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Research ArticleRegular Articles

Knowledge and Attitudes of Psychiatrists About the Gun Rights of Persons With Mental Illness

Megan E. Nagle, Kaustubh G. Joshi, Richard L. Frierson, Martin W. Durkin and Alexandra Karydi
Journal of the American Academy of Psychiatry and the Law Online March 2021, 49 (1) 28-37; DOI: https://doi.org/10.29158/JAAPL.200050-20
Megan E. Nagle
Dr. Nagle is an Inpatient Psychiatrist, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Joshi is Associate Professor of Clinical Psychiatry, and Associate Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Frierson is the Alexander G. Donald Professor of Clinical Psychiatry and Vice Chair for Education, and Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Durkin is a Biostatistician, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Karydi is Director, Project 2025, The American Foundation of Suicide Prevention, New York, NY.
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Kaustubh G. Joshi
Dr. Nagle is an Inpatient Psychiatrist, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Joshi is Associate Professor of Clinical Psychiatry, and Associate Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Frierson is the Alexander G. Donald Professor of Clinical Psychiatry and Vice Chair for Education, and Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Durkin is a Biostatistician, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Karydi is Director, Project 2025, The American Foundation of Suicide Prevention, New York, NY.
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Richard L. Frierson
Dr. Nagle is an Inpatient Psychiatrist, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Joshi is Associate Professor of Clinical Psychiatry, and Associate Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Frierson is the Alexander G. Donald Professor of Clinical Psychiatry and Vice Chair for Education, and Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Durkin is a Biostatistician, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Karydi is Director, Project 2025, The American Foundation of Suicide Prevention, New York, NY.
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Martin W. Durkin
Dr. Nagle is an Inpatient Psychiatrist, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Joshi is Associate Professor of Clinical Psychiatry, and Associate Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Frierson is the Alexander G. Donald Professor of Clinical Psychiatry and Vice Chair for Education, and Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Durkin is a Biostatistician, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Karydi is Director, Project 2025, The American Foundation of Suicide Prevention, New York, NY.
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Alexandra Karydi
Dr. Nagle is an Inpatient Psychiatrist, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Joshi is Associate Professor of Clinical Psychiatry, and Associate Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Frierson is the Alexander G. Donald Professor of Clinical Psychiatry and Vice Chair for Education, and Program Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Durkin is a Biostatistician, Prisma Health – University of South Carolina School of Medicine, Columbia, SC. Dr. Karydi is Director, Project 2025, The American Foundation of Suicide Prevention, New York, NY.
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    Figure 1.

    Number of knowledge questions answered correctly.

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    Table 1

    Demographics

    Male92 (50.0)
    Board-certified161 (86.1)
    Currently in training19 (10.2)
    Currently practicing176 (94.6)
    Have a concealed weapons permit18 (9.6)
    Own a firearm54 (29.0)
    Patient suicide by firearm85 (45.7)
    Patient violence by firearm93 (50.3)
    Patient prohibited from owning firearm123 (68.7)
    Length of practice, y
        <530 (16.0)
        <1025 (13.4)
        <2045 (24.1)
        >2087 (46.5)
    Age, y
        <3527 (14.4)
        <4548 (25.7)
        <5532 (17.1)
        <6539 (20.9)
        ≥6541 (21.9)
    • Data are presented as n (%).

    • View popup
    Table 2

    Respondents' Answers to the Five Knowledge Questions and the Question About Conducting an Evaluation to Restore Gun Rights

    QuestionAnswer SelectionDid Not Answer% Correct
    ABCDEB&C
    116117*25391161.6
    25967*30241035.3
    308155*24381.6
    418561890*847.4
    5932682*743.2
    691792NA
    • Question 6 only had a “yes” (A) or “no” (B) choice and the response was neither correct nor incorrect.

    • ↵* Indicates the correct answer.

    • NA = not applicable

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    Table 3

    Reasons for Not Participating in the Gun-Restoration Process

    Never asked86.3%
    Lack of knowledge about the process33.7%
    Concerns about liability22.6%
    Lack of time to perform evaluations9.5%
    • Note: Respondents had the option to select more than one answer.

    • View popup
    Table 4

    Psychiatrists' Views on Gun Ownership by Persons With Mental Illness

    Strongly DisagreeDisagreeNeutralAgreeStrongly AgreeNot Applicable
    Restrictions on persons with mental illness from possessing a firearm should be terminated after a specific time frame.54 (28.4)75 (39.5)26 (13.7)25 (13.2)8 (4.2)2 (1.1)
    A person with mental illness should be reevaluated at certain intervals after their gun rights have been restored to determine if they can still safely possess a firearm.10 (5.3)26 (13.7)16 (8.4)67 (35.3)70 (36.8)1 (0.5)
    A patient with a history of suicidal ideation that DID NOT involve a firearm should NOT have access to a firearm.23 (12.1)63 (33.2)34 (17.9)41 (21.6)26 (13.7)3 (1.6)
    A patient with a history of suicidal ideation that DID involve a firearm should NOT have access to a firearm.7 (3.7)24 (12.6)19 (10.0)59 (31.1)78 (41.1)3 (1.6)
    A patient with a history of antisocial personality disorder should NOT have access to a firearm.9 (4.7)42 (22.1)40 (21.1)46 (24.2)51 (26.8)2 (1.1)
    A patient with a history of homicidal ideation with a history of violence should NOT have access to a firearm.1 (0.5)4 (2.1)12 (6.3)56 (29.5)115 (60.5)2 (1.1)
    A patient with a history of homicidal ideation WITHOUT a history of violence should NOT have access to a firearm.7 (3.7)37 (19.5)44 (23.2)60 (31.6)40 (21.1)2 (1.1)
    A patient with active psychotic symptoms (hallucinations and/or delusions and/or disorganized thinking) should NOT have access to a firearm.0 (0.0)7 (3.7)11 (5.8)58 (30.5)112 (58.9)2 (1.1)
    A patient with a successfully treated psychotic disorder (e.g., schizophrenia) should NOT have access to a firearm.15 (7.9)69 (36.3)46 (24.2)39 (20.5)19 (10.0)2 (1.1)
    A patient with a history of recurrent depression should NOT have access to a firearm.23 (12.1)80 (42.1)44 (23.2)27 (14.2)12 (6.3)4 (2.1)
    A patient with a history of a single episode of major depression that is currently in remission should NOT have access to a firearm.52 (27.4)99 (52.1)25 (13.1)5 (2.6)6 (3.2)3 (1.6)
    A patient with successfully treated bipolar I disorder should NOT have access to a firearm.33 (17.4)91 (47.9)41 (21.6)10 (5.2)11 (5.8)4 (2.1)
    A psychiatrist who believes their patient should NOT have a concealed weapon permit should report that concern to South Carolina Law Enforcement Division (SLED).11 (5.8)12 (6.3)31 (16.3)80 (42.1)53 (27.9)3 (1.6)
    A patient with a current substance use disorder should NOT have access to a firearm.11 (5.8)46 (24.2)51 (26.8)46 (24.2)33 (17.4)3 (1.6)
    A patient with a substance use disorder that is in sustained remission should NOT have access to a firearm.37 (19.5)97 (51.1)41 (21.6)7 (3.7)4 (2.1)4 (2.1)
    I believe there should be special training involved prior to conducting an evaluation to restore gun rights in persons with mental illness.1 (0.5)0 (0.0)7 (3.7)49 (25.8)131 (68.9)2 (1.1)
    • Data are presented as n (%).

  • Attitudes About Gun Right Among Persons With Mental Illness

    Questions
    For questions 7 to 22, participants were asked to respond along a continuum of Strongly Agree to Strongly Disagree
    7. Restrictions on persons with mental possessing a firearm should be terminated after a specific time frame.
    8. A person with mental illness should be reevaluated at certain intervals after their gun rights have been restored to determine if they can still safely possess a firearm.
    9. A patient with a history of suicidal ideation that DID NOT involve a firearm should NOT have access to a firearm
    10. A patient with a history of suicidal ideation that DID involve a firearm should NOT have access to a firearm.
    11. A patient with history of antisocial personality disorder should NOT have access to a firearm.
    12. A patient with history of homicidal ideation with a history of violence should NOT have access to a firearm.
    13. A patient with history of homicidal ideation WITHOUT a history of violence should NOT have access to a firearm.
    14. A patient with active psychotic symptoms (hallucinations and/or delusions and/or disorganized thinking) should NOT have access to a firearm.
    15. A patient with a successfully treated psychotic disorder (e.g., schizophrenia) should NOT have access to a firearm.
    16. A patient with a history of recurrent depression should NOT have access to a firearm.
    17. A patient with a history of a single episode of major depression that is currently in remission should NOT have access to a firearm.
    18. A patient with successfully treated bipolar I disorder should NOT have access to a firearm.
    19. A psychiatrist who believes their patient should NOT have a concealed weapon permit should report that concern to South Carolina Law Enforcement Division (SLED).
    20. A patient with a current substance use disorder should NOT have access to a firearm.
    21. A patient with a substance use disorder that is in sustained remission should NOT have access to a firearm.
    22. I believe there should be special training involved prior to conducting an evaluation to restore gun rights in persons with mental illness.
    Please answer your demographic characteristics
    23. What is your gender?MaleFemale
    24. Are you currently board-certified?YesNo
    25. Are you currently in your psychiatry residency training or fellowship training?YesNo
    26. Are you currently practicing psychiatry?YesNo
    For questions 27 and 28, “Prefer not to answer” was another option
    27. Do you have a concealed weapons permit?YesNo
    28. Do you own a firearm?YesNo
    29. Have you ever had a patient die from suicide by firearm?YesNo
    30. Have you had a patient commit an act of violence with a firearm?YesNo
    31. Have you ever had a patient who was prohibited from gun ownership?YesNo
    32. How long have you been practicing psychiatry (in years)?(<5, <10, <20, >20)
    33. What is the setting of your practice?(Mental health center, Private practice,Academic setting, Public hospital, Private hospital)
    34. Where did you do your psychiatric training?(Northeast, Southeast, Midwest, Northwest, Southwest)
    35. What is your age?(<35, <45, <55, <65, ≥ 65)
    36. In which county of the state is your primary practice?
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Journal of the American Academy of Psychiatry and the Law Online: 49 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 49, Issue 1
1 Mar 2021
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Knowledge and Attitudes of Psychiatrists About the Gun Rights of Persons With Mental Illness
Megan E. Nagle, Kaustubh G. Joshi, Richard L. Frierson, Martin W. Durkin, Alexandra Karydi
Journal of the American Academy of Psychiatry and the Law Online Mar 2021, 49 (1) 28-37; DOI: 10.29158/JAAPL.200050-20

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Knowledge and Attitudes of Psychiatrists About the Gun Rights of Persons With Mental Illness
Megan E. Nagle, Kaustubh G. Joshi, Richard L. Frierson, Martin W. Durkin, Alexandra Karydi
Journal of the American Academy of Psychiatry and the Law Online Mar 2021, 49 (1) 28-37; DOI: 10.29158/JAAPL.200050-20
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