“The underpinnings of violence are often present in some form or another and may be represented by marginalized demeanor and extremist views and often ignored by those in the cross hairs” according to Michael Sefton, Director of Psychological Services at Whittier Rehabilitation Hospital in Westborough, MA.

This quote represents a recurring belief about the evolving coping skill of an active shooter until the very end according to M Sefton.  The terminal event is often preceeded by growing fury and red flag signs of anger.  It suggests that greater awareness by outside observers of sudden changes in mental status should be recognized along with the utilization of stopping and containment protocols and coordination of care in or out of the state correctional system.