Extreme Risk Protection Orders in Washington: A Tool for Reducing the Lethality of Dangerous Behaviors
Authors: Shannon Frattaroli, Nathan A. Irvin
Journal: Annals of Internal Medicine (2020)

Editorials1 September 2020Extreme Risk Protection Orders in Washington: A Tool for Reducing the Lethality of Dangerous BehaviorsFREEShannon Frattaroli, PhD, MPH and Nathan A. Irvin, MD, MSHPRShannon Frattaroli, PhD, MPHThe Johns Hopkins Bloomberg School of Public Health, Center for Gun Policy and Research, Baltimore, Maryland (S.F.)Search for more papers by this author and Nathan A. Irvin, MD, MSHPRThe Johns Hopkins School of Medicine, Baltimore, Maryland (N.A.I.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4323 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail We read with great interest the article by Rowhani-Rahbar and colleagues (1) describing the initial 29-month experience of Washington's use of extreme risk protection orders (ERPOs). In Washington, the ERPO is a tool law enforcement and families can use to initiate a civil process for temporary gun dispossession when someone is behaving dangerously and at risk for harming themselves or someone else. The authors document several aspects of ERPO use in Washington. For example, we learn that the 237 ERPOs filed were most often used when violence against “others alone” (n = 86 [36%]) and “both others and self” (n = 84 [35%]) was the concern, although responses to “self-harm alone” (n = 67 [28%]) motivated a substantial portion of petitions. Law enforcement filed most ERPO petitions (n = 206 [87%]), and courts granted most (n = 192 [81%]) of those requests. The authors also highlight that petitioners noted respondents' history of domestic violence, criminal justice encounters, suicidal ideation, or substance misuse in 24%, 37%, 62%, and 47% of petitions, respectively. These findings are interesting and suggest that ERPOs are being used as a response to different types of violence, and often for persons who have a history of dangerous behaviors that are associated with future violence. As such, the article is an important contribution to the literature and to ongoing ERPO policy discussions.Two aspects of this descriptive analysis deserve further consideration. First, the inclusion of respondents' history of treatment for mental illness (as noted by petitioners who are not required to explain the relevancy of that history to assessing respondents' current dangerousness) as a finding, without information about the precipitating events and behaviors that led to the ERPO petition, risks leaving readers to conclude that ERPOs are a mental health intervention. This potential inference runs counter to the evidence base underlying ERPOs and risks further stigmatizing persons with mental illness (2). In 2013, the Consortium for Risk-Based Firearm Policy recommended that states adopt what are now known as ERPO laws (3). That recommendation was based on an extensive literature review by a multidisciplinary group of experts, who concluded that dangerous behaviors, not mental illness diagnoses, are the best indicators of future violence risk. In addition, a civil process (based on domestic violence protection orders) for determining which dangerous behaviors should lead to temporary prohibitions on gun purchase and possession provides an evidence-informed mechanism for intervening early in the trajectory of violence. In 2019, Washington legislators embraced this foundational ERPO principle with an amendment that replaced “dangerous mental health issues” (1 of the original criteria for judges to consider) with “behaviors that present an imminent threat of harm to self or others” in the statute (4). We urge readers to interpret the findings concerning respondents' history of mental health treatment with caution, and encourage future researchers to include information about dangerous behaviors when collecting ERPO data and designing studies to evaluate the impact of ERPOs.Second, as we consider the findings from this article, the United States is openly grappling with racism and police abuse of power. Calls to abolish police departments, to scale back police funding, and for comprehensive reform signal that fundamental change is likely in some jurisdictions. For those who are calling for reform, we suggest that the ERPO offers an example of a different role for law enforcement that may inform part of a comprehensive path forward. Three aspects of ERPOs guide our perspective. First, ERPOs are prevention oriented. By creating a mechanism to temporarily remove firearms from someone who is at risk for committing violence before it happens, the ERPO offers an opportunity for early intervention. Anecdotal evidence from law enforcement personnel in King County, Washington, suggests that for some, this upstream shift is a welcome addition to their role in the communities they serve (5). Second, ERPOs require judicial oversight. Petitioners in Washington, as in most states, tend to be police officers or sheriff deputies (in some states, law enforcement is the only eligible petitioner). To request an ERPO, a petitioner must complete a written statement detailing the respondent's dangerous behaviors and must testify in court. This engagement with the courts inserts a deliberative process, and decisions about whether to issue an ERPO are made by a judge in a courtroom, away from the scene of the incident that precipitated the ERPO petition. Third, by design, ERPOs are more therapeutic than punitive. Their goal is to reduce the risk for lethality by temporarily removing firearms if violence is imminent. In most instances, no crime has been committed; no punishment is being sought; and, as demonstrated in this article, many respondents actually received health care as part of the process. The ERPO offers communities a police response that aims to prevent violence, includes judicial oversight, and leads with therapeutic goals. The importance of this role cannot be overstated, because many persons are traumatized by their experiences with law enforcement officers and fear any interaction with them. The opportunity for family members (who in some cases, the authors note, initiate the response leading to the ERPO) to partner with law enforcement in a productive and nonpunitive way to save loved ones' lives may offer a critical step toward repairing these fractured relationships. Furthermore, although most respondents (87%) in this study were White, a proportionate number of Blacks (5.3%) with respect to their demographic representation in the state (3.7%) were also represented. These numbers suggest the potential for acceptance of these procedures across demographic groups, which is critical given the current climate. Such principles align with some of the reform conversations under way. As ERPO scholarship evolves, attention to how the ERPO is implemented, perceived in, and received by communities of color will be important to evaluate both the effect of the intervention and the relevance of ERPOs to larger conversations about the future of policing.We acknowledge that current conversations about racism and police are the result of dangerous, illegal, and deadly behaviors by armed police, and may prompt calls for processes to dispossess police officers of firearms when they are behaving dangerously. Perhaps ERPO lessons can also inspire conversations about the risks, wisdom, and reform of a police force that is always armed.References1. Rowhani-Rahbar A, Bellenger MA, Gibb L, et al. Extreme risk protection orders in Washington. A statewide descriptive study. Ann Intern Med. 2020;173:342-9. [PMID: 32598226]. doi:10.7326/M20-0594 LinkGoogle Scholar2. McGinty EE, Frattaroli S, Appelbaum PS, et al. Using research evidence to reframe the policy debate around mental illness and guns: process and recommendations. Am J Public Health. 2014;104:e22-6. [PMID: 25211757] doi:10.2105/AJPH.2014.302171 CrossrefMedlineGoogle Scholar3. Consortium for Risk Based Firearm Policy. Guns, Public Health, and Mental Illness: An Evidence-Based Approach for State Policy. Coalition to Stop Gun Violence; December 2013. Google Scholar4. Engrossed Substitute Senate Bill 5027, 2019. Accessed at http://lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bills/Session%20Laws/Senate/5027-S.SL.pdf?q=20200419124156 on 19 April 2020. Google Scholar5. Johns Hopkins Bloomberg School of Public Health, Bloomberg American Health Initiative. Extreme Risk Protection Order: A Tool to Save Lives. Accessed at https://americanhealth.jhu.edu/implementERPO on 14 June 2020. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: The Johns Hopkins Bloomberg School of Public Health, Center for Gun Policy and Research, Baltimore, Maryland (S.F.)The Johns Hopkins School of Medicine, Baltimore, Maryland (N.A.I.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4323.Corresponding Author: Shannon Frattaroli, PhD, MPH, The Johns Hopkins Bloomberg School of Public Health, Center for Gun Policy and Research, 624 North Broadway, Baltimore, MD 21205; e-mail, [email protected]edu.Current Author Addresses: Dr. Frattaroli: The Johns Hopkins Bloomberg School of Public Health, Center for Gun Policy and Research, 624 North Broadway, Baltimore, MD 21205.Dr. Irvin: Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Suite A-150, Baltimore, MD 21075.This article was published at Annals.org on 30 June 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoExtreme Risk Protection Orders in Washington Ali Rowhani-Rahbar , M. Alex Bellenger , Lauren Gibb , Heather Chesnut , Madison Lowry-Schiller , Emma Gause , Miriam J. Haviland , and Frederick P. Rivara Metrics 1 September 2020Volume 173, Issue 5Page: 392-393KeywordsBehaviorDisclosureDomestic violenceFearFirearm injuriesForecastingHealth carePrevention, policy, and public healthPsychiatry and mental healthPublic policy ePublished: 30 June 2020 Issue Published: 1 September 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...