Extreme risk protection orders show potential for reducing firearms-related injury

A descriptive study in Washington State, where an extreme risk protection order law went into effect in December 2016, examined the circumstances in which such orders were filed, as well as characteristics of the respondents.

Extreme risk protection orders (ERPOs), which are used to restrict access to firearms by individuals who pose harm to themselves and others, may have the potential to help reduce firearms-related injury, a recent study found.

Researchers performed a descriptive study of respondents, or those for whom an ERPO had been filed from Dec. 8, 2016 to May 10, 2019, in Washington State. As of May 1, 19 states and the District of Columbia had enacted some version of a risk-based firearm restriction law. In Washington State, which funded the study, an ERPO issued by a judge results in a one-year prohibition on firearms for the respondent. The study's objective was to determine the characteristics of respondents as well as the circumstances in which ERPOs had been filed. Reasons for filing; respondents' characteristics; respondents' reported history of domestic violence perpetration, mental illness, substance misuse, and suicide ideation or attempt; the number and type of firearms removed; and whether the ERPO was granted or not granted were measured. The study was published June 30 by Annals of Internal Medicine.

During the study period, 238 ERPOs were filed in Washington State. Eighty-two percent of the respondents were white, and 48% were between 25 and 44 years of age. Of the 238 ERPOs, 67 were filed due to concern that respondents would harm themselves, 86 were filed out of concern for potential harm to others, and 84 were filed out of concern that respondents would harm both themselves and others.

Eighty-seven percent of ERPOs were filed by law enforcement officers; 81% of ERPOs were granted. Seventy-nine percent of respondents owned a firearm, and 54% had expressed intent to obtain one, according to the petitioners. Sixty-four respondents had at least one firearm removed from them, with 641 firearms removed from respondents in total.

In 24% of cases, the ERPO petitioner reported previous domestic violence on the part of the respondent. In 40% and 47% of cases, the petitioner reported that the respondent had a previous diagnosis of a mental health condition and substance misuse, respectively, and in 62% of cases, the petitioner reported that the respondent had a history of suicide ideation or attempt. Mental health evaluation was ordered by the court as part of the ERPO process in 30% of cases.

The researchers noted that since most of the ERPOs were filed by law enforcement officers, there may be a need for additional public education about ERPOs and how to use them. Some of the ERPOs in the study were filed in court by law enforcement officers after concerned family members called the police, researchers said. Limitations of the study included inconsistent filing of forms, missing information, variation in detail by jurisdiction, and lack of review of law enforcement records.

The authors concluded that laws on ERPOs are a potential tool to help protect patients or family members from harming themselves or others by restricting the possession and purchase of firearms. They called for additional studies to examine the long-term effects of ERPOs on harm from firearm-related injury and death and to determine how to increase their use. “In the meantime, promoting awareness about ERPO laws among various stakeholders, including health professionals, may accelerate the uptake of these laws and translate into improvements in health and well-being among petitioners and respondents who interact with the health care system,” the authors wrote.

An accompanying editorial said the article is an important contribution to the literature and to ongoing policy discussions about ERPOs. They cautioned, however, that including petitioner-reported history of treatment of mental illness as a finding in the absence of additional context may imply that ERPOs are a mental health intervention and may risk further stigmatizing mental illness. “We urge readers to interpret the findings concerning respondents' history of mental health treatment with caution, and encourage future researchers to include information about dangerous behaviors when collecting ERPO data and designing studies to evaluate the impact of ERPOs,” they wrote.

The editorialists also considered the study findings in light of the current nationwide calls for law enforcement reform in the United States and said that ERPOs may provide one example of a way forward, since they involve a police response that is aimed at preventing violence, require judicial oversight, and have therapeutic rather than punitive goals. The editorialists recommended that future studies consider how ERPOs are implemented and perceived in communities of color to help inform discussions about police reform.