Late last month, 23-year-old Robin Westman, born Robert, opened fire in a Minneapolis church, a massacre that left two children dead. Westman ended the rampage by taking his own life. He left behind a grieving community and a trail of questions with no clear answers.
Much about Westman’s background remains uncertain, including what kind of mental-health treatment, if any, he received. What has emerged, however, is a troubling record of violent ideation, instability, and missed opportunities for intervention.
Former school employees, teachers, and classmates recalled early warning signs: Westman was antisocial, engaged in self-harm, and was frequently sent to the principal’s office for disruptive behavior.
His journals reveal that he was deeply disturbed from a young age. His preoccupation with school shooters, he wrote, began in the seventh grade. That year, after asking a classmate where she would hide during a school shooting, he was suspended for a week—but said he didn’t recall being referred to a therapist.
The violent fantasies continued as he moved through multiple schools and into adulthood. “Every school I went to, I have some fantasy at some point or another of shooting up my school. Even every job,” he wrote.
In high school, Westman’s mother was reportedly concerned about his behavioral and social issues. Westman himself later wrote that his mother could have anticipated the attack “due to my rocky past with violent threats.” Police were called to his home numerous times, though it’s unclear whether those calls concerned him or his siblings. At 17, he legally changed his name to Robin to reflect a female transgender identity, then abandoned that identity in adulthood.
Taken together, these details reveal a young person in need of serious intervention. In a video uploaded shortly before the attack, Westman whispered, “there’s bugs in my skin,” which suggests he may have been experiencing psychotic symptoms. He stated in his journals that he needed help but does not appear to have sought treatment. Instead, Westman wrote that he avoided therapy and confiding in family because he feared being “reported and put on a watchlist.”
Sarah Reely, Westman’s art teacher when he was a ninth-grade student at St. Thomas Academy in 2017, remembered him as a troubled youth. “Every murderer was once a kid in someone’s classroom who needed help,” she wrote in a Facebook post. She observed that the national conversation after the shooting quickly split along partisan lines: the Left focused on gun laws, while the Right pointed to transgender ideology.
Both narratives contain some truth—Westman obtained firearms with disturbing ease, and his fixation on a trans identity may have deepened his mental health challenges. But, as Reely emphasized, the central issue was the absence of timely, intensive mental-health support.
“At-risk youth fall through the cracks,” she wrote, pointing to year-long waitlists, the difficulty of navigating resources, and the prohibitive costs of evaluation and treatment without insurance—each of which have contributed to Minnesota’s broader mental-health crisis.
In the wake of the tragedy, First Lady Melania Trump called for more early detection and awareness of behavioral warning signs in youth. That is a necessary first step. But for children with persistent and escalating struggles like those seen in Westman, what must follow is access to intensive treatment.
Residential treatment is one of the few settings equipped to help youth with significant mental health and behavioral challenges that cannot be addressed in outpatient care. It encompasses programs that provide 24-hour, individualized support for children in psychiatric crisis as well as teens whose behavior has become dangerous, aggressive, or unmanageable at home and school.
Yet access to this type of care has steadily eroded. According to AspireMN, the statewide association of service providers, Minnesota had nearly 2,500 licensed residential beds in 2005. By 2023, that figure fell to 1,586—a 36 percent decline.
The group identifies staffing shortages as the primary barrier to children’s residential mental health care. Even where beds exist, many remain empty because facilities cannot hire or retain enough qualified staff. Some institutions report having lost more than half their capacity.
With too few residential beds, Minnesota increasingly sends children out of state. Other kids spend months on waitlists, board in emergency rooms, or end up in juvenile detention when no treatment bed is available. According to the Star Tribune, some 12,000 children in Minnesota boarded in hospitals in 2023 for days, weeks, or even months. At Children’s Minnesota alone, kids collectively spent over 1,600 days waiting for an open placement, and emergency mental health visits have nearly doubled in just five years.
Many youth now board in juvenile detention centers due to lack of bed space; according to one estimate, as many as 20 percent of children in detention centers are there “due to their mental illness.” Capacity in facilities that serve court-involved youth has also declined by as much as 40 to 50 percent since 2015, according to a special report by the Star Tribune.
Some of these facilities were shuttered due to policymakers’ opposition to institutional care. With no adequate replacements, the closures have left another critical gap in the system.
When families cannot secure timely access to residential care on their own because of cost or lack of availability, the child protection system often becomes the only entry point. Parents sometimes feel forced to relinquish custody just to get help. Data from Minnesota’s Department of Children, Youth, and Families show that nearly 12 percent of foster care entries last year involved children placed not because of abuse or neglect, but for treatment.
The decline in residential treatment is the result of policy choices and a workforce in crisis. Minnesota, like many progressive states, has grown reluctant to place children in residential programs, often equating them with “institutionalization.” In line with the federal Family First Prevention Services Act, which limits federal support for residential care and directs it instead toward outpatient treatment and community-based services, Minnesota reported a 32 percent drop in youth entering out-of-home care between 2018 and 2022.
State policymakers resisted building Psychiatric Residential Treatment Facilities—a Medicaid-funded program created to serve youth with severe psychiatric needs—for nearly two decades after the designation was established, not opening the first one until 2018. As a result, the state lacks the infrastructure to meet demand, though efforts are now underway to expand capacity.
Guided by a philosophy that assumes any time away from home is harmful, the state has prioritized family- and community-based care, even when these are insufficient. Though state law requires that admission to residential treatment be based on clinical need, county case managers and insurers often insist that a youth must first “fail” multiple community-based services before approval is granted. For those who do receive care, the target is discharge within one to three months—far less than the six months that research shows are needed to sustain progress and prevent readmission.
This philosophy has devastating consequences in practice. Earlier this year, The Imprint reported on a 15-year-old Minnesotan boy with multiple psychiatric diagnoses who had exhausted practically every community-based service available and had made repeated psychiatric ER visits. His condition continued to deteriorate. Eventually, he was charged with domestic assault and sent to juvenile detention, where he has remained for the past year. He was institutionalized—but instead of receiving treatment in a therapeutic setting, he now faces the justice system.
Minnesota’s challenges mirror a national trend. More than 61 percent of the nation’s residential treatment facilities have closed since 2010. Across the country, residential care has been overshadowed by its association with the so-called “troubled teen industry,” as activists conflate today’s licensed programs—even high-quality ones— with unregulated programs of the past.
The narrative that abuse is widespread in these settings persists despite being empirically unfounded. Emotionally charged accounts dominate the debate, but treatment providers often cannot respond publicly because of privacy laws. This has left regulators operating in an atmosphere shaped more by anecdote than evidence, prompting them at times to shutter programs unnecessarily.
Meantime, staff turnover has surged at these facilities. Residential treatment centers have always struggled to retain workers, but public distrust has made it even harder. Employees are paid poorly, must manage aggressive youth, and sometimes sustain injuries that take them out of the workforce. Laws in some states restricting the use of restraints have further compromised staff safety. Workers are also subjected to formal abuse investigations—sometimes triggered by minor incidents or unfounded allegations—that can place them on unpaid leave. The cumulative effect is a demoralized workforce in a profession many enter out of a genuine desire to help profoundly troubled children.
Thinking of residential treatment as inherently harmful, or as something that should be used only as a last resort, is misguided. The sector has evolved significantly over the years and now encompasses a wide range of treatment models and evidence-based practices. Programs combine individual and group therapy, psychiatric oversight, and accredited schooling, and research shows that many youth leave having made measurable gains.
In the aftermath of tragedies like the Minneapolis church shooting, the debate often narrows to guns or culture. Both matter, but they are not the whole story. The deeper problem is untreated serious mental illness, compounded by the systematic dismantling of residential treatment and psychiatric hospitals. Rebuilding this capacity will require political courage: acknowledging that not all youth can be served in outpatient settings, updating reimbursement rates, easing unnecessary regulatory burdens, and ensuring that families can access treatment without waiting months.
Westman’s journals reveal a young man in profound distress. Whether or not he ever received treatment, his decline and the lives he took remind us what is at stake in the debate over residential treatment. Without renewed investment in intensive care, more young people will fall through the cracks, and more communities will grieve preventable tragedies. Will we act before the next headline forces us to ask, once again: How did so many warning signs get missed?
Photo by Elizabeth Flores/The Minnesota Star Tribune via Getty Images
