A recent, evolving case (at the time of this writing) pertains to a father who killed eight children in Louisiana. It has received limited national attention compared to other mass tragedies like the Oxford H.S. Shooting in Michigan (which had half the fatalaties). Sadly, it is not the first time a mass killing has unfolded within a family, nor will it be the last.

But cases like this raise an important question we rarely ask:

Are we misunderstanding where mass violence actually begins?

When most people hear the phrase “mass killing“, they picture Uvalde, Pulse Nightclub, Aurora Theater shooting or El Paso Walmart homicide event. This is understandable. They wouldn’t be wrong. These tragedies dominate headlines, interrupt programming, and command national attention.

But that image is incomplete.

Most mass killings do not occur in public spaces. They happen in private homes, within families, behind doors that never make national news. These cases—often involving children—receive far less coverage and fade more quickly from public awareness than news events that unfolded in a public space.

Why does this matter? This distinction matters because it quietly reinforces a myth: that danger is greatest in public, among strangers.

In reality, most lethal violence is relational. It ignites within family systems—where stress, control, frequent contact, despair, and untreated (or undertreated) mental health struggles intersect. These are not random events. They are often preceded by patterns, concerns, and warning signs that unfold gradually. It raises the question, can they be prevented?

Getting back to the case of Shamar Elkins, details coming out about his mental health. In 2019 Elkins was arrested on charges of illegal use of a weapon and carrying a firearm on school property. He fired five rounds at a car about 300 feet from Shreveport High School and sped away. He later pled guilty and was placed on 18 months probation. The firearm charge was dropped.

About three years ago his wife told him she wanted to leave him and take the children. If she followed through on her threat Shamar promised to “kill you, my kids and myself.” In April of this year he attempted suicide.

On April 9, 2026 he posted the following on Facebook: “Dear God. Today I ask You to help me guard my mind and my emotions.” Shortly later he added another. “When depression tries to settle in, when anger rises, when anxiety or panic comes, give me the awareness to recognize what is not from You and the strength to reject it immediately in the name of Jesus.” On Easter he told his mother and stepfather he was “drowning in dark thoughts.” His father tried to reassure him, but Elkins wasn’t comforted. He replied, “Some people don’t come back from their demons.”

His wife filed for divorce and the couple had significant financial debts.

These are clear warning signs of an eruption about to surface.

In the weeks before the fatal shootings he sought mental health treatment for his “dark thoughts” through Veteran Affairs and was hospitalized for about ten days. He emerged a calmer man. But it was too little too late.

What happened here is anything but unique. The hospitalization created a kind of ideal hothouse environment – highly structured, insulated, low stress and temporary. Once released back into the harsher climate of his life outside, there was little preparation, support or gradual transition. He was returned to the very situation that overwhelmed him in.

The Visibility Problem—and Why It Matters

Public mass violence shocks us. And it should. But family mass killings are often framed differently—they ar briefer, more private, often ambiguously and sometimes only locally. They are treated as isolated tragedies rather than part of a broader, recurring pattern. And they are seen as something which does not involve the public. As a result, the public—and even professionals—can develop a skewed sense of risk.

We overestimate danger in crowds. We underestimate danger in relationships under strain.

There is a reason for this. Domestic violence killings involving three or more victims are not tracked as a distinct category—despite their impact. Public mass killings, however, are consistently tracked by the Centers for Disease Control and Prevention, National Violent Death Reporting System, and the Federal Bureau of Investigation, but they are tracked by relationship – not victim count. This omission matters, especially when more than half of female homicide victims are killed by intimate partners.

Another way of saying this is that homicides are tracked through law enforcement and public health systems. But domestic violence resulting in homicide is not tracked as a group. They can only be inferred through “relationship coding.” This makes them far less visible.

Sources such as the Violence Project conclude that domestic violence is a leading context for mass killngs.

This isn’t just a media issue. It’s a perception issue. And perception shapes everything from policy priorities to prevention strategies to funding to human behavior.

Mental Health: Awareness Has Grown—Access Has Not

As in the case of Mr. Elkins, there are almost always prior warnings about deteriorating mental health; critical points where tragedy might be averted. Family members often notice. They register the withdrawal, agitation, paranoia, outbursts, absences, threats, escalating drinking, preoccupation and a web of despair. They worry. Rightly so. Sometimes they seek help.

And still, the outcome unfolds.

It’s important to be precise here. Mental illness alone does not explain violence. Not in adults nor in minors. The vast majority of individuals with mental health conditions are not violent and are far more likely to be victims than perpetrators. Other factors play a role also – financial stress, divorce, school bullying, unemployment, parental neglect, serious medical diagnoses or the death of someone close.

At the same time, we cannot ignore the reality that serious, untreated—or undertreated—mental health struggles, when combined with stressors, contribute to catastrophic outcomes like a perfect storm.

The system we have built is not keeping pace with the need.

• About 1 in 4 adults in the U.S. experiences a mental illness each year, yet only about half receive treatment of any kind.
• One in four adults who need care report they cannot access it at all.
• Among youth, millions experience severe depression, while many go untreated.
• And nearly 40% of Americans live in areas with a shortage of mental health providers.

Here is a visual of what I am saying. These maps show access to emergency psychiatric care for adults and for minors. The dominating orange color is a distress signal. Are we paying attention?

And, keep in mind, because a bed exists does not mean a bed is available.

One additional pressure stems from the closing of rural hospitals.

The average number of rural facilities is frightengly absent. Roughly 75% – 80% of rural counties in the U.S. have zero inpatient psychiatric beds.

As a result: the entire rural poplation of about 46 million people is left relying on 10,300 beds spread across the entire country. And just when you think it cannot get worse. Think again. Because, when it comes to minors, less than 10% of rural counties have dedicated inpatient pediatric psychiatric units – fewer than 1,100 beds nationwide.

And we wonder how the Ethan Crumbleys (Oxford H.S.), Adam Lanzas (Sandy Hook) and Salvador Rolando Ramos (Uvale) materialize.

Put yourself in the shoes of these parents. You see the warning signs in your teenager. You may even ask your health care provider about them. But what do you do when they erupt? How do you summon help (the proper help) when minutes count?

Paradoxically, we are living in a time when awareness about mental health struggles and access to important information has expanded dramatically. We can easily learn about it through podcasts (i.e. Mental Health News Radio Network), the evening news (Robin Williams) or on the silver screen (American Sniper).

But as these maps show, access has not kept pace. Even when families recognize a problem, they often encounter a fragmented system: long waitlists, limited providers, high costs, thresholds for intervention that are simply too high and lack of follow up. It’s like waiting for a hip replacement until you cannot walk without the follow up of physical therapy or post-operative assessment. It’s too little, too late.

When Private Struggle Becomes Public Tragedy

And there is another wrinkle. Private matters don’t always stay private. One of the most widely known cases of mass violence—Sandy Hook Elementary School shooting—is often remembered for what happened inside a school. But the story did not begin there.

In the years leading up to that day, there were well-documented concerns about mental health, increasing isolation, and significant strain within the home. By many accounts, repeated efforts were made to seek help for the young shooter, Adam Lanza. Resources were available. A parent was involved and trying. They had excellent insurance but help failed to meet the needs of Adam.

The Uvalde School Shooting also started as a private matter. The shooter, Salvador Ramos, had been frequently bullied in school for having a speech disorder, ridiculed for his hygiene, his dated clothes, and his family’s bleak financial situation. In time, his private mental health crisis spilled over into the public domain and nineteen innocent children and two teachers died as a result.

And so did the Parkland School shooting in Florida on Valentine’s Day, 2018. That is the fateful day Nikolas Cruz opened fire on fellow students and staff at Marjory Stoneman Douglas H.S. in Parkland, Florida. It resulted in the deaths of 17 people.

It had long been known that Cruz had obsessions with other mass shootings and expressed racist, sexist, antisemitic, xenokphobic. and homophobic views. He legally purchased various firearms before the shooting.

Psychiatrists recommended an involuntary admission to a residential treatment facility in 2013. At this time, a school resource officer suggested he undergo an involuntary psychiatric examination under the provisions of the Baker Act. Two guidance counselors agreed, but a mental institution did not. State investigators reported he had problems with ADHD and depression with a history of attempted suicide. In their assessment, the investigators concluded Cruz was “at low risk of harming himself or others”. He had previously received mental health treatment, but not in the year leading up to the shooting.

Are we better off today? Would these troubled kids fared better if their obvious mental health struggles were documented? No. We still have limited resources for troubled kids. In fact, it is easier for a teenager to get a hold of a weapon than a psychiatric bed.

What’s often missed in public discourse is that tragedies which began as a slowly evolving cauldron of warning signs behind doors, exploded outward into public settings with devastating consequences.

The public remembers the school tragedy. Not the roots of what led up to it.

The Big Lie: “We Can’t Afford More Mental Health Clinics”

Stop and consider the way we are currently paying for untreated mental health care in the form of gun violence from emotionally ill people. How much is your personal household paying for homicide annually even if it never touches you directly? The answer may surprise you.

Across the United States, homicide costs society between $180 – $340 billion every year. That figure includes emergency and medical response, investigations, court proceedings, incarceration, lost job productivity, probation, and the long-term strain placed on public systems like foster care and mental health agencies. (And that figure doesn’t inlude expenses for the victim-families in the form of funerals, medical bills for survivors, lost wages, legal expenses and sometimes crime scene cleanup.

When national costs for murder are spread among us, the impact is clear: roughly $1,300 to $2,600 per household each year — every year — is needed to address the problem of homicide after the fact. That’s on par with what many households budget for basic utilities for electricity, water and heat.

Homicide carries the highest economic cost of any crime.

Yet a national average for funding for mental health clinics is a fraction of that – about $19 billion. Investing a small proportion of the pricetag for homicide back into community clinics, mobile crisis teams and structural “wrap-around” care after psychiatric discharge is a wise fiscal step (let alone a moral one). We are already spending the money. We are just spending it in courtrooms and funeral homes and prisons instead of mental health facilities. And maybe if we had done that, the eight innocent children caught in the middle in Louisiana would be alive today.

The “Gray Zone” We Don’t Address

Our current system tends to respond at two points:

• when someone is stable enough to wait for outpatient care
• or when they’re in acute crisis and meet criteria for brief emergency intervention

But what about the space in between; that gray zone—where someone is clearly deteriorating but has not crossed a legal or clinical threshold? This is where many families, like Shamar Elkins’ family, found themselves days after his release.

They were worried.
They watched changes unfold.
They were unsure what to do.

And we, as a nation, don’t either.

What Needs to Change

If we are serious about prevention, the conversation has to widen. Not just toward more awareness—but toward earlier, more accessible, and more practical intervention.

Some steps are already within reach:

1. Make mental health screening routine

Mental health should be assessed as routinely as blood pressure—especially in primary care settings where people are most likely to show up.

2. Expand early-intervention pathways

We need services that exist before crisis:

• mobile crisis teams that respond quickly
• consultation pathways for families seeking guidance
• short-term stabilization programs that fall between outpatient care and hospitalization (somewhat like urgent care clinics)

3. Increase system capacity

This includes:

• more psychiatric beds where too few or none exist
• better funding for community mental health centers
• incentives for providers to serve underserved populations once discharged (this is sometimes called “wrap around services”)
• expanded telehealth access

4. Support families as frontline observers and potential victims

Families are often the first to notice change—but the least supported.
They need:

• clear guidance on early warning signs
• practical steps for seeking help
• access to consultation without triggering punitive systems

5. Build a parallel awareness framework

We have made meaningful progress in suicide awareness—normalizing conversations, identifying warning signs, and creating clear pathways for help.

There is no comparable framework for when concern shifts outward—when families begin to worry not only about someone’s well-being, but about their stability in relation to others.

Developing a carefully framed public health approach—one that helps people recognize escalating risk and know where to turn—could fill a critical gap. Not to alarm, and not to stigmatize, but to provide direction in moments of uncertainty.

A More Accurate Lens

We cannot prevent what we misunderstand.

As long as mass violence is framed as something that happens without warning by a stanger “out there in public gatherings,” we will overlook where it most often takes root—within strained relationships, untreated distress, and systems that respond too late, too little, or not at all.

If we continue to define mass violence only by where it ends, we will continue to miss where it begins. And if we miss that, we will continue to see innocent peopile die.

Because prevention does not start in public spaces. It starts earlier—inside homes, inside relationships, and inside systems that are stubbornly ill-equipped to respond to a clear and present danger.

And until we shift our focus upstream, we will keep reacting to tragedies we might have interrupted.

The single best first call in the US

→ 988 Suicide & Crisis Lifeline

• Call or text: 988
• Available 24/7, free, confidential
• You can also chat online

👉 This is not just for suicide. It’s for:

• escalating mental health symptoms
• emotional distress
• substance-related crises
• situations where a family says, “something is not right and we don’t know what to do”

Why 988 is the best first step

Because it solves the exact problem families face in the moment:

1) It buys time and lowers temperature

You reach a trained crisis counselor immediately, not a voicemail, not a waitlist.

2) It helps you think when thinking is impaired

Crisis workers help families:

• assess risk
• decide next steps
• avoid overreaction (or underreaction)

3) It’s designed for ambiguity

You do not need:

• a diagnosis
• certainty
• suicidal intent

In fact, they encourage calling before things become severe

The decision fork families struggle with

In real life, families are often stuck between two options:

Option A: Do nothing (wait and hope)

Option B: Call 911 (which may escalate fast)

👉 988 is the middle path

• mental-health–specific
• de-escalation-focused
• can guide whether emergency services are actually needed

What happens when you call

• You’re routed to a local or regional crisis center
• A counselor:
  • listens (nonjudgmental)
  • assesses safety
  • helps create a plan
• They can connect you to:
  • local crisis teams
  • outpatient care
  • emergency services (only if necessary)

Other supports (secondary—but important)

211

• Good for:
  • housing instability
  • caregiver overwhelm
  • connecting to local services
• Less specialized for acute psychiatric crisis
  

911 (last resort)

• Necessary if:
  • immediate danger
  • violence
  • medical emergency

But:

• It introduces law enforcement
• It can escalate situations unintentionally

The deeper clinical reality

Families don’t call because they’re:

• unsure it’s “bad enough”
• afraid of overreacting
• afraid of what will happen next

👉 So the most important message is:

You don’t have to wait until it’s an emergency to call 988.