A profound mental health crisis lies at the heart of violence in America. Decarlos Brown Jr., the suspect in the brutal stabbing death of the Ukrainian woman Iryna Zarutska in Charlotte, North Carolina, was in a mental hospital earlier this year and was diagnosed with schizophrenia. But doctors wouldn’t have released him if they had viewed him as a danger to himself or others.

Similarly, the killers at Minneapolis’ Annunciation Catholic School and Nashville’s Covenant School both struggled with mental illness. Nearly all mass shooters also battled suicidal thoughts.

Our mental health system cannot serve as the last line of defense — too many mistakes slip through.

“We will never arrest our way out of issues such as homelessness and mental health,” Charlotte Mayor Vi Lyles warned after the stabbing death. “Mental health disease is just that — a disease. It needs to be treated with the same compassion.” After the Minneapolis attack, House Speaker Mike Johnson underscored the issue: “The problem is the human heart. It’s mental health. There are things that we can do.”

Yet despite the fact that more than half of mass public shooters over the past 25 years were already under the care of mental health professionals, not a single one was identified as a danger to themselves or others. An entire body of academic research now explores why mental health experts so often fail to predict these attacks.

What’s the plan?

When professionals cannot identify threats before atrocities are committed, society must ask: What is the backup plan?

The Minneapolis school murderer admitted: “I am severely depressed and have been suicidal for years.” After the Nashville school shooting, police concluded the killer was “highly depressed and highly suicidal throughout her life.” Yet even with regular psychiatric care, experts found no signs of homicidal or suicidal intent.

The 2022 Buffalo supermarket killer showed the same pattern. In June 2021, when asked about his future plans, he answered that he wanted to attend summer school, murder people there, and then commit suicide. Alarmed, his teacher sent him for evaluation by two mental health professionals. He told them it was a joke, and they let him go.

Later he admitted: “I got out of it because I stuck with the story that I was getting out of class, and I just stupidly wrote that down. It was not a joke; I wrote that down because that’s what I was planning to do.”

Many well-known mass killers saw psychiatrists before their attacks. U.S. Army Maj. Nidal Malik Hasan, who murdered 13 people at Fort Hood in 2009, was himself an Army psychiatrist. Elliot Rodger, the UC Santa Barbara "incel" shooter, had received years of high-level counseling, but like the Buffalo killer, Rodger simply knew not to reveal his true intentions. The Army psychiatrist who last saw Ivan Lopez (the second Fort Hood shooter) concluded there was no “sign of likely violence, either to himself or to others.”

Aurora movie theater shooter James Holmes’ psychiatrist did warn University of Colorado officials about Holmes’ violent fantasies shortly before his attack, but even she dismissed the threat as insufficient for custody. And both a court-appointed psychologist and a hospital psychiatrist found Virginia Tech shooter Seung-Hui Cho posed no danger to himself or others.

Psychiatrists have every incentive to get these diagnoses right. Beyond professional pride and the desire to help, they face legal obligations to report threats. Families of victims have even sued psychiatrists for failing to recommend confinement. Despite this, psychiatrists consistently underestimate the danger.

The problem runs deep enough to generate a whole academic literature. Some experts suggest psychiatrists try to prove their fearlessness or become desensitized to risk. Additional training in unusual cases may help, but predicting such rare outcomes will always remain extremely difficult.

Hindsight makes the warning signs look obvious. Before the attack, even to experts, they rarely do. And while addressing mental illness, we should not stigmatize it. Mentally ill people are far more likely to become victims of violence than perpetrators. Only a tiny fraction ever commit murder.

Take schizophrenia: More than 3.5 million Americans live with the disorder, yet only one schizophrenic has committed a mass attack since 2019. That makes the odds of such a crime less than 1 in 3.5 million — extremely rare.

Victims left defenseless

No one wants dangerous individuals to access weapons. Are we going to disarm all mentally ill people, even though they themselves are at increased risk of violent crime? One woman we know saw her husband murdered in front of her by her stalker. She was very depressed but feared that in seeking mental help she would be denied the right to own a gun (which she needed to protect herself).

Another factor that makes these attacks difficult to stop is that they are planned long in advance, with six months being about the shortest. The Sandy Hook massacre was planned for over two and a half years, allowing the perpetrator plenty of time to obtain weapons.

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These killers, like the recent attacker in Minneapolis, often state outright in their manifestos and diaries that they target “gun-free zones.” They may be crazy, but they aren’t stupid. They expect to die, but they want attention when they do. They know that the higher the body count, the more media coverage they’ll receive. That’s why they choose places where no one can fight back.

Weapons bans won’t work

The attack in Charlotte happened in a gun-free zone. The woman had no chance to defend herself when the attacker struck from behind, and no one on the train intervened. Bystanders may have hesitated out of fear — after all, the killer was a large man armed with a knife, even though knives are also banned on public transportation. Someone with a firearm possibly could have stopped the assault, just as a Marine veteran in July did in a Michigan Walmart, where at gunpoint he forced a knife-wielding attacker to drop his weapon. Others who tried to stop the attacker without a gun were stabbed.

Our mental health system cannot serve as the last line of defense — too many mistakes slip through. If mental health professionals can’t reliably stop these attackers before they strike, we must ask: What’s the backup plan? Leaving targets unprotected isn’t the best option.

Editor’s note: This article was originally published by RealClearPolitics and made available via RealClearWire.