On a frigid evening in Taipei, chaotic violence broke out at two of the city’s most crowded metro stations. In just a few minutes, lives were lost, numerous individuals sustained injuries, and the inevitable cycle ensued: shock, anxiety, demands for increased security, and inquiries regarding public safety. However, for those of us in the healthcare sector, this should not merely be seen as a shortcoming of policing. It should be acknowledged for what it genuinely represents: a breakdown of the health system well before the first weapon was brandished.

Chaotic violence does not arise spontaneously. It is seldom abrupt and almost never unaccompanied. It frequently signifies the final overt collapse of underlying issues (untreated mental health disorders, social disconnection, disjointed care, and repeated missed chances for timely intervention). Metro stations such as Taipei Main Station and Zhongshan Station are not merely transportation hubs. They function as the nervous systems of the city. When violence occurs in these places, it signifies more than just personal issues; it exposes collective pressures. Overcrowding, anonymity, stress, and alienation converge. When the system falters, the collapse occurs where the signals are most densely packed.

Following every such event, hospitals transform into the ultimate safety net. Emergency departments handle the turmoil. Surgeons work through the night. Intensive care units test their capacities. Mental health experts are called to act, but only after irreversible damage has been inflicted. Healthcare is consistently viewed as a responsive mechanism, relegated to repairs while barred from taking part in prevention.

This trend should alarm clinicians. We are educated to identify warning signals, risk indicators, and trajectories of deterioration. Yet when those very concepts apply beyond the hospital environment (in communities, transit systems, and public areas), we act as if these issues lie outside medicine’s purview. They do not. Mental health cannot be confined to psychiatry alone. It originates in primary care, community engagement, ongoing treatment, and early detection of those slipping out of care. Every untreated psychotic episode, every disrupted follow-up, and every individual lost between systems represents a clinical shortcoming, even if the repercussions occur far from the clinic.

It is disconcerting to raise these inquiries following acts of violence. We dread that acknowledging systemic flaws may seem like making excuses. It is not. Accountability and prevention are not contradictory; they are intertwined. We ought to inquire: Where was this individual months prior to the attack? Were there interactions with the healthcare system that led nowhere? Was treatment inaccessible, interrupted, or disjointed? Did anyone observe, and if so, did the system permit them to take action?

Violence in public transport is not solely a safety concern. It serves as a public health indicator. When mental distress accumulates without accessible care pathways, it does not vanish. It erupts. As clinicians, we cannot restrict our duties to the instant a patient arrives bleeding at the emergency department. If we are sincere about prevention, we must push for mental health systems that operate before a crisis occurs, not in reaction to media coverage.

Hospitals should not be the last bastion of defense. They ought to be part of a continuum that never permits despair to escalate to this level. When random violence flares up in a metro station, it signifies not only a public safety tragedy. It serves as a reminder that medicine, when severed from community and continuity, arrives too late.

Gerald Kuo, a doctoral candidate at the Graduate Institute of Business Administration at Fu Jen Catholic University in Taiwan, specializes in healthcare management, long-term care systems, AI governance within clinical and social care realms, and elder care policy. He is associated with the Home Health Care Charity Association and maintains a professional profile on Facebook, where he shares updates on his research and community initiatives. Kuo assists in running a day-care center for older adults, collaborating closely with families, nurses, and community physicians. His research and practical endeavors focus on minimizing administrative burdens on clinicians, enhancing continuity and quality of elder care, and creating sustainable service models through data, technology, and interdisciplinary cooperation. He is particularly interested in how emerging AI technologies can aid aging clinical workforces, improve care delivery, and foster greater trust between health systems and the general public.