Multiple-homicide school shootings are rare events, but when they happen they significantly impact individuals, the school and the community. The authors focus on multiple-homicide incidents and identified mental health issues of shooters. To date, studies of school shootings have concluded that no reliable profile of a shooter exists, so risk should be assessed using comprehensive threat assessment protocols. Existing studies primarily utilize retrospective case histories or media accounts. The field requires more empirical and systematic research on all types of school shootings including single victim incidents, those that result in injury but not death and those that are successfully averted. The authors discuss current policies and practices related to school shootings and the role of mental health professionals in assessing risk and supporting surviving victims. Abstract published by arrangement with Springer.