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Journal Article

Citation

Frattaroli S, Sharfstein JM. JAMA Health Forum 2021; 2(4): e210948.

Copyright

(Copyright © 2021, American Medical Association)

DOI

10.1001/jamahealthforum.2021.0948

PMID

36218812

Abstract

Recent, widely publicized mass shootings in Atlanta, Georgia, Boulder, Colorado, Orange, California, and elsewhere have resurfaced questions about what can be done to prevent these terrible events. Nineteen states--as politically diverse as Florida and California--have laws on the books to temporarily prohibit gun purchase and possession by people who are behaving dangerously and at risk of committing violence, including self-harm. However, early evidence indicates that few clinicians are aware of how to use this emerging legal tool to prevent violence.

Here are the basics. In each state that has authorized what are called extreme risk protection orders (ERPOs), the law sets out who can file a petition with a civil court about someone of concern. Eligible petitioners always include law enforcement officers; in most states, family members are eligible, and in Hawaii, Maryland, and Washington, DC, clinicians are on the list. The petitions specify the reasons for concern, such as threatening violence, illegally and recklessly brandishing a gun, or articulating a suicide plan. A judge then reviews the request and decides whether to issue an ERPO. In most cases, the petitions are granted, leading to temporary removal of firearms for up to 1 year. After the order has expired, the people on whom restrictions are levied are able to regain possession of their guns and buy new guns. The ImplementERPO website includes detailed information about state ERPO laws.

The ERPO laws are based on public health principles that focus on risk and offer a strategy to reduce the lethality of that risk.1-3 They are a tool for intervening early in the trajectory of violence, before behaviors occur that rise to the level of a crime or life-threatening self-injury. They are also a mechanism for providing help to individuals at risk for committing violence, rather than waiting for tragedies to occur. At the same time, these laws are designed to be fair to individuals and respect their Second Amendment rights.

So far, the ERPO process has been used thousands of times around the country. In one instance, for example, a woman filed an ERPO petition with her husband, who suffered from depression and was experiencing suicidal thoughts. They testified together, with the husband acknowledging the danger of having access to guns at that time in his life. In another instance, law enforcement filed for an ERPO after responding to a call from a university. One student had been making repeated, specific threats to shoot several classmates. His agitated state further amplified the threat, and several students approached a faculty member, who called the police. In a state where clinicians can petition, an ERPO was used prior to discharging a patient who had survived a suicide attempt involving a gun. The clinical team was more comfortable discharging the patient, knowing he would be returning to a home without guns...


Language: en

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