October President’s Column: Extreme Risk Protection Orders

Extreme Risk Protection Orders in Maryland

In the past weeks, Extreme Risk Protection Orders (ERPOs) have been a recurrent topic in my conversations.  I interpreted that occurrence as a sign to devote October’s President’s Column to the topic.  As a forensic psychiatrist, I am familiar with ERPO or “red flag” laws, but in practice, as a community psychiatrist, I rarely hear them mentioned.  This disconnect is particularly notable in Maryland, which has unique aspects to ERPO laws.  More education about this topic is needed for all clinicians, and the discussion is timely as we just concluded Suicide Prevention Month yet continue to be plagued by acts of gun violence.  Selfishly, addressing this topic in my president’s column allowed me to quote great research on the topic (and avoid writing my own content), but it also allowed me to interview one of the nation’s experts on suicide prevention and lethal means restriction for the monthly Vlog – our own Paul Nestadt.

ERPO laws can be a tool to prevent firearm injury and an intervention in threats of mass violence and suicide prevention1.  ERPO laws allow interested parties to petition the court that an individual who is behaving dangerously and is at risk of harming themselves or others be temporarily prohibited from purchasing and possessing firearms and surrender their firearms and ammunition to law enforcement.  If approved, final ERPOs may remain in effect for as long as one year.2  In October 2018, Maryland became the first US state to authorize physicians and other clinicians as petitioners under the ERPO law (in addition to spouses, roommates, relatives, romantic partners, guardians and police officers).3.4 Authorizing clinicians to petition the court for an ERPO can be beneficial as they are often tasked with responding to threats and behaviors that might result in violence.

Despite having access to this valuable tool, the question remains why ERPOs are not utilized more often.  A discussion with Dr. Nestadt will provide useful guidance and clarification.  In addition, please refer to these two helpful resources.  The first is a link to a brochure created by the Behavioral Health Administration for simple guidance for you or your patients.  The second is a flyer that provides contact information to navigators who can assist with the ERPO process.

Ronald Means, M.D.
MPS President

References:

  1. Wintemute GJ, Pear VA, Schleimer JP, et al. Extreme risk protection orders intended to prevent mass shootings: a case series. Ann Intern Med. 2019;171(9):655-658. doi:10.7326/M19-2162
  2. Frattaroli S, Hoops K, Irvin NA, McCourt A, Nestadt PS, Omaki E, Shields WC, Wilcox HC. Assessment of Physician Self-reported Knowledge and Use of Maryland’s Extreme Risk Protection Order Law. JAMA Netw Open. 2019 Dec 2;2(12):e1918037. doi: 10.1001/jamanetworkopen.2019.18037. PMID: 31860108; PMCID: PMC6991220.
  3. The Johns Hopkins Bloomberg School of Public Health; Bloomberg American Health Initiative. Extreme risk protection order: a tool to save lives. https://americanhealth.jhu.edu/implementERPO.
  4. Maryland Code. Public Safety: Title 5, Firearms—Subtitle 6, Extreme Risk Protective Orders, § 5-601(e)(2)(i) (2018). http://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gps&section=5-601&enactments=false.