海角大神

Amid the grief and shock that hung over Germany in 2009, after a student stormed into his own school in Winnenden and shot dead 15 peers, staff, and others, was also a nagging question for psychiatrists like Joachim Nitschke.

Dr. Nitschke spent a career working in a high-security hospital for the dangerously mentally ill, usually sent听by the police or the court system.听 鈥淚t occurred to me we always reacted too late,鈥� says the forensic doctor. 鈥淲e needed a different approach.鈥�

Stirred by the Winnenden attack, he started a clinic where patients are treated at home, with doctors and social workers visiting them, instead of being institutionalized. He has since treated 200 cases, and Bavaria is creating four new centers, modeled on his clinic.

It鈥檚 just one of the ways that Europe preempts tragedy at the hands of those suspected of being dangerous to society because they are mentally ill or deeply emotionally troubled.

Europe has suffered much less gun violence than the United States, in part due to the types of weapons-restrictions laws that American students demanded in the 鈥淢arch for Our Lives鈥� protests in cities across North America Saturday. But there is a mental health care component as well. A big part of prevention in countries like Germany (where mass shootings have occurred) and Switzerland (where gun ownership is widespread) revolves around the psychological clues that potential perpetrators leave and the responsibility society has to recognize and report them, so they can be helped before harm comes to anyone.

Schools needed to 'be more awake'

Winnenden is an idyllic southern German town of rolling vineyards and half-timbered homes. And now it鈥檚 also infamous, after Tim Kretschmer entered the Albertville School and killed 12 people, before killing three more while on the run, this month nine years ago.

It wasn鈥檛 so different from what happened in Parkland, Florida, at Marjory Stoneman Douglas High School last month, says Gisela Mayer, whose daughter Nina, a teacher trainee, was one of the victims at Winnenden.

One thing that always ties mass shootings together, she says, whether in Winnenden or Oslo or Parkland, is access to weapons. But another is psychological cues of emotional distress, which Ms. Mayer took on with her non-profit听Foundation against School Violence, part of a wider German response around psychology and prevention when it comes to violence. 鈥淭here are warning signs, but nobody detects them,鈥澨齭he says.

That鈥檚 what a 3 million euro, German government-sponsored research project sought to change. For three years, a team of police officers, psychiatrists, and researchers combed through the personal histories of perpetrators of mass shootings in Germany from 1993 to 2013 to build a sharper profile of the perpetrators. They found that while the perpetrators were not mentally ill in the pathological sense of the term 鈥� they were not psychopaths, for example 鈥� they were deeply emotionally troubled. Most were ostracized and hateful of everything.

Schools needed to 鈥渂e more awake,鈥� says criminologist Britta Bannenberg of the University of Giessen near Frankfurt, who coordinated the research project. Crisis intervention teams were established in schools in various regions in Germany. Dr. Bannenberg herself created a national, voluntary hotline for people concerned about the potential for violence. When a distraught parent calls up, she and her team refer them to the right person, including the police, who can go to the person鈥檚 house and check for weapons, or search the computer for suspicious websites.

Experts say that privacy and doctor confidentiality have been issues in Germany, including the case of the Germanwings pilot who slammed into the Alps, killing everyone on board. But that is changing. The key to the German approach is making sure that no opportunity for detecting troubled youth is overlooked 鈥� by parents, teachers, or students. And if warning signs are seen, a whole team of people, with a range of expertise, can be brought in: teachers and parents if emotional support is needed, police if there's need for legal action, and mental health experts should treatment be necessary.

Swiss screening

That link between health professionals and authorities is a key to gun safety in Switzerland, which unlike most of Europe has one of the highest per capita rates of gun ownership in the world 鈥� after the US and Yemen, according to the Small Arms Survey. The prevalence of guns here is rooted in Swiss tradition of compulsory military service for men. That means most Swiss gun owners are psychologically screened.

There have been mass shootings in Switzerland, including one in 2001 that took 14 lives in the local parliament in Zug, but never in a school.

In Switzerland, doctors are encouraged to inform the police if they believe a person could be a danger to himself or someone else. In that case, police, under the Swiss Weapons Act of 1999, have the right to investigate and take an individual鈥檚 arms away, says Lulzana Musliu, a spokeswoman for the Federal Office of Police in Bern. (Germany has similar laws.)

Philip Jaff茅, a forensic psychologist in Switzerland, says this underlines a responsible gun culture, based on trust, on display in his country. 鈥淐onfidentiality ends with the level of threat that the person may represent, which makes a lot of sense,鈥� he says. 鈥淲ho can evaluate the threat level better than a physician?鈥�

There is no national arms registry in Switzerland 鈥� the idea was rejected in a 2011 referendum 鈥� but there is an information system where all refusals for firearm permits, including for psychological or criminal reasons, are listed. The police have access to this information system, which is consulted each time someone wants to purchase a firearm. 鈥淚f, for example, I am in Zurich and I want to get an arm, but they can see I鈥檓 a violent person, I have beaten up my wife, I won鈥檛 get the arm, and not in another canton either, because all of the systems of the police are linked,鈥� Ms. Musliu says.

Sara Miller Llana/海角大神

Gaston Poyet, who has run this family store in an arcade in downtown Bern, Switzerland, sells a hunting rifle to a customer who turns his 鈥渃lean鈥� criminal record over. All the paperwork will then go to the police of Bern. He says when his father opened this store in the 1950s, all they took down was a name.

Fewer people fall out of the social safety network in much of Europe, including Switzerland and Germany. 鈥淲e know to a large degree people with mental illness [in Switzerland] have services that take care of them, they don鈥檛 generally fall between the cracks,鈥� says Dr. Jaff茅. 鈥淭here is not a big population of drifters.鈥�

Of course there are always exceptions and room for mistakes, says Gaston Poyet, who owns a family-run gun shop in the upscale center of Bern. He accepts a steady tightening of gun control measures and background checks in Switzerland over the past two decades, a far cry from when his father started the business in the 1950s and hardly a question was asked. 鈥淧eople today are quicker to hurt somebody,鈥� Mr. Poyet says.

Preemptive prevention

That is where Germany is trying to make a difference. Dr. Nitschke says only 2 percent of those diagnosed with mental illness are considered a danger to a public.听But there are many vulnerable members of society, especially impressionable teens who are deeply disturbed and could become a threat.

At Friedrich Schiller High School in Ludwigsburg, about 12 miles west of Winnenden, Marion Werling-Barth is carrying out her role in prevention with her class, 鈥淏ecoming an Adult.鈥�

The class, which is offered in every secondary school in the region, is part of a package of initiatives by the state of Baden-W眉rttemberg after the Winnenden shooting, including hiring more school psychologists. It also established crisis intervention teams in most of its 3,850 public schools. Ms.听Werling-Barth is one of hundreds of 鈥減revention advisers鈥� and is not just in charge of her students鈥� emotional well-being; she is charged with calling a psychologist or the police if need be.

On this day she starts her class with the memory of the shooting in Winnenden, and tells her pupils about the boy who had no one he trusted, who felt 鈥渞ejected.鈥�

Every year on March 11, Albertvillle School pupils organize a memorial ceremony. This year the candlelight march was also dedicated to the American youth planning to head to the streets in Washington on Saturday.

Tenth grader Lisa G盲rstlauer wasn鈥檛 at the school yet nine years ago. But what she鈥檚 learned over the past years is that to prevent another tragedy, the most important thing is to better bond with her classmates. 鈥淭here should be no bullying anymore,鈥� she says.

Ms. Mayer agrees. 鈥淔eeling ostracized is the worst injury you can suffer from in this society. You don't belong and start hating everything. Hatred turns into revenge,鈥� she says.

One of the classrooms where students were killed remains the way it was on March 11, 2009 at 9:33 am. There are pieces of paper with the names of the victims, as well as a candle and flowers, on each desk. On the wall hang words from French writer Antoine de Saint-Exup茅ry's 鈥淭he Little Prince鈥�: 鈥淚t is only with the heart that one can see rightly.鈥�

But one thing is gone. The bullet hole that hit the wall. To have left it would have focused attention on the perpetrator, not the victims.