After the recent tragedies in Uvalde and Buffalo, extreme risk protection orders (ERPO), also known as red flag laws, are back on the public agenda. ERPOs can be implemented by police when there is reason to believe that someone who owns a firearm is at immediate risk to themselves or others. Research suggests that ERPOs reduce both suicide and homicide. There is even preliminary evidence to suggest that ERPOs can help prevent mass shootings. However, reduction of suicide is the main focus of ERPO laws, given that suicide represents over half of all deaths involving a firearm. Due to their lethality, guns are responsible over 50% of suicide deaths despite accounting for only 5% of suicide attempts. Although Connecticut has been a leader in creating policy for the use of ERPOs, potential users such as healthcare providers have been slow to take advantage. Our research suggests some potential changes that could make the policy more effective.
After the tragedy at the Connecticut Lottery in 1998 where a lottery worker killed four bosses and himself, Connecticut became the first state in the nation in 1999 to create an ERPO, modeled after domestic violence risk orders. This law required a concerned party to call the police and report that a person is an imminent risk. Police would then investigate and determine whether to remove any firearms from the home.
Two studies have suggested that Connecticut’s ERPO law has helped reduce suicide by firearm. In a review of 762 cases of ERPO being invoked in Connecticut from 1999 to 2006, the authors estimated that one suicide was averted for every 10-20 gun seizures. These authors reported that police removed guns in 99% of the cases reported to them, and removed an average of seven weapons from each home. Another study estimated a modest 1.6% reduction in firearm suicide in Connecticut after the law was enacted, but this went up to 13.7% immediately after the Virginia Tech shooting in 2007, suggesting the efficacy of the law is related to greater enforcement. More research is needed to ensure equitable use of ERPO to avoid disproportionate targeting of communities of color while still serving communities in need, given that young Black men are the group with the fastest rising rates of suicide using firearms.
Connecticut expanded the ERPO law this year, thanks to the work of groups like Connecticut Against Gun Violence. Now, family members and some healthcare professionals (physicians, physician assistants, nurses, psychologists, and social workers) can petition a court for a risk protection order without needing to contact the police directly. The new law also requires a court hearing to determine risk of imminent violence before the firearms are returned.
Health care providers are in a unique position to learn of imminent harm from their patients and are well positioned to use ERPO effectively. Unfortunately, only about 8% of ERPOs are initiated by employers or clinicians. The low usage of ERPO by physicians and employers is probably due to many factors. Many lack knowledge of the law, find it complicated and time intensive to navigate, or worry that invoking ERPO may interfere with the clinical relationship.
As members of the Connecticut Hospital-Based Violence Intervention Program, we recently surveyed 100 Connecticut health care providers at four Connecticut hospitals. The majority of providers had little to no awareness of ERPO laws. 57% stated they were not familiar at all, and only 5% said they were very familiar with ERPO. Most of these providers (57%) stated that they encounter someone who is at imminent risk and owns a firearm a few times per year and about a third (35%) would be likely to use ERPO in these situations. To date, only one respondent has completed an ERPO and that provider found the process to be helpful.
Barriers exist to increasing provider use of ERPO. 25% of respondents shared they would be more likely to use ERPO if they did not have to call the police directly Other barriers include fear of negatively impacting the patient/provider relationship (25%), and time barriers to filing reports and following up (20%). Respondents do express a desire for further training in ERPO (26%), connection with trained coordinator at their health care facility to walk them through the process (20%), and specific institution-led policies for providers to follow (15%).
As discussions ramp up to consider a nationwide ERPO policy, Connecticut can be proud of serving as a leader. The policy has helped save lives in Connecticut could help reduce gun deaths across the country. Connecticut’s new expansion of their ERPO law is a welcome change that should be a model for states looking to create policy to reduce gun deaths. This policy can become even more useful to healthcare providers if healthcare facilities can create institutional policies, disseminate them to providers, families and patients, and create point-people to facilitate provider use of ERPO.
Sarah Raskin is the Charles A. Dana Professor of Psychology and Neuroscience at Trinity College and a member of the Connecticut Chapter of the Scholars Strategy Network.
Nishant Pandya is a pediatrician at Yale New Haven Hospital.