Cover Story

"There's something wrong here."

That was the reaction of Washington, D.C., physician Janis Orlowski, MD, at a press conference just after the Sept. 16 Navy Yard shooting that left 12 dead and sent scores of victims to her emergency room. Like many Americans, Orlowski, then MedStar Washington Hospital Center's chief operating officer, was haunted by the "senseless trauma" caused by yet another violent attack. "There is something wrong," she repeated.

For years, psychologists have been working to right that wrong by identifying the precursors to violence and the interventions that can help prevent it. They're finding that with evidence-based approaches, there can be more cases when something is right.

Take the high school student in New Bedford, Mass., for example, who told a teacher in 2001 that several of her classmates were discussing plans to bomb and shoot people at the school. The tip made its way to law enforcement professionals, who found bomb-making materials, instructions and plans to carry out a Columbine-like attack.

The New Bedford incident is the first known example of research on threat assessment being used to prevent an attack, according to Marisa Randazzo, PhD, the former chief research psychologist at the U.S. Secret Service. One of the investigators in the case had read a Secret Service report on threat assessment in schools by Randazzo and colleagues and reacted accordingly. Since then, there have been many more examples of other averted attacks, she says.

Today, the threat assessment approach has gained broad support for preventing violence in schools, workplaces and communities. The U.S. Secret Service, FBI and U.S. Department of Education have all recommended that K–12 schools implement threat assessment teams. The American National Standards Institute endorsed the use of such teams in colleges in 2010 and workplaces in 2011. And research on threat assessment is getting a boost with the launch of APA's Journal of Threat Assessment and Management, which debuts in March.

"There's tremendous consensus that this is a valuable approach," says Randazzo, now a managing partner of SIGMA Threat Management Associates, a consulting firm focused on violence prevention. She also served on the APA panel of experts that released a report on gun violence prediction and prevention in December (see related article).

She and several other prominent psychologists are among those working to prevent violence by studying the behaviors of past attackers, consulting with law enforcement professionals who evaluate threats, and training people in schools, workplaces and communities to recognize and report concerns long before individuals turn violent.

Ultimately, they're working to promote the idea that before "there's something wrong," there's something we can do.

"Many of these things can be prevented," says University of Nebraska–Lincoln forensic psychologist Mario Scalora, PhD, who studies targeted violence. "The tragedy is that we sometimes take a pessimistic view that we're powerless, but I think it's quite the opposite."

Pre-attack behaviors

One focus of threat assessment is studying the behaviors of people who have already been violent. Forensic psychologist Robert Fein, PhD, co-directed two of the most comprehensive of such studies, both conducted by the U.S. Secret Service. The first looked at 83 people who attacked or attempted to attack public figures, such as U.S. presidents (Journal of Forensic Sciences, 1999), and the other, which was partially funded by the U.S. Department of Education, reviewed school shooting cases between 1975 and 2000. Together, the studies indicated that "targeted violence is the end result of an understandable and often discernible process of thinking and behavior," says Fein, now a national security psychologist. In other words, people don't just "snap," he says.

Specifically, the studies found that attackers usually plan for days and months before committing a crime. In addition, while perpetrators don't often threaten their targets directly, other people usually know enough to be concerned before a plan is carried out. In 80 percent of the school shooting cases, for example, other students knew trouble was ahead. Few spoke up.

"It seems increasingly clear that when bad things happen, there are people around the person who know enough to have concerns," Fein says. In one case he studied, for example, a teacher, guidance counselor and principal were all disturbed by a high school student's poem about suicide and homicide. Two weeks after the school board dismissed it as a "family problem," the student shot his English teacher and a janitor, with the aim of being executed by the state. He had failed to kill himself four times. "[The poem] was clearly an effort to communicate, ‘help me, help me, help me,'" Fein says. "Others who are considering acts of targeted violence may make similar communications in an effort to get help."

In a more recent study of more than 3,750 high school students, University of Virginia psychologists found that even when students were personally threatened, they tended to keep mum. Among the 12 percent of students who reported being threatened at school, only 26 percent told a higher up, such as a teacher or school officer, the study found (Journal of School Violence, 2012).

"Kids get caught up in the code of silence that is so strong, they fail to see the larger picture," says study coauthor Dewey Cornell, PhD, who directs the University of Virginia's Virginia Youth Violence Project and is an author of the APA report on gun violence.

Other common themes among attackers include experiencing a loss, failure or public humiliation in the days or weeks before the attack, the Secret Service studies found. In the case of Richard Farley, who killed seven employees at his former workplace in 1988, a temporary restraining order seems to have filled this criterion: It was sought by a colleague Farley had stalked for years and ordered by a court one week before he bought a shotgun and two weeks before the rampage.

The attackers may also feel that they have been bullied or persecuted by others. That was the case for Evan Ramsey, who in 1997 killed his school principal and a fellow student after feeling that school authorities had given up on him, according to Fein, who interviewed Ramsey as a part of the school shootings study.

"There are lots of healthy ways all of us deal with stress," Fein says, such as spending time with friends and family, exercising or going to the movies. "But if normal ways of coping with stress don't work, and a person experiences life as unbearably stressful," a small number of people come to believe that violence is the way to solve their problems, he says. That's where threat assessment comes in.

Threat assessment in action

Threat assessment involves three functions: identify, assess, manage. Threat assessment is different from the more established practice of violence-risk assessment, which attempts to predict an individual's capacity to generally react to situations violently. Instead, threat assessment aims to interrupt people on a pathway to commit "predatory or instrumental violence," the type of behavior associated with targeted attacks, says Reid Meloy, PhD, co-editor of the International Handbook of Threat Assessment, out last month. "Predatory and affective violence are largely distinctive modes of violence," he says.

Cornell, the Virginia psychologist, likes to think of threat assessment in public health terms: prevention, not prediction. Just as seatbelts and speed limits prevent injuries without predicting who will crash a car, and restrictions on cigarette sales reduce lung cancer deaths without pinpointing who will get the disease, threat assessments aim to prevent violence without profiling potential attackers.

"We don't intervene because we predict someone is dangerous, we want to intervene because they're troubled or there's conflict or people are worried about them," Cornell says. "Prevention becomes a bonus or a secondary gain from dealing with the underlying issue."

Here's how the process works:

  • Identify. Authorities identify threats. To do that, people need to know when, how and where to report concerns. In the Washington, D.C., Metro system, for example, an intercom announcement reminds commuters and tourists that if they "see something, say something" to uniformed employees. At the University of Nebraska, posters and Web pages encourage students to report problems of all kinds — whether it's a depressed friend or a bad joke about guns — through an online portal or phone number. It's important to keep the message simple. "If you hand them a lot of criteria [such as only report if the threat involves a weapon], they start to think what the criteria are versus what their concerns are," Scalora says.

Authorities also must convey that tips will be dealt with carefully and responsibly. According to research by Scalora and colleagues, people are reluctant to report potential threats out of fear that they'll wrongly implicate someone else, that they'll entangle themselves in trouble, or both. That's why at Nebraska, students can report anonymously. "We give them the reassurance that these things can be managed very discreetly, and not every report is handled with a direct response or action," Scalora says.

  • Assess. The next step in a threat assessment is gathering and evaluating information from multiple sources. That could involve security professionals, school counselors, supervisors or human resources managers talking to the person of concern and his or her peers and supervisors, as well as looking to social media sites, to better understand whether or not the person is planning violence. Authorities may also analyze the subject's current situation. They ask: Has the subject recently lost a job, gone through a divorce or filed for bankruptcy? How has he or she handled adversity in the past? Importantly, says Fein, investigators ascertain whether or not the person of concern has a motive, a target and the organizational skills to carry out an attack. Can he or she get a weapon and use it?

Had such questions been posed about Washington Navy Yard shooter Aaron Alexis, authorities might have noticed the red flags: He had a history of reacting violently to minor disturbances, and he owned and had used guns before. No matter that Alexis had never made a threat.

"The central question is whether the subject poses a threat, not whether the subject made a threat," Fein says, adding that many people who pose a threat don't make one. Nevertheless, he says, all threats should be taken seriously because some people interpret a threat being ignored "as a message to move toward violence."

  • Manage. More often than not, an assessment reveals a manageable underlying issue such as bullying, anxiety or depression that mental health professionals are well trained to handle, says Cornell, who developed the Virginia Student Threat Assessment Guidelines in 2006. The guidelines offer a decision tree that steers authorities through the identify, assess and manage steps and has been shown in a randomized controlled trial to increase the use of counseling services and parent conferences and decrease long-term suspensions (School Psychology Review, 2012). They're now implemented in schools across the country and serve as a model for others in Europe.

"We found in case after case, with a systematic, careful approach focused on the problem that stimulated the threat, the threat can go away and the concern about violence diminishes," Cornell says. "Every threat is really a symptom of a problem that someone can't resolve."

In the rare case that the assessment reveals a true threat — such as the situation in New Bedford, Mass. — law enforcement and other threat assessment professionals develop a plan to interrupt the potential pathway to violence. In the short term, that could mean alerting potential victims and restraining the subject. But in the long term, it means to "aid someone who might be on a path to despair, who may be prepared to die, to move them on a path to hope," Fein says.

Further reading and resources