If a patient is at acute risk of violence to self or others, it is an emergency.

In these cases, for example, with patients experiencing homicidal or suicidal ideation or intent, referrals to social services or mental health services, substance abuse referrals, or lethal means counseling might be appropriate.

Ambulance © UC Regents

Depending on the circumstances, you may need to contact local law enforcement or the patient’s family.

If the patient or someone in the patient’s home is in a time of crisis, you can recommend firearms be temporarily stored outside the home. Local law enforcement or a gun range or retailer might be legally able and available to store firearms temporarily, until the period of imminent risk has ended. Check to see what options exist in your area.

In some states, emergency risk protection orders (ERPOs) might be an option.

Seventeen states and the District of Columbia have provisions for temporarily removing from the home the firearms of persons deemed to be at immediate risk of violence to self or to others. These are civil orders and in most states are available to immediate family members, household members, and members of law enforcement. In most states (excepting Maryland), health care providers cannot directly petition for these orders, but you may discuss this option with a patient at imminent risk or his or her family if a policy exists in your state.

Evaluations of these policies suggest that they may be particularly useful in preventing suicides.1, 2

Find out whether a Gun Violence Restraining Order (GVRO), Extreme Risk Protection Order (ERPO), or a similar legal intervention is an option in your state by visiting the Giffords Law Center online.

  1. Swanson JW, Norko MA, Hsiu-Ju L, Alanis-Hirsch K, Frisman LK, Baranoski MV, Easter MM, Robertson AG, Swartz MS, Bonnie RJ. Implementation and Effectiveness of Connecticut’s Risk-Based Gun Removal Law: Does it Prevent Suicides? 80 Law and Contemporary Problems. 2017; 179-208.
  2. Kivisto AJ, Phalen PL. Effects of Risk-Based Firearm Seizure Laws in Connecticut and Indiana on Suicide Rates, 1981–2015. Psychiatric Services 69 (8): 855–62. https://doi.org/10.1176/appi.ps.201700250.