Mental health services are frequently scrutinized following mass school shootings. Subsequently, national, federal, state, and local commissions convene to identify preventative measures including implications for mental health. In order to address the question of what recommendations were offered to mental health professionals, a systematic review of commission reports covering multiple school shootings was conducted. After a comprehensive database search, 16 qualifying reports covering incidents from 1974 through 2018 were identified and reviewed. Several themes emerged, which are pertinent to mental health providers. Suggestions included expanding access to counseling, increasing training of school personnel on threat assessment and mental illness, using interdisciplinary threat assessment teams, monitoring and following up on treatment plans, expanding involuntary treatment, implementing bullying prevention, and increasing interdisciplinary communication.