On November 30, a 15-year-old sophomore at Oxford High School in Michigan killed four students and injured seven others. Both the student and his parents are presently incarcerated and charged with numerous crimes.

In the days following this tragic event, questions arose regarding what the parents and school might have done to prevent this from happening. The parents are facing charges of involuntary manslaughter and a federal lawsuit, perhaps the first of others to follow, has been filed against the school district alleging that more could have and should have been done.

Warning signs and preventive actions.

With each school shooting we again find ourselves asking ourselves what can be learned in terms of warning signs and actions that could be taken. The September Mental Health Matters column in AJN, which I co-authored with Arlene Holmes—whose son James was responsible for the mass shootings in Aurora, Colorado, in 2012—highlighted warning signs that might indicate potential violence by someone experiencing mental health problems.

What can be learned from the events that unfolded in Oxford that could be applied to a similar scenario, perhaps heading off another tragedy? The following checklist compiled by Sandy Hook Promise, a nonprofit organization that aims to educate youth to prevent gun violence, includes warning signs that someone could be experiencing mental health issues in need of immediate and supportive intervention:

  1. Suddenly withdrawing from friends, family, and activities (including online or via social media)
  2. Bullying, especially if targeted towards differences in race, religion, gender or sexual orientation
  3. Excessive irritability, lack of patience, or becoming angry quickly
  4. Experiencing chronic loneliness or social isolation
  5. Expressing persistent thoughts of harming themselves or someone else
  6. Making direct threats toward a place, another person, or themselves
  7. Bragging about access to guns or weapons
  8. Recruiting accomplices or audiences for an attack
  9. Directly expressing a threat as a plan

In addition to the above, having access to guns or weapons, being a victim of possible abuse and/or neglect, or directly asking for help should also raise a red flag.

Educating teachers and staff on warning signs.

The Oxford shootings took place in a school, which is unfortunately such a common location that the term “school shooting” has become part of our everyday vocabulary. Teachers have a front row seat to child and adolescent behaviors. If a school has not done so, I would encourage conducting sessions for faculty and staff on a regular basis regarding what is normal and what might be pathological behavior in this population, including signs and symptoms that herald the need for immediate intervention with any student.

The teachers at Oxford are to be commended for bringing their concerns to the school’s attention. But a teacher’s reach only goes so far. As a former high school teacher, I know that a school has the last word and can make a determination to suspend any student for certain behaviors, as well as require a student to take leave until the student meets the criteria the school puts in place in order to return. In the above case, since the student had no prior behavior problems, he was allowed to stay. However, we should know by now that just because someone has no prior behavior issues or record is no guarantee that they will remain harmless.

Removing a student from the classroom and the school until such time as a thorough evaluation and appropriate treatment can be conducted by a licensed mental health practitioner is not only the prudent thing to do to protect the school community, but is also beneficial to the student in question to help him or her to address some of the issues that are creating the concerns and problems. If they don’t already have one, it would be advisable for schools to develop an action plan addressing how and when to send students who have exhibited concerning behaviors home—and not be afraid to act upon it if need be.

As we now unfortunately know, no school is immune to the potential for mass shootings. While preventing all future shootings from happening is impossible, there are things that can be done to mitigate and/or prevent future incidents, even when doing so requires some difficult choices and measures.

Donna Sabella, MEd, MSN, PhD, PMHNP-BCPhD, is a psychiatric mental health NP, a professor at the Pennsylvania College of Health Sciences in Lancaster, and the coordinator of AJN’s Mental Health Matters column.