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Practitioners’ Perspective on Extreme Risk Protection Orders

Practitioners’ Perspective on Extreme Risk Protection Orders Invited Commentary | Public Health David D. Martin, JD; Kimberly L. Wyatt, JD; Sandra B. Shanahan, MSW The article “Assessment of Extreme Risk Protection Orders in California From 2016 to 2019” by Pallin Related article et al is an important contribution to understanding state-level extreme risk protection order (ERPO) Author affiliations and article information are adoption. We write to encourage more analysis at the practitioner level. As much as ERPO data are listed at the end of this article. needed, a just ERPO process is foundational to building public trust in this lifesaving tool. Intervening in high-risk situations with ERPOs will prevent firearm deaths because most are, in fact, preventable. To build legitimacy of the ERPO as a tool, we need data paired with transparency and insight about the procedures and processes at the practitioner level. Data must include collecting and analyzing procedures and processes used by practitioners, how the law affected people at their lowest points, and how ERPOs saved lives and prevented future harm. Every firearm death tells a story of suicide, violence, or mass shooting. ERPOs offer a tool to intervene and disrupt these stories from unfolding while also protecting people’s constitutional rights. ERPOs prevent the escalation of violence because they allow family members and law enforcement officers (who see warning signs) to come before a court and petition for a temporary order that blocks the at-risk individual from purchasing and possessing the most dangerous, efficient, and lethal of weapons: firearms. Due process is built into every step because judicial officers oversee each phase. While not a panacea, the ERPO is a critical legal tool many states have recently adopted, using due process to temporarily limit an individual (who is engaging in behaviors that are a threat to self or others) from possessing firearms. To accomplish this, we need community awareness of ERPOs as a credible tool and public trust in its implementation. Unfortunately, some see any effort to intervene to prevent gun violence as an attack on their community, rights, and beliefs. Changing that perception and building the legitimacy of ERPOs will require analysis of the procedures and overall processes : how were the orders obtained, and were procedurally just steps taken between legal actors and members of the public? Transparency allows the public to put themselves in the shoes of a loved one or a law enforcement officer to determine whether they too would have concerns about the individual’s access to firearms during that period of crisis. For perspective, temporarily removing firearms under these circumstances often pales in comparison to loss of life by suicide, involuntary commitment, or time in prison because of a homicide or serious injury to the public. The loss of firearm rights with the use of an ERPO is temporary; most last for 1 year. As a multidisciplinary team addressing gun violence, we know firsthand that we rarely have the opportunity to intervene before gun violence occurs. Instead, we react only after it takes place. There are few, brief windows of opportunity to intervene to prevent future harm. ERPOs create an opportunity for a meaningful pause to assess the risk and ensure immediate safety—to prevent suicide, homicide, and community violence. While there is much promise with ERPOs, the key to adoption is not just data about who and how many; we need real stories to accompany data. The daily reality of ERPO cases in King County, Washington, illustrates a range of emergent, high-risk situations across a variety of applications. In both 2018 and 2019, law enforcement was the most common petitioner for ERPOs. In 2018, most (45%) were sought in response to individuals exhibiting suicidal ideation or making suicide attempts. In 2019, that percentage represented 31% of cases. The other broad themes include cases involving threats to others (33% in 2018, 31% in 2019) and threats to self and others (22% in 2018, 35% in 2019). Requests for ERPOs come from those most likely to be alerted to concerning changes in behavior or threats: medical professionals, who are concerned about a patient’s suicidal ideation; Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2020;3(6):e208021. doi:10.1001/jamanetworkopen.2020.8021 (Reprinted) June 18, 2020 1/2 JAMA Network Open | Public Health Practitioners’ Perspective on Extreme Risk Protection Orders intimate partners or families, who observe the words, actions, or behaviors of a loved one that involve threats of self-harm or harm to others; and law enforcement officers, who find people at the lowest point of a behavioral health or substance abuse crisis, which manifest in threats to harm themselves or others. Each case involves possession, access to, or a stated desire to obtain firearms. Although the facts giving rise to these cases are different, there are common threads among them. In each, brief windows of opportunity were taken advantage of in a responsible and procedurally just way. All involve someone in a behavioral health crisis with access to firearms or a desire to obtain them. Some individuals have no objection to the ERPO and express gratitude that someone cared enough to make sure they did not have access to a gun. Every case illustrates how the law was used to prevent harm to self or others by temporarily removing and preventing purchase or possession of firearms. Inviting transparency raises awareness of ERPOs and promotes procedurally just processes. We build legitimacy when we show, in practice, how families with loved ones in a behavioral health crisis can use tools like the ERPO to temporarily prevent access, possession, and purchasing of firearms to help save their loved ones’ lives. Without ERPOs, we are often helpless in preventing a suicide or homicide from occurring. Families with loved ones in behavioral health crisis need tools, like ERPOs, to save lives. Few people who attempt suicide and survive go on to attempt again. This is in stark contrast with common myths about suicide in our country. Unfortunately, those who attempt with firearms rarely survive because of their lethality. ERPO laws work and save lives by making firearms, the most lethal means, unavailable to those at their lowest point. Changing perceptions of skeptics will depend on serious studies, like those described earlier, and by showing procedurally just ERPO use between legal actors and the public. Sharing the daily reality of ERPOs and the temporary removal of firearms from these volatile situations is critical to building their legitimacy as a tool to save lives. ARTICLE INFORMATION Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.8021 Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Martin DD et al. JAMA Network Open. Corresponding Author: David D. Martin, JD, Domestic Violence Unit and Regional Domestic Violence Firearms Enforcement Unit, King County Prosecuting Attorney’s Office, W554 516 Third Avenue, Seattle, WA 98104 (david. martin@kingcounty.gov). Author Affiliations: Domestic Violence Unit and Regional Domestic Violence Firearms Enforcement Unit, King County Prosecuting Attorney’s Office, Seattle, Washington. Conflict of Interest Disclosures: None reported. REFERENCES 1. Pallin R, Schleimer JP, Pear VA, Wintemute GJ. Assessment of extreme risk protection order use in California from 2016 to 2019. JAMA Netw Open. 2020;3(6):e207735. doi:10.1001/jamanetworkopen.2020.7735 2. Swanson JW, Norko MA, Lin HJ, et al. Implementation and effectiveness of Connecticut's risk-based gun removal law: does it prevent suicides? Law Contemp Probs. 2017;80(2):179. Accessed May 18, 2020. https://lcp.law. duke.edu/article/implementation-and-effectiveness-of-connecticuts-risk-based-gun-removal-law- swanson-vol80-iss2/ 3. De Cremer D, Tyler TR. The effects of trust in authority and procedural fairness on cooperation. J Appl Psychol. 2007;92(3):639-649. doi:10.1037/0021-9010.92.3.639 4. Owens D, Horrocks J, House A. Fatal and nonfatal repetition of self-harm: systematic review. Br J Psychiatry. 2002;181(3):193-199. doi:10.1192/bjp.181.3.193 5. Betz ME, Miller M, Barber C, et al; ED-SAFE Investigators. Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers. Depress Anxiety. 2013;30(10):1013-1020. doi:10.1002/da.22075 6. de Moore GM, Plew JD, Bray KM, Snars JN. Survivors of self-inflicted firearm injury: a liaison psychiatry perspective. Med J Aust. 1994;160(7):421-425. doi:10.5694/j.1326-5377.1994.tb138267.x JAMA Network Open. 2020;3(6):e208021. doi:10.1001/jamanetworkopen.2020.8021 (Reprinted) June 18, 2020 2/2 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Network Open American Medical Association

Practitioners’ Perspective on Extreme Risk Protection Orders

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American Medical Association
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Copyright 2020 Martin DD et al. JAMA Network Open.
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2574-3805
DOI
10.1001/jamanetworkopen.2020.8021
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Abstract

Invited Commentary | Public Health David D. Martin, JD; Kimberly L. Wyatt, JD; Sandra B. Shanahan, MSW The article “Assessment of Extreme Risk Protection Orders in California From 2016 to 2019” by Pallin Related article et al is an important contribution to understanding state-level extreme risk protection order (ERPO) Author affiliations and article information are adoption. We write to encourage more analysis at the practitioner level. As much as ERPO data are listed at the end of this article. needed, a just ERPO process is foundational to building public trust in this lifesaving tool. Intervening in high-risk situations with ERPOs will prevent firearm deaths because most are, in fact, preventable. To build legitimacy of the ERPO as a tool, we need data paired with transparency and insight about the procedures and processes at the practitioner level. Data must include collecting and analyzing procedures and processes used by practitioners, how the law affected people at their lowest points, and how ERPOs saved lives and prevented future harm. Every firearm death tells a story of suicide, violence, or mass shooting. ERPOs offer a tool to intervene and disrupt these stories from unfolding while also protecting people’s constitutional rights. ERPOs prevent the escalation of violence because they allow family members and law enforcement officers (who see warning signs) to come before a court and petition for a temporary order that blocks the at-risk individual from purchasing and possessing the most dangerous, efficient, and lethal of weapons: firearms. Due process is built into every step because judicial officers oversee each phase. While not a panacea, the ERPO is a critical legal tool many states have recently adopted, using due process to temporarily limit an individual (who is engaging in behaviors that are a threat to self or others) from possessing firearms. To accomplish this, we need community awareness of ERPOs as a credible tool and public trust in its implementation. Unfortunately, some see any effort to intervene to prevent gun violence as an attack on their community, rights, and beliefs. Changing that perception and building the legitimacy of ERPOs will require analysis of the procedures and overall processes : how were the orders obtained, and were procedurally just steps taken between legal actors and members of the public? Transparency allows the public to put themselves in the shoes of a loved one or a law enforcement officer to determine whether they too would have concerns about the individual’s access to firearms during that period of crisis. For perspective, temporarily removing firearms under these circumstances often pales in comparison to loss of life by suicide, involuntary commitment, or time in prison because of a homicide or serious injury to the public. The loss of firearm rights with the use of an ERPO is temporary; most last for 1 year. As a multidisciplinary team addressing gun violence, we know firsthand that we rarely have the opportunity to intervene before gun violence occurs. Instead, we react only after it takes place. There are few, brief windows of opportunity to intervene to prevent future harm. ERPOs create an opportunity for a meaningful pause to assess the risk and ensure immediate safety—to prevent suicide, homicide, and community violence. While there is much promise with ERPOs, the key to adoption is not just data about who and how many; we need real stories to accompany data. The daily reality of ERPO cases in King County, Washington, illustrates a range of emergent, high-risk situations across a variety of applications. In both 2018 and 2019, law enforcement was the most common petitioner for ERPOs. In 2018, most (45%) were sought in response to individuals exhibiting suicidal ideation or making suicide attempts. In 2019, that percentage represented 31% of cases. The other broad themes include cases involving threats to others (33% in 2018, 31% in 2019) and threats to self and others (22% in 2018, 35% in 2019). Requests for ERPOs come from those most likely to be alerted to concerning changes in behavior or threats: medical professionals, who are concerned about a patient’s suicidal ideation; Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2020;3(6):e208021. doi:10.1001/jamanetworkopen.2020.8021 (Reprinted) June 18, 2020 1/2 JAMA Network Open | Public Health Practitioners’ Perspective on Extreme Risk Protection Orders intimate partners or families, who observe the words, actions, or behaviors of a loved one that involve threats of self-harm or harm to others; and law enforcement officers, who find people at the lowest point of a behavioral health or substance abuse crisis, which manifest in threats to harm themselves or others. Each case involves possession, access to, or a stated desire to obtain firearms. Although the facts giving rise to these cases are different, there are common threads among them. In each, brief windows of opportunity were taken advantage of in a responsible and procedurally just way. All involve someone in a behavioral health crisis with access to firearms or a desire to obtain them. Some individuals have no objection to the ERPO and express gratitude that someone cared enough to make sure they did not have access to a gun. Every case illustrates how the law was used to prevent harm to self or others by temporarily removing and preventing purchase or possession of firearms. Inviting transparency raises awareness of ERPOs and promotes procedurally just processes. We build legitimacy when we show, in practice, how families with loved ones in a behavioral health crisis can use tools like the ERPO to temporarily prevent access, possession, and purchasing of firearms to help save their loved ones’ lives. Without ERPOs, we are often helpless in preventing a suicide or homicide from occurring. Families with loved ones in behavioral health crisis need tools, like ERPOs, to save lives. Few people who attempt suicide and survive go on to attempt again. This is in stark contrast with common myths about suicide in our country. Unfortunately, those who attempt with firearms rarely survive because of their lethality. ERPO laws work and save lives by making firearms, the most lethal means, unavailable to those at their lowest point. Changing perceptions of skeptics will depend on serious studies, like those described earlier, and by showing procedurally just ERPO use between legal actors and the public. Sharing the daily reality of ERPOs and the temporary removal of firearms from these volatile situations is critical to building their legitimacy as a tool to save lives. ARTICLE INFORMATION Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.8021 Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Martin DD et al. JAMA Network Open. Corresponding Author: David D. Martin, JD, Domestic Violence Unit and Regional Domestic Violence Firearms Enforcement Unit, King County Prosecuting Attorney’s Office, W554 516 Third Avenue, Seattle, WA 98104 (david. martin@kingcounty.gov). Author Affiliations: Domestic Violence Unit and Regional Domestic Violence Firearms Enforcement Unit, King County Prosecuting Attorney’s Office, Seattle, Washington. Conflict of Interest Disclosures: None reported. REFERENCES 1. Pallin R, Schleimer JP, Pear VA, Wintemute GJ. Assessment of extreme risk protection order use in California from 2016 to 2019. JAMA Netw Open. 2020;3(6):e207735. doi:10.1001/jamanetworkopen.2020.7735 2. Swanson JW, Norko MA, Lin HJ, et al. Implementation and effectiveness of Connecticut's risk-based gun removal law: does it prevent suicides? Law Contemp Probs. 2017;80(2):179. Accessed May 18, 2020. https://lcp.law. duke.edu/article/implementation-and-effectiveness-of-connecticuts-risk-based-gun-removal-law- swanson-vol80-iss2/ 3. De Cremer D, Tyler TR. The effects of trust in authority and procedural fairness on cooperation. J Appl Psychol. 2007;92(3):639-649. doi:10.1037/0021-9010.92.3.639 4. Owens D, Horrocks J, House A. Fatal and nonfatal repetition of self-harm: systematic review. Br J Psychiatry. 2002;181(3):193-199. doi:10.1192/bjp.181.3.193 5. Betz ME, Miller M, Barber C, et al; ED-SAFE Investigators. Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers. Depress Anxiety. 2013;30(10):1013-1020. doi:10.1002/da.22075 6. de Moore GM, Plew JD, Bray KM, Snars JN. Survivors of self-inflicted firearm injury: a liaison psychiatry perspective. Med J Aust. 1994;160(7):421-425. doi:10.5694/j.1326-5377.1994.tb138267.x JAMA Network Open. 2020;3(6):e208021. doi:10.1001/jamanetworkopen.2020.8021 (Reprinted) June 18, 2020 2/2

Journal

JAMA Network OpenAmerican Medical Association

Published: Jun 18, 2020

References