On December 1, 1997, Carneal wrapped a shotgun and a rifle in a blanket and took them to school, passing them off as an art project he was working on.

[11] Carneal told reporters that he could not give a single explanation for his crimes, and that contributing factors included a mistaken belief of his that his parents did not love him, taunting from classmates, and false claims he was gay.

[16][17] Dewey Cornell and Diane Schetky, who evaluated Carneal after the shooting, later changed their diagnosis to schizophrenia.

[16][17] He has been hospitalized several times since the start of his incarceration due to psychosis, and takes the anti-depressant Zoloft and Geodon, an anti-psychotic used to treat schizophrenia.

[18][19] Carneal had in his locker at the time a copy of Stephen King's novel Rage, first published in 1977 under the pseudonym Richard Bachman.

According to prosecutor Tim Kaltenbach, the plea allows Carneal to receive mental health treatment during imprisonment as long as this is necessary for him or until he is released.

[23] In 2007, Carneal filed an appeal claiming that he was too mentally ill to plead guilty to the shooting at Heath High School.

[25][26][27] The "serve out" ruling, under Kentucky law, means the inmate in question cannot be considered for any future parole hearings (though commutation or a pardon from the governor is still possible).

At the time of settlement Carneal had no assets and his family's insurance company, Kentucky Farm Bureau, has insisted repeatedly through court motions that it is not liable for his actions.

[29] In early 1999, the parents of three victims represented by Jack Thompson filed a $33 million lawsuit against two Internet pornography sites, several computer game companies and makers and distributors of the 1994 film Natural Born Killers and the 1995 film The Basketball Diaries.

[30] Both Thompson[31] and United States Attorney General John Ashcroft claimed Carneal's proficient marksmanship was due to practice in violent video games.