I worked in an institutional hospital in Florida which housed individuals identified through the court system as insane and therefore incompetent to proceed to trial. Most of them were paranoid schizophrenics. When the disorder is exacerbating, it is not a difficult diagnosis to make and at the same time not easy to fake.
Trust me when I say these people were not responsible for their crimes. Typically they had perpetrated what in their mind was either a first strike assault/murder to avoid a perceived coming attack, or their voices were telling them that they were on a special assignment from god to eradicate someone evil.
I wish professionals working in law enforcement and schools knew the age of onset and how to determine whether individuals with mental health symptoms in high school, college and the armed services who might have such a problem. These people have symptoms easily recognizable to someone who knows how to interview.
Very commonly shooters who go on a rampage have already come the attention of law enforcement or mental health providers who lack adequate training for needed screening.
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