of the pre-attack behaviors of active shooter in the United State between 2000 and
           2013. Washington, D.C.: U.S. Department of Justice, Federal Bureau of Investigation.

Statista, the Statistics Portal. (2019). Weapon types used in mass shootings in the United States Between 1982 and November 2018.  statista.com.

 Terzian, P. (2018, Nov. 2). Is there really nothing we can do about mass shootings? The Weekly Standard.

 Wikipedia.

Firearms and Suicide Fact Sheet

Background Information

• At least one third of households in the United States have firearms
• Approximately half of suicide deaths in the United States result from firearms
• More people in the United States die each year from firearm suicides than firearm homicides
• Access to firearms is not associated with developing suicidal thoughts, but is associated with death by suicide
• If someone becomes suicidal and has access to a firearm, the risk of death is increased o Higher risk if firearms are stored unlocked and loaded
• Firearms are a highly lethal method of attempted suicide

o   Estimates show 85-95% of individuals attempting suicide via firearm die, compared to 23% of those who attempt suicide via intentional overdose

What can clinicians do to reduce suicide by firearms?

• Routinely ask clients about firearms in the home in a non-judgmental manner and encourage safe storage practices
• Firearms should be stored unloaded, in a locked location (e.g., gun safe), separate from ammunition
  • Ideally firearms should be hidden from view (e.g., not in glass cabinets or wall racks) to discourage thieves or children
  • Ammunition should be stored in a separate, locked location, away from children and flammables
• Routinely screen clients for elevated suicide risk—thoughts or plans of suicide or a history of suicide attempts
• If thoughts, plans, or history are endorsed, conduct a thorough assessment of empirically supported suicide risk and protective factors and match the intervention to the level of risk
• Examples of suicide risk assessment resources:
• Scientizing and Routinizing the Assessment of Suicidality in Outpatient Practice (1999)
• Advances in the Assessment of Suicide Risk (2006)
• Managing Suicide Risk in Primary Care (2009)

• One possible intervention is means safety—taking action to make a method of suicide less deadly or less accessible during a suicide attempt.  The goal is to prevent individuals from dying when they do attempt suicide
• Means safety with regard to firearms can involve:

▪ Encouraging storage of firearms away from an individual at elevated risk of suicide during the period of elevated risk

• Storing firearms outside of the home or in locked locations inaccessible to the person at risk
• Routine safe storage of firearms when they are not in use—not just in times of crisis

References and Resources

• American Association of Suicidology
• Firearms and Suicide Policy Statement
  • North Carolina Hunter Education Online Study Guide
• “Storing Ammunition Safely.” North Carolina Hunter Ed Course, Kalkomey Enterprises, LLC, www.hunter-ed.com/northcarolina/studyGuide/ Storing-Ammunition/20102802_700170086/
• “Storing Your Firearm.” North Carolina Hunter Ed Course, Kalkomey Enterprises, LLC, www.hunterhttps://www.hunter-ed.com/northcarolina/studyGuide/Storing-Your-Firearm/20102802_700170085/ed.com/northcarolina/studyGuide/Storing-Your-Firearm/20102802_700170085/
  • Suicide Risk Assessment Articles
• Bryan, C. J., Corso, K. A., Neal-Walden, T. A., & Rudd, M. D. (2009). Managing suicide risk in primary care: Practice recommendations for behavioral health consultants. Professional Psychology: Research and Practice, 40(2), 148-155.
• Bryan, C. J., & Rudd, M. D. (2006). Advances in the assessment of suicide risk. Journal of Clinical Psychology,62(2), 185-200.
• Joiner Jr, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and routinizing the assessment of suicidality in outpatient practice. Professional psychology: Research and practice, 30(5), 447-453.

Threat Assessment: Preventing Targeted Violence 

Background information

• United States (U.S) government agencies (White House, U.S. Department of Justice/FBI, U.S. Department of Education, and U.S. Department of Homeland Security/Federal Emergency Management Agency) define an “active shooter” as “an individual actively engaged in killing or attempting to kill people in a confined and populated area” with firearms.¹
• Between 2000 and 2013, 160 active shooter incidents occurred with 1,043 casualties (486 killed; 557 wounded). In 158 incidents one person carried out the attack.  40% of shooters committed suicide. 96.25% were male.¹
• Outside of intimate partner relationships, direct threats to law enforcement or the target (i.e., person verbalizes an intent to do harm) are not effective predictors of violence.^2,3
• Most persons do not “snap” and commit violent attacks.  Instead, there are a number of key indicators and observable behaviors evidenced by the individual before the violence occurs.⁴ 
• Mental illness is rarely a “direct cause” of violent behavior.  Instead, mental health problems are “stressors” that may play a role in increasing risk. Co-occurring factors can increase or decrease this risk.⁵
• Threat assessment is an “idiographic, fact‐based, dynamic, and behavioral method of assessing low base rate violence risk toward an identified target” in order to prevent violent behaviors from occurring.⁶
• Threat assessment is utilized to interrupt a person who is on the pathway to engage in instrumental or targeted violence.  This differs from violence-risk assessments which attempt to determine if a person has the capacity (generally) to react to situations in a violent manner.⁷
• Threat Assessment uses a systemized and thorough approach to determine if a person is on the pathway towards violence using multiple sources of data (e.g., collateral and intelligence information; investigation and interviews with multiple key stakeholders; administration of objective instruments and tools, etc.).⁸
• Multidisciplinary threat assessment teams utilize structured professional judgement based on evidence-based guidelines to determine level of risk.⁸
• The primary goal of threat assessment is prevention.  After identification and assessment teams work to develop, implement and monitor a management plan to help reduce the chance of violence and minimize harm.⁹
• What can psychologists do to help prevent violence?
• Psychologists play a key role in helping develop evidence-based approaches in the identification, assessment and mitigation of persons at risk for engaging in violence. 
• Understand the risk factors associated with the pathway to violence.  Routinely screen your clients for the absence or presence of these risk factors.
• If your client demonstrates concerning behaviors, receive consultation from a forensic psychologist with experience in Violence Risk Assessments (VRA) regarding next best steps (if you are not already a forensically trained mental health professional).
• If you identify a person who may be on the pathway towards violence and needs a threat assessment conducted, you may contact your local law enforcement partners or the Behavioral Threat Assessment unit of the North Carolina State Bureau of Investigation ([email protected]). NCSBI is an assisting agency to your local law enforcement agencies.
• If the person you identify is a client, understand HIPAA and reporting laws in the jurisdiction you practice in.  Know when and to whom to report concerning behavior. 
• Help to reduce stigma.  Misinformation about the link between mental health disorders and violence persist.  When possible, educate the public on mental illness and its association with the risk of violence towards others.

References and Resources

¹United States Department of Justice Federal Bureau of Investigation (2013).  A study of active shooter incidents in the United States between 2000 and 2013.  Retrieved from: https://www.fbi.gov/file-repository/active-shooter-study-2000-2013-1.pdf/view

²Fein, R., & Vossekuil, B. (1999). Assassination in the United States: An operational study of recent assassins, attackers, and near‐lethal approachers. Journal of Forensic Sciences, 44, 321–333.

³James, D. V., Mullen, P., Meloy, J. R., Pathé, M., Farnham, F., Preston, L. & Darnley, B. (2007). The role of mental disorder in attacks on European politicians, 1990–2004. Acta Psychiatrica Scandinavica, 116, 334–344.

⁴Toole, M.E. & National Center for the Analysis of Violent Crime (U.S.). (2000). The school shooter: A threat assessment perspective. Quantico, VA: FBI Academy.

⁵United States Department of Justice Federal Bureau of Investigation (2017).  Making prevention a reality: Identifying, assessing, and managing the threat of targeted attacks.  Retrieved from: https://www.fbi.gov/file-repository/making-prevention-a-reality.pdf/view

⁶Meloy,J.R. & O’Toole, M.E. (2011).  The concept of leakage in threat assessment.  Behavioral Sciences and the Law, 29, 513-527. 

⁷Miller,A. (2018).  Threat Assessment in Action. Monitor on Psychology,45, 37.

Juvenile Threats of Mass Violence in North Carolina 

This following information is relevant only to the Division of Juvenile Justice, therefore juveniles who are older than 16 years old are excluded from this data.

In 2018, there has been a sharp uptick in juveniles being charged with Making a false report concerning mass violence on educational property.  In fact, District 5 (New Hanover and Pender Counties) has not seen any juveniles charged with this offense prior to 2018.  The North Carolina Legislature defines this offense as:

Upon being charged with this offense, many juveniles are taken to the detention center and their homes are searched in the interest of public safety.  Not all juveniles are placed in secure custody, as this decision is dependent upon the situation.  With 10 days, they are required to go before a judge for a felony first appearance, and within 15 days they have a probable cause hearing.  A felony notification letter is sent to their school pre-adjudication in order to notify the juvenile’s school that they have been charged with a felony (this happens for all felony charges). 

Not all juveniles are placed on probation.  This charge is not one that is felony non-divertible, meaning that the Court Counselor has the option of keeping the matter out of court by placing the child on a Diversion Contract.  Having the charge diverted is in the child’s best interest if it is a first offense and if there is no reason to believe that there was actual intent behind the threat. If a juvenile is adjudicated of a felony, they cannot play school sports and may not be able to participate in other activities like driver’s education. 

If the charge is approved for court, then the juvenile is not eligible to go to a Youth Development Center, or YDC, if it is their first offense.  They are adjudicated on the lowest level of probation (Level 1) if they have no other juvenile court history.  As part of their probation requirements, they must abide by a curfew if one is established by the Court Counselor, they cannot associate with other juveniles who are on probation, they may be assigned community service and restitution, and they must comply with any mental or behavioral health treatment recommendations.  They are typically released from probation after six to nine months, unless they have a prior juvenile history, or they violate their probation requirements.

Between January 1, 2018 and June 1, 2018, there were 244 juveniles charged with Making a false report concerning mass violence on educational property.  Only 40 of those 244 juveniles were female.  A cursory assessment of the data from that time period indicates that the vast majority of the juveniles who were charged are white and fall between the ages of 11 and 14 years.  Remember, this data is only for youth who were younger than 16 years old at the time of the offense.

A review of records in New Hanover County  indicates that 90% of the juveniles who were charged with this offense and who were referred to Community Justice Services post-adjudication reported being bullied in school.  Ninety percent of the youth were male and 100% were white.  Approximately half of the individuals were described by their classmates as “weird,” and all of them had some form of difficulty with social skills and peer relations.  Most concerning of all was that  20% of them were referred to as “School Shooter” by their classmates several months prior to the threat being made. 

⁸Association of Threat Assessment Professionals (2006).  Risk assessment guideline elements for violence: Considerations for assessing the risk of future violent behavior.  Retrieved from: https://cdn.ymaws.com/www.atapworldwide.org/resource/resmgr/imported/documents/RAGE-V.pdf

⁹Fein, R.A., Vossekuil, B., & Holden, G.A. (1995). Threat assessment: An approach to prevent targeted violence.  United States Department of Justice Office of Justice Programs.  Retrieved from: https://www.ncjrs.gov/pdffiles/threat.pdf

Background on Funding Obstacles in Gun Violence Research

In 1993, results of research on gun violence funded by the CDC were published in the New England Journal of Medicine, attributing gun ownership as a risk factor of homicide in the home.¹ The National Rifle Association (NRA) and supporters then campaigned for the elimination of the CDC’s National Center for Injury Prevention (Center). The result was a decrease in federal funding to the CDC Center as detailed in the 1996 Omnibus Consolidated Appropriations Bill, commonly referred to as the “Dickey Amendment” (Pub. L. 104-208)² after the author of the amendment, former U.S. Representative Jay Dickey (R-AR). More specifically no funds made available to the CDC were to be used to advocate or to promote gun control. This provision has been in place for the past 20 years, at a great cost.

Since then, U.S. Supreme Court rulings have cited the Second Amendment of the U.S. Constitution in upholding the right of states to regulate firearms (District of Columbia v. Heller, 2008³; McDonald v. Chicago, 2010⁴). In the wake of these decisions, even those previously on opposing ends of the debate have reached consensus. Most notably, in July 2012, former Representative Dickey and former Director of the CDC’s Center, Mark Rosenberg, co-authored an article in the Washington Post viewing gun violence as a public health concern and calling for scientific research to be conducted to prevent firearm injuries and deaths while upholding the rights of legitimate gun owners.⁵

The Importance of Multidisciplinary and Bipartisan Efforts

In February 2013, the 113th Congress Gun Violence Prevention Task Force developed “A Comprehensive Plan That Reduces Gun Violence and Respects the 2nd Amendment Rights of Law-Abiding Americans” which was chaired by Congressman Mike Thompson (CA-05). The task force met with key interest groups, cabinet secretaries, Vice-President of the United States, and members of Congress on both sides of the issue. Specific to this Bill, the task force was supportive of funding of CDC for research on gun violence prevention, requesting that the Dickey Restrictions be removed.⁶ Also in 2013, the CDC and the CDC Foundation requested the Institute of Medicine and National Research Council to propose a potential research agenda which was subsequently detailed in the report on the Committee on Priorities for a Public Health Research Agenda to Reduce the Threat of Firearm-Related Violence.⁷

The American Psychological Association convened a panel of experts on Gun Violence: Prediction, Prevention, and Policy approaching the problem as a public health crisis at the individual and community level.⁸ In May 2014, Clinton Anderson Ph.D., Associate Executive Director for the American Psychological Association’s Public Interest Directorate supported introduction of the Bill. Roughly five years since the panel’s recommendation, there have been no changes in funding of research on gun violence prevention and our nation continues to be hit with alarming rates of firearm violence.

In March 2018, APA collaborated with the March for Science and co-authored an open letter to Congress urging law makers to support federal funding for gun violence research by repealing the Dickey Amendment (thwarts research funding) and the Tiahrt Amendment (precludes use of gun trace data in academic research of gun use in crime).⁹ 

Advocacy

Gun violence is indeed a public health crisis impacting our nation. As mental health professionals, you will encounter consumers of your service who have been directly affected by gun violence and who may have been stigmatized as it relates to mental illness and violence.  The consensus among experts, providers, and everyday citizens is that more research needs to be done in this area as a prevention and action when threat occurs.  Within the course of your provision of clinical services, consider advocacy.  The American Psychological Association has a Federal Action Network (FAN) by which you may receive legislative updates and engage in advocacy around Health, Education and Training, Research, Social Justice and Human Rights, and Violence Prevention. The violence prevention initiative includes an emphasis on advocacy around suicide prevention, interpersonal violence prevention, and gun violence prevention.

Review APA’s stance and take a stand of your own.^10,11 You may sign up^12,13 and access FANto encourage your Senators to support the following action points posited by APA in the supplemental attachment to the open letter to Congress.^10,11

• Adopt common sense restrictions on firearm access to reduce the harm caused by violence.
• Expands background checks to all gun sales.
• Incentivizes state reporting to the National Instant Criminal Background Check System.
• Bans assault-style weapons and high-capacity ammunition clips.
• Resists calls to arm teachers or school personnel.
• Invest in greater support for individuals in crisis, who are at risk for violence.
• Enact legislation to improve the National Suicide Prevention Hotline.
• Invest in Crisis Intervention Training.
• Establish federal support and technical assistance for states to implement Gun Violence Restraining Orders.
• Support school- and community-based behavioral threat assessment teams that include mental health and law enforcement partners.
• Fully fund Garret Lee Smith Suicide Prevention Programs through the Substance Abuse and Mental Health Services Administration. These funds support suicide prevention initiatives for states, tribes, and college campuses.
• Prioritize the development of effective preventive interventions by increasing funding for gun violence research.
• Affirm the authority of the Centers for Disease Control and Prevention (CDC) to carry out research into the causes and prevention of gun violence.
• Support research on self- and other-directed violence at the CDC, the National Institutes of Health, the Veterans Health Administration, and the Department of Justice.
• Fund ongoing evaluations of state and local efforts in implementing cross-sector, coordinated approaches to violence prevention.
• Strengthen support for school, family, and community-based prevention efforts, which can reduce the risk of violence by targeting structural inequalities and increasing resilience.
• Foster positive school climates and fund school-based mental health and anti-bullying programs.
• Address adverse childhood experiences (ACEs) through early intervention and prevention.
• Increase access to evidence-based behavioral health care and treatment for substance use disorders and provide broader access to these services under Medicaid.
• Increase access to evidence-based integrated care models in primary care settings.
• Adequately fund federal safety net programs that support low-income people’s access to food, healthcare, housing, education, and income supports.

References

¹ Arthur L. Kellermann, A.L., Frederick P. Rivara, F.P., Norman B. Rushforth, N.B., Banton, J.G., Reay, D.T., Francisco, J.T., Locci, A.B., Prodzinski, J.P., Hacman, B.B., and Somes, G. (1993). Gun ownership as a risk factor for homicide in the home. New England Journal of Medicine, 329(15), 1084-1091.

² 104th Congress. Public Law 104–208.

³ District of Columbia v. Heller, 554 U.S. 570 (2008)

⁴ McDonald v. Chicago, 561 U.S. 742 (2010).

⁵ Dickey, J. and Rosenberg, M. (2012, July 27). We won’t know the cause of gun violence until we look for it. The Washington Post. Retrieved from http://washingtonpost.com

⁶ United States House of Representatives (2016). A comprehensive plan that reduces gun violence and respects the 2^nd Amendment rights of law-abiding Americans. Penny Hill Press.

⁷ Institute of Medicine and National Research Council (2013). Priorities for research to reduce the threat of firearm-related violence. Washington, DC: The National Academies Press.

⁸ American Psychological Association. (2013). Gun violence: Prediction, prevention, and policy. Retrieved from http://www.apa.org/pubs/info/reports/gun-violence-prevention.aspx.

⁹ APA Council of Representatives. (2014). Resolution on Firearm Violence Research and Prevention. Retrieved from http://www.apa.org/about/policy/firearms.aspx.

¹⁰ Henderson Daniel, J. and Evans, A.C. (2018) Letter to Speaker Ryan and Leaders McConnell, Schumer, and Pelosi. Retrieved from http://www.apa.org/advocacy/gun-violence/prevention-letter.pdf.

¹¹ Henderson Daniel, J. and Evans, A.C. (2018) Attachment to Letter to Speaker Ryan and Leaders McConnell, Schumer, and Pelosi. Retrieved from http://www.apa.org/advocacy/gun-violence/prevention-report.pdf

¹² American Psychological Association Federal Action Network. (2018). Retrieved from http://advocacy.apascience.org/sign-up.

¹³ American Psychological Association Federal Action Network. (2018). Retrieved from http://www.apa.org/advocacy/gun-violence/index.aspx.

Addendum

NCPA/NCPF Statement Following Gun Violence in Pittsburgh and Louisville: 

The members and staff of the North Carolina Psychological Association express our deepest condolences to those affected by the recent shootings in Pittsburgh and Louisville.  We resolutely reject the discrimination, bigotry, and hate embodied by this kind of violence.  Bias or stigma directed toward any individual or group is psychologically damaging to the targets of the behavior and contribute to the stress and distress level of society in general.  Prejudice and violence contribute to various forms of psychological difficulties including anxiety, depression, acute and post-traumatic stress, and feelings of insecurity and helplessness.

We are in agreement with Jessica Henderson Daniel, PhD, president of the American Psychological Association who observed: “Hate crimes are the most extreme expression of prejudice. Compared to other crimes, hate crimes have a more destructive impact on victims and communities because they target core aspects of our identity as human beings. Hate crimes also send the message to members of the victim’s group that they are unwelcome in the community, decreasing feelings of safety and security.”

Psychologists are stewards of public health who are invested in the welfare and safety of our fellow citizens. We work with individuals who are victims of firearm violence, as well as perpetrators. Psychologists counsel individuals grieving or experiencing trauma. Psychologists are also invested in accurate representations of mental illness and minimizing stigma as it relates to mental illness and violence, particularly gun violence. We strive to be informed by scientific evidence and sensitive to cultural variables in our professional work. We support the efforts of researchers, law enforcement, clinicians, teachers and policymakers to reduce the prevalence of violence and to mitigate the effects on victims.

We urge those who are experiencing trauma in the aftermath of this tragedy to take care of yourselves and one another. Connect with family and friends and talk about your feelings. Remember that professional help is available and is extended to you.

Further information  and assistance are available from the American Psychological Association:

https://www.apa.org/news/press/releases/2017/10/mass-shootings.aspx

APA Division 17 Webinar: “Taking action against anti-Semitism: An intergenerational dialogue” 

https://www.youtube.com/watch?v=TZ9fMUh9Vrs (cut and paste into your browser)