Investigators stand outside the Tops Friendly Market on Saturday, May 21, 2022, in Buffalo, New York.
CNN  — 

The 18-year-old White man who opened fire at a Buffalo supermarket, killing 10 and injuring three, was first known to authorities in 2021 after making a generalized threat while attending his high school, according to Buffalo Police Commissioner Joseph Gramaglia.

New York State Police took the suspect to a hospital for a psychiatric evaluation after he made a threat and worked on a school project that mentioned murder-suicides. But authorities released him after a day-and-a-half after determining that his threat was not specific enough to warrant further action, investigators have previously said. This allowed him to legally purchase the AR-15-style weapon he used in the attack.

The case of the Buffalo suspect – who pleaded not guilty to the 25-count indictment against him – exemplifies how high-risk adolescents, left untreated and unmonitored, can fall through the cracks of the system that aims to disrupt potentially violent behaviors, which allows those young people to carry out deadly acts of violence, several experts tell CNN.

Experts researching and developing approaches for long-term treatment to troubled teenagers say that they demand intensive services over a long period of time across agencies in mental health, community and law enforcement.

High-risk adolescents are characterized by antisocial disorders, social withdrawal, depressed mood and a lack of empathy or remorse, according to a National Policing Institute report released earlier this year on managing high-risk adolescents in community contexts. Those who become radicalized by extremist groups or harbor dangerous, racist views, experts say, require a more complex treatment plan that seeks to address the underlying causes of their ideology and reframe their mindset entirely.

The role of police in dealing with high-risk adolescents is to respond to an articulated or imminent threat of danger, an arrest, or transportation to a psychiatric or crisis center for an evaluation, according to Frank Straub, director of the National Policing Institute’s (NPI) Center for Targeted Violence Prevention.

From there, experts say the individualized treatment plan determines whether the person should return to school or be homeschooled, undergo therapy or be taken to a psychiatric facility and be involved in pro-social groups such as sports or after school activities.

But experts assert that there isn’t a consistent or widespread system in place that provides treatment for people like the alleged Buffalo shooter that connects them with long-term guidance, regular interaction and mentoring that has been proven in studies to be effective in rehabilitation.

Part of the problem, experts say, is that many communities don’t have the experience or funding to effectively treat people who articulate a threat to themselves or others.

“One of the things that we see as a shortfall is that assessment is a continuous process. You don’t do one threat assessment and say if an individual is at risk or not and then release him,” Straub said.

Behavioral threat assessment teams in schools are typically composed of law enforcement officers, school psychologists or social workers, school administrators and, in some cases, teachers. Threat assessment teams – which also operate in university and private sector settings – are designed to identify and manage potentially dangerous people in an effort to thwart violence.

But it is equally important, experts say, to deploy trained professionals who connect teenagers and their families to long-term counsel, regular check-ins, psychological treatment and community-based programs.

The research into this multidisciplinary approach is targeting what Straub calls the “gray area” in which at-risk adolescents fall between mental health, law enforcement and criminal justice system responses.

Case study highlights gap in mental health system

Straub leads the Averted School Violence (ASV) project, a national database developed by NPI that analyzes averted and completed school attacks.

A recent NPI report includes the 2018 case of a Michigan high school student who displayed mental illness and suicidal ideation, the report says. He also had chronic social and academic difficulties and showed signs of psychopathic tendencies.

In February 2018, the school’s principal observed the context of one of his notebooks “filled with detailed notes regarding his experimentation with homemade explosives” and called in a police officer, who then requested an evaluator to conduct a threat assessment.

Although there was a concern, the assessment found that his behavior “did not meet the criteria for arrest, school disciplinary action, or referral to a mental health provider,” the report said. Law enforcement officers also searched the teenager’s room but found no concerning materials, which closed the case.

In March, however, the teenager’s mother found two sawed-off shotguns in the drawer of his room and brought him into police custody, where she reported that he was plotting to attack his high school in Paw Paw using modified firearms and homemade explosives.

The teenager was arrested and remanded to juvenile detention and was later sentenced to spend a year in a residential treatment center, where he remained until his 19th birthday. In July 2021, he was released from all legal supervision by a judge.

One month after his release, he went to a beach pier in South Haven, Michigan, armed with two guns. On August 20, 2021, he shot two people, killing one of them on a pier. The teenager made his way toward the beach, firing several shots at people, missing them as they ran for cover, before fatally shooting himself.

The report’s authors concluded that the case of the South Haven shooter proves the need for specially trained community-based teams that can provide long-term counsel and mentoring to at-risk adolescents and their families.

The Buffalo supermarket shooting suspect arrives for a hearing at the Erie County Courthouse on May 19, 2022, in Buffalo, New York.

“Had such a team existed, it could have been engaged immediately following the discovery of his notebook by his teacher, the risk evaluation, and law enforcement response. A second opportunity to engage such a team presented itself upon his release from the juvenile facility,” the report stated.

There are parallels, according to Straub, between the South Haven shooter and the alleged Buffalo shooter – both cases illustrate how the country’s mental health system doesn’t have the capacity to allocate intensive resources and ongoing evaluation to them.

In the case of the Buffalo suspect, Staub said, “we see there’s a psychiatric evaluation, but after a couple of days he’s back out in the community. There’s no team, no entity to hand that person off to so they can be mentored and evaluated regularly.”

In the case of the South Haven shooter, Straub added, “there’s a clear articulation by at least one psychiatrist in the juvenile facility that he was still high-risk and in need of continuing support in a community context. But that doesn’t happen.”

The period after an articulated threat is ‘particularly high-risk’

Elizabeth Jeglic, a psychology professor at John Jay College, says research suggests that the period after a threat is made is “particularly high-risk” and requires intense supervision of the individual to mitigate dangerousness.

In the alleged Buffalo shooter’s case, Broome County District Attorney Michael Korchak told CNN that there were “no direct threats made to any student or teacher.” The teenager was treated, released and cleared to return to school after the evaluation, according to Korchak, who added that it’s “hard to say” whether more should have been done after the incident.

Now, the Broome County District Attorney’s Office is investigating that school threat incident, as well as the suspect’s overall behavior “going back several years,” Korchak told CNN.

Straub is part of a team of experts who have been developing a model called the Center for Targeted Violence Prevention (CTVP), a partnership between the NPI and Michigan State University’s Department of Psychiatry, which would assist Michigan schools and communities in establishing intensive support teams in preventing adolescent violence, reducing danger and supporting rehabilitation.

Michigan, Colorado developing new practices

The Michigan model is unique because it focuses on adolescents, aged 10 to 15, and offers “voluntary and/or court mandated assistance for populations that may or may not have a clinical diagnosis of mental illness,” Straub said.

“You need to do this on a regular basis because you need to be able to measure whether the interventions and support that you’re putting into place are in fact reducing an individual’s risk for engaging in self-harm or harm to others,” he said.

Michigan Gov. Gretchen Whitmer has allocated $15 million in funding as part of the state’s 2022-2023 fiscal budget to pilot a “cross-system” intervention approach that includes five regional teams. They would be tasked with identifying and supporting middle and high school students “that are determined to be at risk for violence through a psychiatric or psychological assessment,” according to the governor’s budget proposal.

The Michigan model has adopted elements of existing practices in a few pockets of the country, Straub says. Colorado recently established a Targeted Violence Prevention program that deploys teams of trained mental health clinicians who work with law enforcement, schools and family members to target potential violence.

The Aurora Police Department’s Crisis Response Team houses a Targeted Violence Prevention Program, which works to “identify behaviors exhibited by a person suffering from a mental illness or mental health crisis,” according to its website.

A memorial for the victims of the Buffalo supermarket shooting, on May 21, 2022.

The process starts with a referral from police, which triggers an immediate behavioral threat assessment by an evaluator to determine the level of threat, according to Courtney Tassin, the program manager for the Aurora Mobile Response Team.

Tassin says it’s critical to target every aspect of that person’s life – education, family and social – while also coordinating with local law enforcement agencies. The response teams do regular check-ins and identify gaps that could be the source of certain grievances.

“It’s important not to rely on other agencies to carry out your management plan. While we want the participation of as many agencies as possible, our team holds up their end of the deal and makes sure these individuals are connected to the right resources,” Tassin said.

There can be an intrusive aspect to the prolonged interaction between these multidisciplinary teams and the adolescents they aim to treat, which might be rejected by some, according to Philip Yanos, a psychology professor at John Jay College of Criminal Justice who has researched interventions for people diagnosed with mental health conditions who are under investigation and suspicion by law enforcement.

“Some people are uncomfortable with the idea of a professional coming into their home. So, the services have to be provided in a way that shows awareness of that. Schools might respond negatively to outsiders coming to talk with them, as well,” Yanos said, noting that schools often have their own guidance counselors and on-site mental health services.

This type of service also requires collaboration with local entities such as police departments and schools, Yanos says, and there’s no guarantee they will agree to participate if the program is run by the state government.

Yanos argues that these programs should be made available on a voluntary basis and should not be mandated if someone has not committed a crime.

Radicalized teens require more complex treatment plan

It’s not uncommon for adolescents like the South Haven shooter and the alleged Buffalo shooter to adopt a certain ideology or join extremist groups “in an effort, a lot of times, to get a sense of belonging,” said Dr. Alyse Ley, associate chair of the Michigan State University Department of Psychiatry who is leading the CTVP with Straub.

Such teenagers require a deeper, more complex layer of treatment. Under the Michigan model, specialized teams would work with high-risk youth to identify underlying causes and mental health challenges that have moved them in that direction, according to Straub.

“When someone is so far down that pathway to violence or is so far radicalized, they truly do believe that what they’re doing is for the best and the greater good,” Tassin said, adding that the treatment plan requires “a whole reframe of their current mind state.”

“It’s very different than working with someone who has severe or persistent mental illness, or someone who is just endorsing mental health concerns like severe depression,” she said.

Sammie Wicks, a senior program manager at the CTVP, said he has engaged with many adolescents who have “ideologically based grievances,” such as White supremacy, as part of his violence prevention work in Aurora.

Wicks said it’s important not to initiate interventions by challenging a person’s ideological beliefs, “because they will shut down immediately.” It’s more effective, he says, to identify the factors that might be pulling individuals towards certain ideologies, identities, groups or movements.

Aurora’s targeted violence prevention team, in operation since 2020, has seen the success of its work through various metrics, Wicks says. Improvements are measured by the person’s continued engagement in their treatment plan, a positive change in behavior, participation in pro-social activities – like sports or community groups – and refraining from any criminal or violent behavior, Wicks says.

As part of his work in Aurora, Wicks says his team often partnered with organizations like Parents for Peace, an alliance made up of families whose loved ones were recruited into extremism. These groups would help connect the person to a former extremist who can help “poke holes” in their belief system, especially if they appear to have moments of questioning their ideology.

“If you’re part of a community where those kinds of extremist views are supported and reinforced, it’s very hard to separate them,” said Jeglic, referring to social media communities or family environments.

In some cases, it’s necessary to restrict the person’s social media exposure, access to weapons or put them in an in-patient facility if they continue to pose a danger to themselves or others, Jeglic says.

“We can’t allow people to continue going into supermarkets, schools, stores and churches and killing people,” Straub said. “If we can identify them early on as having these deep needs for evaluation, support and intervention, we can stop this.”