Experts say the most important thing to do if you suspect that you, or a loved one, might be struggling with mental health is to seek treatment.
They say Maryland is much better off in terms of accessibility of mental healthcare than other states.
"We are very lucky in our state, in Maryland, we have one of the best mental health systems in the country. It's very accessible, it doesn't matter whether you can afford it or not. There is access and one has many options to seek help and we should encourage people to seek help when they need it," Dr. Elias Shaya, Chief of Psychiatry at Medstar Good Samaritan Hospital, said.
However it's getting people to take advantage of that care that may be most challenging.
Police say chilling journal entries prove Darion Aguilar recognized his own mental struggles long before the morning of Jan. 25.
"Certainly the writings that we have seized support that he was dealing with mental health issues, that he had thoughts of suicide. He even acknowledges at some points in his journal that he needs to see a psychiatrist," Howard County Police Chief William McMahon said.
Chief McMahon said there is no evidence that Aguilar ever followed through and saw a mental health professional.
The fact that the shooter knew something wasn't right, along with investigators saying no one in Aguilar's life saw this coming, has many feeling like nothing can be done.
"Feeling helpless is a big part of this because it doesn't make any sense, because it's so difficult to predict, because there are not so many warning signs about it. It makes it so difficult to understand. So difficult to make sense out of it and we end up trying to make sense out of something that doesn't really make sense, in reality," Shaya explains.
But it's so natural for so many.
The most common question immediately after the shooting became 'why?'
Shaya says we will often be disappointed with the answer. He also stresses how rare it is for mental illness to take someone to this point.
"It is much more likely for me to be hit by lightening than it is for me to be shot by a patient with psychiatric disease. That's important to keep in mind so now trying to predict about something that is so rare is a difficult task to do," Shaya says.
So what now?
Is there a way to prevent shootings like the one at Columbia mall?
Shaya says there are specific warning signs with people who are in treatment, but when they're not, it becomes even more difficult.
"It's kind of a balancing act that our society has to walk between what the law says and how we may change that law. At what level do we start taking over the rights of individuals just because they may be showing something that is unusual versus the extreme case, where we may miss opportunities, which again, is rare."
Shaya says the stigma on mental health is diminishing a little but there is still a ways to go.
He says people need to stop separating mental illness from physical illness and treat them both seriously.