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I don't know what the answer is as far institutionalization but it's something worth discussing.

Yep, it's clearly not a general answer. It's "obvious" in the three cases I cited, but even in 20/20 hindsight, under e.g. the old rules, it does not seem like it would have happened with the shooters behind the Charleston, Sandy Hook, and Littleton, Colorado (high school) shootings, and a whole bunch more. Heck, the perpetrator of that incident of "workplace violence" at Fort Hood was himself a psychiatrist, and, not particularly mentally ill.



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