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Psychiatric Times
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Extreme risk protection orders may be an effective suicide prevention tool.
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SPECIAL REPORT: FORENSIC PSYCHIATRY PART 2
Extreme risk protection orders (ERPOs) may be an effective suicide prevention tool, according to research published in The Journal of the American Academy of Psychiatry and the Law.
To better understand the impact of ERPOs in preventing suicide by firearms, Jeffrey W. Swanson, PhD, MA, and colleagues conducted an in-depth analysis via a pooled study (N= 4583) across 4 states with ERPOs: California (N=1386), Connecticut (N=1407), Maryland (N=1347), and Washington (N=443). In general, most of the ERPO petitions were completed by law enforcement. Maryland was the exception, with just over half (56.8%) coming from law enforcement and nearly one-third (31.7%) coming from an intimate partner. Of the individuals who suicided (N=45), about half (N=20) was due to firearm injury; 97% of those individuals were male. The average age for those who suicided regardless of method was 43.7.
The study authors also sub-analyzed the pooled sample where there was a baseline concern of suicide (N=2850). In this group, 21 individuals attempted suicide via firearms; and 19 completed suicide, yielding a 90% fatality rate). Swanson et al analyzed the data and found 1 life was saved for every 13 ERPOs issued.
Although they the data support the notion that ERPOs can save lives, the authors cautioned there are other real world factors to consider, including regional variability in issues like ease of obtaining a gun, cultural issues, crime, and the like.
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Pointing to the number of suicides by firearms in this pooled analysis despite the ERPOs, Swanson and colleagues acknowledged the intervention was not 100% successful, although ERPOs do seem to reduce the risk. They further noted that only 8 of the 20 firearm suicides occurred when the ERPO was active, postulating these individuals may have benefited from a renewal of the ERPO.
Known colloquially as “red flag laws,” 21 states in the US currently allow ERPOs, which are “individualized, risk-based, time-limited civil restraining orders that, following due process of law, temporarily makes firearms legally inaccessible for the duration of the order, removing guns and prohibiting their purchase for an individual deemed by a court to pose an imminent risk of harm to self or others.” Although they are most often initiated by law enforcement, some states allow clinicians, family members, and others to petition the court as a result of behaviors that indicate risk of firearm violence. There are no criminal implications associated with ERPOs, unless an individual violates the order.
With more than half (52%) of suicide deaths attributed to firearms, advocates believe ERPOs aid in prevention. Moreover, despite the relatively low rate of firearm use for suicide attempts (approximately 5%), its fatality rate is much higher than other methods. Previous studies have found that “for every 10 to 20 firearm removal actions, 1 life was saved by averting a suicide.”
“ERPOs alone are not a panacea for preventing firearm injury and mortality in the United States, but they are an important piece in the puzzle of gun violence prevention, and this study adds to the evidence suggesting they have saved lives,” the authors concluded. “ERPOs would have a bigger impact if more people on the frontlines of responding when people are behaving dangerously and at risk of suicide or interpersonal violence (eg, clinicians, law enforcement) knew about them and used them, so they could be scaled up and applied to a larger proportion of the population at high risk of gun violence and suicide.”
Reference
Swanson JW, Zeoli AM, Frattaroli S, et al. Suicide prevention effects of extreme risk protection order laws in four states. J Am Acad Psychiatry Law. 2024;52(3):327-337.
