Suicide Prevention Effects of Extreme Risk Protection Order Laws in Four States

Article Figures & Data
Figures
Figure 1. Association between the probability that a male gun owner who attempts suicide will use a firearm in the attempt and the estimated number of ERPOs needed to prevent one suicide death: evidence from 4,583 ERPOs in four states. ERPO = extreme risk protection order.
Figure 2. Firearm ownership rate and proportion of male suicides that involve guns in selected high gun ownership states, U.S. adult males, and in ERPO respondents. ERPO = extreme risk protection order; FS/S = firearm suicides to all suicides.
Tables
ERPO Statutory Characteristics CA CT MD WA Categories of authorized ERPO petitioners Law enforcement officers X X X X Family or household members X a X X Licensed clinicians and mental health care providers a X Others: employers, coworkers, dating partners, people who have a child in common, and certain school personnel X Standard of proof for ex parte orders Probable, reasonable, or good cause b X X X Substantial likelihood b Standard of proof for final orders Preponderance of the evidence X Clear and convincing evidence X X X X Duration of ex parte orders 1–2 days X 14 days X X 21 days X Duration of final orders Up to one year b a X X 1–5 years X Until respondent initiates review in which either law enforcement determines no probable cause of a risk or the state fails to prove by clear and convincing evidence at hearing that there is a risk X ERPO = extreme risk protection order
↵a In Connecticut, prior to June 1, 2022, only law enforcement and state officials could petition for an order; thereafter, family and household members could petition for an investigation by law enforcement that can result in law enforcement petitioning for an order. The law changed after the study was completed. During the study period, duration of the ERPO was up to 1 year.
↵b In California, the standard of proof for temporary orders is “probable cause” for orders petitioned by law enforcement only and “substantial likelihood” for orders petitioned by family and law enforcement. During the study period, duration of the ERPO was up to 1 year.
Counterfactual Estimates Observed Number of Suicide Deaths and Extrapolated Estimate of Suicide Attempts Suicide Attempts Suicide Deaths Suicide Method Observed Suicides, by Method National Case Fatality Rate (CFR) Estimated Suicide Attempts, by Method Firearm Other Method Firearm Other Method Total Firearm 20 0.90 22.3 22.3 — 20.0 — 20.0 Drug or poison 8 0.02 416.0 162.2 253.8 146.0 4.9 150.9 Suffocation 12 0.42 28.9 11.3 17.6 10.1 7.3 17.5 Cutting 2 0.01 283.2 110.4 172.7 99.4 1.2 100.6 Jumping 2 0.28 7.2 2.8 4.4 2.5 1.2 3.7 Other 1 0.02 58.2 22.7 35.5 20.4 0.6 21.1 Total 45 815.8 331.8 484.0 298.5 15.3 313.8 Expected 313.8 Observed 45.0 Lives saved 268.8 ERPOs 4,583.0 Number of ERPOs per life saved 17.1 CFR = case fatality rate; ERPO = extreme risk protection order