We are psychiatrists and allied mental health professionals, not politicians or lawyers. However, to do our work we need to understand legal issues and the legal system. Most of the time, this involves understanding laws related to involuntary treatment, obligations to notify potential victims of violence, capacity to accept/refuse treatment, etc. But when a problem like gun violence takes such a massive toll on our patients and communities, we need to understand laws and policies related to gun violence prevention and firearm regulation as well. Our aim is to treat gun violence as a public health crisis, with potential public health solutions that include better policies, just like many other public health problems in the US. The US Surgeon General agrees with this framing, and has declared gun violence a public health crisis. See the advisory here.

First, it is important to know that policies aimed at preventing gun violence do work. For example, a review and meta-analysis examining the findings from 130 studies from 10 countries published between 1950 and 2014 concluded that laws that restrict access to and govern the use of guns are associated with reductions in gun-related deaths, lower rates of intimate partner homicide, and reductions in unintentional gun-related deaths of children.

Another study in the United States (US) showed that states that have stricter gun reform laws have lower homicide rates and lower gun-related suicide rates, and that gun death rates decrease following the passing of the legislation.

The Israeli Defense Force changed its policy in 2006 to require that soldiers leave their guns on the base when they went home on weekends. This resulted in a 40% drop in annual suicides among soldiers, with the entire decrease attributable to a reduction in suicides on the weekends.

An example of effective gun policy changes on a national level comes from Australia: 

The worst public mass shooting in Australia’s history occurred in 1996, when 35 people were killed and 23 wounded with a semi-automatic rifle while eating lunch at a café. In response, Australia passed legislation banning automatic and semi-automatic rifles and shotguns, established a registry for all guns owned, and required permits for new firearm purchases. In addition, 650,000 guns were removed from communities with a mandatory buy back program. Before the event, 13 mass shootings occurred in Australia in the preceding 18 years, killing 100 people. There have been no public mass shootings since. Also, in 7 years after the law passed, gun homicides dropped by 42% and gun suicides by 57%.

There are many other similar examples. No study is perfect, and most studies have flaws. But the preponderance of evidence suggests that stronger gun laws would help decrease gun violence rates in the US. We could have even stronger evidence for what works to prevent gun violence, but there has been a de facto moratorium on federally funded gun violence prevention research since the US Congress passed the Dickey Amendment in 1996.

One example of a particularly promising law is Extreme Risk Protection Orders (ERPOs), sometimes also referred to as Gun Violence Prevention Restraining Orders. An ERPO is a court-issued order prohibiting people found to be dangerous to themselves or others from purchasing or possessing a firearm. It:

•Entitles a family member, household member, police officer, and/or district attorney to petition a court about the person they are concerned about;

•The court may grant a temporary ERPO if the application presents sufficient evidence of threats, serious bodily harm, attempts at suicide or homicide, or other violent or dangerous behavior to oneself or others.

•If the temporary ERPO is granted by the court, the individual in crisis will also have the right to a hearing. At the hearing, the court will determine whether there is sufficient evidence to grant a final ERPO (time-limited).

As of 2024, ERPO and similar laws have been enacted in 21 states and the District of Columbia.

A 2016 study showed how in Connecticut gun removals from people in crisis may have prevented at least 70 and up to up to 100 suicides, and an update to this study found that for every 22 ERPOs, one suicide is prevented. Another study showed that the law was followed by 40% drop in gun homicides.

Another study examining ERPO laws in Connecticut and Indiana confirmed significant decreases in firearm suicide after the laws were enacted, and people did not appreciably substitute other methods in Indiana. And another study showed that Florida’s ERPO law was associated with a lower-than-expected rate of gun homicides.

However, research has found significant barriers to ERPO implementation, including lack of access to supportive/social services, confusion about the legal proceedings, and petitioner distress, suggesting potential opportunities for improving use of ERPOs.

On February 25, 2025, P4GVP hosted a webinar about ERPOs, entitled, “Red Flag Laws: What Every Psychiatrist Needs to Know,” with national experts from Yale, Drs. Reena Kapoor and Mike Norko. Please find a recording here.

State-level laws have limits, though. 60% of guns used in crimes in Chicago come from outside Illinois, 19% from Indiana (a state with relatively weak gun laws, ERPO notwithstanding). 74% of guns used in crimes in New York come from states with weak gun laws in the South (the “iron pipeline”). 70% of guns used in crimes in Mexico come from US.

Unfortunately, there are many US states that still have dangerous gun laws, and laws in many states have been getting worse over the past few decades:

All 50 states have passed some type of concealed carry law.

31 states have passed laws to allow open carry without any license or permit.

Only 15 states require some type of license or permit to openly carry a gun.

Concealed carry reciprocity passed the House in 2018. Fortunately, it did not pass the Senate, as it would have required all states to recognize concealed carry laws from any other state, creating a “race to the bottom” for gun regulations and undermining laws promoting gun safety in many states.

Four states have passed laws to prevent health care providers from speaking with patients about guns and firearm safety. The “Medical gag law” in Florida was the most aggressive but it was struck down in Federal court.