Firearm Disqualification and Rights Restoration Among Adults with Mental Illness in Virginia

  • Journal of the American Academy of Psychiatry and the Law Online
  • August 2025,
  • JAAPL.250048-25;
  • DOI: https://doi.org/10.29158/JAAPL.250048-25

Abstract

This study evaluated legal prohibitions on firearm possession in a population of 128,090 adults in Virginia with a serious mental illness and record of at least one psychiatric hospitalization between 1998 and 2015. Approximately half the study population acquired a gun-disqualifying record of a mental health adjudication or felony criminal conviction. Among persons with a mental health disqualification, the annualized arrest rate for gun-involved violent crime subsequently declined by 35.9 percent during the prohibition period; no such decline was seen in the arrest rate for crimes not involving guns. The likelihood of arrest for a gun-involved violent crime was further reduced among people whose disqualifying record was reported to the background check database (odds ratio (OR) = .7; 95% confidence interval (CI) .6 – .8; p ≤ .0010). In a subgroup analysis of individuals (n = 261) who lost and regained firearm eligibility, 14.6 percent had a subsequent arrest for a violent crime, 1.5 percent for a gun-involved crime. Regarding suicide, 1.5 percent of the restored group died of intentional self-inflicted injuries, half of those involving a firearm. The study provides evidence that firearm prohibitions were partially effective, especially when disqualifying records were reported to the background check database. Study findings give cause for modest concern for the safety consequences of gun rights restoration as practiced in one state.

In the quarter-century since the U.S. Department of Justice launched its database of persons legally disqualified from purchasing firearms, the National Instant Criminal Background Check System (NICS) has amassed more than seven million gun-prohibiting records pertaining to individuals with mental illness.1 Most are state-reported records of involuntary civil commitment; the fact that modern inpatient commitment statutes generally require the criterion of danger to self or others2,3 provides a risk-based rationale for designating psychiatric patients’ histories of mandatory hospitalization as a predicate for categorical firearm prohibition.4 In every state, these prohibitions are indeterminate in length, and there is little, if any, empirical evidence that would justify an indefinite prohibition, effectively a lifetime gun ban, resulting from a single, time-limited episode of civil commitment.5 Evidence has also been lacking as to the potential adverse consequences and social costs of gun rights restoration, of setting aside firearm disqualification for people who can show they no longer pose a risk of harm to self or others.

The policy of restoring gun rights to individuals who were previously hospitalized and deemed to be at risk of suicide presents a puzzle for research and practice. On one hand, admission to a psychiatric inpatient treatment facility is one of the most robust lifetime predictors of suicide that researchers have studied, whether or not the hospitalization was involuntary and whatever the legal criteria,6 and year after year suicides account for more than half of the gun deaths in the United States. On the other hand, significant risk of injurious behavior that is clearly attributable to psychopathology alone can be fleeting; most people do recover7,8 and are not at elevated risk of injuring other people. Reasonable legal challenges to the length of the mental health firearm prohibitor rest on the argument that treatment can mitigate risk-correlated symptoms, such that the predictive value and validity of any single event-based indicator of risk inevitably declines over time.9 Questions remain as to the effectiveness of the mental health gun prohibitor in preventing suicides and violent crime with guns and what consequences would likely follow if the prohibitor were removed or reduced in length. This study aimed to inform those policy questions with longitudinal data on mental-health-related and criminal-justice-related firearm prohibition and subsequent gun rights restoration in Virginia, which has a court-based process for granting “relief from firearm disabilities” (RFD).10

Policy Background

The United States differs from other high-income nations in its widespread private gun ownership, constitutional protection of firearm rights, and elevated rate of gun violence.11,–,14 Instead of broadly restricting access to firearms as a public safety measure, federal and state laws prohibit possession by specific categories of individuals deemed to be potentially dangerous or engaged in illegal activity. The federal Gun Control Act of 196815 established a broad prohibition on the purchase or possession of firearms by certain adults with mental illness, including those who have been involuntarily committed to a psychiatric hospital, adjudicated mentally incompetent, or acquitted by reason of insanity in a criminal matter. Little research has examined the long-term effectiveness of these prohibitions or the question of how long they should be kept in place, given that individuals’ risk of injurious behavior changes over time. As a matter of policy, it could be argued that, if disqualification is based solely on public safety concerns, restoration of rights should expediently follow once that risk demonstrably subsides.

The Gun Control Act, as codified in the regulatory language of 18 U.S. Code § 922, initially established what was, in effect, a lifetime firearm prohibition for persons subject to mental health adjudications. Over time, many states developed programs allowing affected individuals to petition for the restoration of their gun rights.16,17 The operational criteria for firearm disqualification have varied across states, as has the reporting of gun eligibility records and processes for rights restoration.

Before the implementation of thorough background checks, individuals with disqualifying histories often could acquire firearms from licensed dealers simply by nondisclosure. The 1993 Brady Act18 aimed to address this problem by requiring federally licensed gun dealers to conduct background checks on prospective buyers. This law led to the creation in 1998 of the National Instant Criminal Background Check System (NICS), which maintains records of individuals prohibited from possessing firearms because of a felony criminal record, mental health adjudication, or one of several other disqualifying categories.19,20

Despite its intent, NICS has had mixed success in preventing firearm acquisitions by those prohibited from ownership. The accuracy of background checks depends on comprehensive data collection, which in turn relies on state compliance with reporting. Initially, states had limited obligations to report mental health adjudication records, and many declined to do so, because of privacy concerns and data system limitations. Some states maintained centralized databases containing involuntary commitment records of state-run hospitals, excluding those occurring in private facilities. Additionally, law enforcement agencies often lacked policies to proactively remove firearms from individuals who acquired prohibiting records. Consequently, many prohibited individuals accessed firearms through alternative sources and markets.

The shortcomings of the background check system became evident in 2007, when an individual who had been deemed by a court to pose a danger to others and was ordered to outpatient mental health treatment was able to legally purchase firearms, which he then used to commit a mass shooting, resulting in 32 deaths at Virginia Tech University. At the time, Virginia policy was to only report inpatient commitment orders. This oversight focused national attention on the problem of states’ underreporting gun-prohibiting records to the background check database. In response, Congress in 2008 enacted the NICS Improvement Amendments Act (NIAA), incentivizing states to enhance their reporting of these records.21

To support this effort, the Department of Justice launched the NICS Record Improvement Program (NARIP),22 providing federal grants to states that increased reporting of firearm-prohibiting records. States receiving NARIP grants were also required to implement a federally approved program for relief from firearm disabilities, allowing individuals with gun-prohibiting mental health adjudications to petition for rights restoration. RFD programs must determine that applicants are not likely to pose a danger to public safety and that granting relief aligns with the public interest.23

In the ensuing years, Virginia significantly improved its reporting of gun-disqualifying mental health records, particularly through automating the transfer of commitment records to the Virginia State Police. As a result of NARIP incentives, many states also enhanced both their reporting systems and RFD programs, seeking to strike a balance between protecting public safety and restoring a constitutional right. Some previous research suggests that individuals with past mental-health-related firearm prohibitions do not typically present a high ongoing safety threat,24,25 which provides justification for restoring rights.

Over time, state laws restricting firearm eligibility as well as RFD processes have evolved.26,–,29 The adoption of RFD programs often coincided with expansions in reporting mental health records; both were incentivized by the NIAA. States differ in their procedural requirements for restoration, with variations in the degree of judicial involvement, evidentiary standards, and psychiatric evaluations.16,30 Some states require mental health evaluations, whereas others do not.31,32

In Virginia, the restoration process involves a judicial proceeding; individuals seeking to regain their gun rights must petition the court for restoration. The court evaluates petitioners’ eligibility based on factors such as success in rehabilitation, compliance with treatment, and public safety considerations. Some individuals have been doubly disqualified from accessing firearms by acquiring both a felony criminal record and an involuntary civil commitment record. In Virginia, restoration of firearm rights in such cases involves a two-step process. The individual must first apply to the governor of Virginia for the restoration of civil rights. If the governor restores the individual’s civil rights, the next step is to petition the circuit court to restore the individual’s gun rights. If successful, the individual’s gun rights will be restored under both state and federal law, unless other prohibitions apply.33

Given the ongoing epidemic of gun violence in the United States, improved implementation of legal tools is necessary. But limited research has evaluated the effectiveness of reporting gun-disqualifying records in reducing gun violence or assessed the risk posed by individuals who regain firearm rights. No prior study has simultaneously examined both the preventive impact of mental-health-related firearm prohibitions and the consequences of lifting such restrictions. This study was designed to fill that gap.

Methods

Study Population

The study population consisted of 128,090 adults with a diagnosis of a serious mental illness (schizophrenia or other psychotic disorder, bipolar disorder, or major depression) with a record of psychiatric hospitalization in Virginia’s public sector behavioral health system between 1998 and 2015. To be age-eligible, individuals had to have been between 18 and 90 years old at any point during this period. For each individual, the observation period varied, consisting of the time segment dating from the first to last event record in the database; in some cases, the last event of record was death. Importantly, for much of the statistical analysis, the unit of observation is the person-month, rather than the individual person. Each person may contribute a different number of person-months to the database.

Data were obtained from several health and public safety agencies within the Commonwealth of Virginia. The Department of Medical Assistance Services (DMAS) and the Department of Behavioral Health and Developmental Services (DBHDS) provided data on Medicaid-covered and state hospital admissions and stays, respectively. These sources also provided information regarding psychiatric diagnoses and demographic characteristics (e.g., age, race, sex). Public safety and criminal justice records were obtained from the Virginia State Police (VSP). Virginia is a full point-of-contact state for background checks, meaning that VSP conducts Virginia’s background checks for federally licensed gun dealers on behalf of the Federal Bureau of Investigation (FBI), in compliance with the Brady Law. VSP provided the study with data on arrests, convictions, and mental health adjudication records that it uses in conducting gun background checks (for example, involuntary commitment, incompetent to stand trial) as well as records of gun rights restoration for individuals who were previously disqualified for mental health reasons. Finally, the Virginia Department of Health (VDH) provided information on individuals who died during the observation period, including month and year of death, and International Classification of Diseases, Tenth Revision (ICD-10) codes indicating the cause of death. Data from these different sources were linked, merged, and deidentified to create a comprehensive, longitudinal dataset for evaluating important health and public safety outcomes in this population.

Measurement

We defined and developed indicators of variables pertaining to firearm eligibility.

Mental Health History Disqualification

For our descriptive analysis of the study population, we classified persons as firearm disqualified if they had one or more of the following records in VSP’s background check system: involuntary commitment to a psychiatric inpatient facility or unit, a temporary detention order with subsequent voluntary admission for inpatient psychiatric treatment (pursuant to Virginia statute as revised after 2008),34 adjudicated incompetent to stand trial or not guilty by reason of insanity in a criminal matter, or adjudicated legally incompetent or mentally incapacitated and assigned to guardianship. A second, independent measure of firearm disqualification via involuntary commitment was obtained from hospital records (DMAS and DBHDS). This measure was used in our analytic models to assess the impact of the reporting of disqualification status to the background check database.

Criminal Disqualification

A separate indicator of criminal disqualification from firearms was created using the criteria of being convicted of: any felony (including having an active felony indictment or a felony-equivalent juvenile delinquency adjudication record for individuals age 28 or younger), misdemeanor assault and battery meeting the federal definition of domestic violence, offense related to habitual drug use in the past year, or a misdemeanor offense punishable by more than one year of imprisonment. Disqualification for criminal legal involvement varied in duration and type of firearm prohibition. Convictions for felonies or misdemeanor domestic assaults result in permanent firearm disqualification in Virginia, unless rights are restored by a court.

Outcome Variables

We classified all arrests on two dimensions (violence and gun involvement), using statutory descriptions of offenses and arresting officers’ notes. We coded violence in two ways, the first corresponding to the FBI’s Uniform Crime Report (UCR) and the second a broader definition including any misdemeanor violent offenses, such as simple battery. UCR violent crime included murder or nonnegligent manslaughter, forcible rape, robbery, and aggravated assault. Definitional violent crime included any crime where physical force or power was used to harm another person or a threat to harm the person with a weapon in hand.

Gun-involved crime was coded from the statutory text of the offenses and arresting officers’ notes, applying keywords and abbreviations indicating firearms. Gun-involved suicide was based on standard ICD 10 codes reported in the death record provided by the Virginia Department of Health (X72-X74).

Analysis

We provide a statistical portrait of the study population (N = 128,090) and key subgroups using the individual person as the unit of analysis. Descriptive and associational statistics were used to summarize and compare demographic characteristics as well as adverse outcomes for relevant subgroups: individuals who never had a reported firearm disqualification, individuals with disqualifying records that were reported to the VSP, and individuals who were disqualified and had their gun rights restored. Demographic characteristics included age, sex, and race. The outcomes that were examined included violent crime arrest and suicide, with and without firearm involvement.

Next, a longitudinal analytic sample was configured with person-month as the unit of analysis to allow repeated measures analysis; there were approximately eight million months for 106,000 people available for analysis, depending on the model. Using this approach, each individual contributed a different number of months to the analytic statistical model, depending on the individual’s status. We calculated and compared risk associated with sets of person-month observations when the person was exposed versus not exposed to a particular gun prohibition. The same individual could have different exposure conditions at different times of the study; there could be months in which there is no prohibition in effect, months in which there is a prohibition but it is unreported, and months in which the prohibition is in effect and reported to the VSP.

We use generalized estimating equations (GEE) for repeated measures to model and estimate statistically the effect of mental-health-related firearm disqualification, and any additional effect of the reporting of disqualification status to the background check database, on the likelihood of future arrests for violent offenses, with and without firearm involvement. This more detailed analysis of the reporting effect per se was conducted for involuntary commitment only, the most common of the four mental health disqualifications, because it could be measured independently of the VSP background check system, therefore illuminating risk during times when people are prohibited from firearm access but not reported to the VSP. Prohibition without reporting was expected during the earlier part of the study observation period, before Virginia implemented wider mental health record reporting. These longitudinal models generated odds ratios for comparing the likelihood of the outcome during months when the gun prohibition was reported versus unreported and among months with no gun prohibition in effect versus months in which there was a prohibition but it was unreported. Periods of time when a person was disqualified for a reason other than involuntary commitment were excluded from the models.

A separate set of analyses focused on the subgroup of individuals whose gun rights were restored at some point following disqualification because of a mental health adjudication (n = 261).

Research using these deidentified data was deemed exempt from regulation of human subjects research by the Duke University School of Medicine Institutional Review Board (Pro00027980).

Results

Reporting and Restoration 1998 to 2015

Our study population was exposed to changes in state law and policy relating to mental-health-based disqualification, reporting, and restoration of firearm rights. Some proportion of the state’s involuntary commitment records had been reported to the background check system since at least 1998, but there were gaps. Figures 1 and 2 illustrate trends in Virginia’s reporting of gun-disqualifying mental health records and restoration of gun rights to disqualified individuals over the study observation period. The number of gun-disqualifying mental health records submitted each year to the state police background check system increased markedly following the 2007 Virginia Tech shooting, from less than 5,000 in 2006 to more than 12,000 by 2009 (Fig. 1); the total number of records approximately tripled over the entire study observation period from 1998 to 2015. In addition, a new criterion of disqualification (a short-term involuntary mental health hold leading to voluntary hospitalization) was added pertaining to observations after 2008 when the aforementioned statute was changed. There was also an apparent increase in the reporting of firearm disqualification because of mental incompetence or incapacity. The significant rise in reported involuntary inpatient and outpatient commitments would be consistent with an increased rate of reporting of commitments, although there could also have been a genuine increase in commitments. Figure 2 shows a similar rise in RFD orders, reflecting a rise in the number of gun-prohibited individuals seeking restoration.

Number of gun-disqualifying mental health adjudications reported to the background check database in Virginia, by year.
Figure 1.

Number of gun-disqualifying mental health adjudications reported to the background check database in Virginia, by year.

Number of gun rights restorations after mental health adjudication, by year.
Figure 2.

Number of gun rights restorations after mental health adjudication, by year.

The legal history of involuntary outpatient commitment highlights a pertinent factor that intersects with gun violence prevention policy in Virginia. Although the commitment statute had authorized outpatient commitment for many years, it was rarely used prior to the mid-2000s. The case of the Virginia Tech shooting by Seung-Hui Cho in 2007 was one of those rare incidences. Whether the issuance of the outpatient commitment order was covered under the firearm reporting statute was ambiguous, and Mr. Cho’s commitment was not reported to the state police. Not surprisingly, the Virginia General Assembly clarified the statute in the next legislative session by declaring that outpatient commitment is reportable as a firearm-disqualifying legal status.

Study Population Characteristics

Table 1 presents descriptive statistics for the study population as a whole and for subgroups who were reported to the VSP as being legally disqualified from accessing firearms because of a mental health record, a criminal record, or both.

View this table:
Table 1

Description of Study Population: Demographic Characteristics by Firearm Disqualification

The study population was divided evenly between males (49.82%) and females (49.95%). Approximately half the sample was aged 18 to 40 years (48.90%). The majority of the sample (64.55%) had a racial identity listed as White. Black or African American individuals were substantially overrepresented in the study population compared with their proportion of the general population of Virginia in the U.S. Census35 (28.65% versus 13.6%).

Of the total study population of 128,090 individuals, a subset of 70,488 individuals (55.03%) were reported as disqualified from firearms at some time during the observation period from 1998 to 2015. A total of 39,859 (31.12%) were disqualified because of a mental health record only, whereas 16,808 (13.12%) were disqualified because of a criminal record only; 13,821 (10.79%) had both kinds of gun-disqualifying records. As a group, individuals who were prohibited from accessing firearms related only to a criminal record were younger and more predominantly male than those who were disqualified for a mental health record only; 62.78 percent versus 36.57 percent were aged 40 years or younger, and 61.63 percent versus 49.15 percent were male.

Table 2 presents frequency distributions for specific types of gun-disqualifying mental health and criminal justice records, arrests for violent crimes with and without gun involvement, and suicide and other deaths with and without gun involvement. Frequencies and percentages are presented for the entire study population and for subgroups with no reported gun disqualification or any reported disqualification and those who had been disqualified by a mental health adjudication but were granted restoration of their gun eligibility by a court.

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Table 2

Prevalence and Characteristics of Any Reported Gun Disqualification and Restoration

Among the different types of gun-prohibiting mental health adjudications, the most common was involuntary commitment to an inpatient mental health facility; 34.29 percent of the study population had such a record, accounting for 62.01 percent of the subgroup with any gun-prohibiting record. It should be noted that this indicator corresponds only to individuals whose involuntary commitment was reported to the Virginia State Police and would therefore have resulted in a denial of purchase if the individual had attempted to purchase a firearm from a licensed dealer. Independent information obtained from state hospital records suggests that the number of individuals with an involuntary commitment or other firearm-disqualifying mental health adjudication record was approximately 72 percent of the study population. The main reason for the gap between actual and reported ineligibility, as mentioned earlier, is that the study data cover the period from 1998 to 2007 that preceded Virginia’s NARIP grant and the policy reforms that routinized and automated all reporting of mental health adjudications to the Virginia State Police for the purpose of conducting background checks on prospective gun buyers.

A smaller group, 12.64 percent of the study population (22.86% of those with any prohibitor), were disqualified by a temporary detention order followed by a voluntary psychiatric hospital admission. Rare insanity acquittals (.15% of the study population, .28% of those with any prohibitor) and incompetency determinations in criminal cases (2.47% of the study population, 4.37% of those with any prohibitor) accounted for the remainder of the gun-prohibiting records pertaining to these individuals.

Almost a quarter of the sample (n = 30,739, 24.00%) had a criminal justice disqualification, with or without an additional mental health disqualification; nearly one in five individuals were disqualified because of a felony conviction (n = 24,449, 19.09%).

Prevalence of Suicide

By the end of 2014, 13,575 individuals (10.60% of the study population) had died. A total of 1,001 individuals died by suicide; this equates to 7.37 percent of the deaths, a proportion approximately five times higher than that found in the general mortality statistics for the U.S. population as a whole.36 Approximately one-third (32.97%, n = 330) of these suicide decedents had used a firearm as the method of intentional self-injury. Slightly more than half of the firearm-related suicides involved individuals who were gun-prohibited at the time of death (53.03%, n = 175), whereas 46.97 percent of firearm suicides involved people who were never disqualified from gun ownership (n = 153) or had their rights restored (n = 2).

Prevalence of Arrest for Violent Offenses

More than one in four individuals in the study population (n = 36,206 of 128,090; 28.27%) had an arrest for a violent offense, broadly defined to include simple assaults. Considering each person’s entire observation period, arrest for a violent offense was more likely among those who received restoration of their eligibility at any time (n = 117 of 261; 44.83%) as well as those who were disqualified at any time, but not restored (n = 27,622 of 70,488; 39.19%), than those who never had a firearm disqualification on record (n = 8,467 of 57,341; 14.77%).

Gun Prohibition, Record-Reporting, Arrest

Figure 3 depicts the violent crime arrest rate in different subgroups of person-month observations in the study, allowing a comparison of the risk of gun violence during times before and while a gun prohibitor was in effect. For individuals with a criminal justice disqualification (CJDQ) only, the average observation time before the CJDQ went into effect was about 80 months with a median of 68 months, whereas the average time while the prohibitor was in effect was 83 months with a median of 76 months. For this group, a combined total of 2,747,096 person-months was observed, with 1,351,567 (49%) months before a prohibitor was in effect and 1,395,529 months (51%) while a prohibitor was in effect. For individuals with a mental health disqualification only (MHDQ), the average observation time before the MHDQ went into effect was about 102 months with a median of 108 months, whereas the average time while the prohibitor was in effect was 81 months with a median of 71 months. For this group, 7,309,911 months were observed, with 4,078,772 months (56%) before a prohibitor was in effect and 3,231,139 months (44%) while a prohibitor was in effect.

Percent change in study members’ violent crime arrest rate for gun-involved and not gun-involved crimes, from periods when they could legally buy guns to periods when they were barred from buying guns.
Figure 3.

Percent change in study members’ violent crime arrest rate for gun-involved and not gun-involved crimes, from periods when they could legally buy guns to periods when they were barred from buying guns.

Rates were calculated for person-month observations before and while the prohibitor was in effect among those who had only a CJDQ or only a MHDQ. The analysis also permits a comparison of these outcomes for individuals who became ineligible because of a mental health adjudication versus a criminal justice gun prohibitor.

Considering person-month observations pertaining to those with a reported mental-health-related firearm prohibition, the annualized rate of arrest for a violent crime with a gun declined by 35.9 percent, from approximately 57 of 100,000 before to 37 of 100,000 after the prohibitor went into effect; no decline was observed in the rate for violent crime not involving a gun. As mentioned, observation periods varied for each person, averaging 163 months for individuals with a criminal justice disqualification only and 183 months for individuals with a reported mental-health-related firearm prohibition only.

The figure elucidates a marked difference in this pattern for non-gun-involved violent crime; the risk of a violent crime not involving a gun stayed virtually the same, with a slight increase of .02 percent. Considering the criminal justice prohibitor, a similar pattern was found, except that risk of violent crime not involving a gun also declined, by 25.5 percent. Notably, the baseline arrest rate for violent crime not involving a gun was several times higher in persons affected by a criminal justice prohibitor than those subjected to a mental health prohibitor alone (7,260.9 versus 1,564.3 per 100,000); those with a gun-prohibiting felony had more room for improvement, statistically speaking.

Similar results were obtained using regression analysis designed to estimate potential effects on the likelihood of arrest for a violent crime, with and without firearm involvement, that are associated with having a firearm-prohibited status and with the reporting of prohibiting records to the background check database for prospective gun purchasers (Table 3). The unadjusted model shows that individuals with a gun-disqualifying record that was reported to the background check database were significantly less likely to be subsequently arrested for a gun-involved violent crime than were other gun-prohibited individuals whose disqualifying records had not been reported to the law enforcement database (odds ratio (OR) = .7; 95% confidence interval (CI) .6 – .8; p ≤ .001). In contrast, the association with arrest for a violent crime not involving a firearm was not statistically significant (OR = 1.0; 95% CI 1.0 – 1.1). In a regression model adjusted for age, sex, race, history of prior arrest, and psychiatric hospital admission, the odds ratio associated with having a gun-prohibited status reported to the gun-purchase background check database remained statistically significant for gun-involved violent offenses (OR = .7; 95% CI .6 – .8; p ≤ .001). In the adjusted model, there was a slight increase in the odds of being arrested for a violent offense that did not involve a firearm among those having a gun-prohibited status that was reported compared with individuals who were gun-prohibited, but not reported (OR = 1.1; 95% CI 1.0 – 1.1; p ≤ .01).

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Table 3

Effects of Prohibition Status and Record Reporting on Violent Crime Arrest, With and Without Firearm Involvement: Unadjusted and Adjusted Regression Models for Repeated Measures

Individuals with Restored Gun Eligibility

Individuals in the study who succeeded in regaining their suspended firearm rights differed from other gun-prohibited individuals in the study who did not receive restoration. They were more likely to have been found mentally incapacitated or incompetent, a gun-disqualifying status that is often temporary. Specifically, nearly one-third (32.2%) of those receiving restoration had a record of adjudication for mental incapacity or incompetence, compared with only four percent of disqualified individuals without a restoration (chi-square = 471.3; p < .0001, Table 4). Individuals who received a firearm restoration were also significantly more likely to have had an involuntary commitment (78.9%) than were disqualified individuals without a restoration (62.01%; chi-square =31.6; p < .0001). In addition, about 30 percent of individuals who had their gun rights restored had a temporary detention order followed by a voluntary admission into inpatient treatment compared with 23 percent of individuals who remained gun prohibited (chi-square = 5.8; p < .05). Twice as many individuals with a firearm restoration had both criminal justice and mental health disqualifications on record compared with their disqualified counterparts who were not restored (41.2% versus 19.6%; chi-square = 78.0; p < .0001). Reasons for this could include an underlying demographic similarity between those who are doubly disqualified and those who are most interested in owning firearms; both groups are predominantly male, for example.

View this table:
Table 4

Timing of Behavioral and Criminal Justice Outcomes Among Individuals with Firearm Restoration Records (n = 261)

Table 4 displays the frequency of different types of gun-disqualifying events and arrests that occurred before and after firearm restoration for individuals who regained their firearm rights. For context, the average time before rights were restored was 133 months with a median of 147 months, whereas the average number of months occurring after restoration was 49 with a median of 45 months. For this group, a combined total of 47,448 person-months were observed with 34,584 (73%) occurring before rights were restored and 12,864 (27%) occurring after firearm rights were restored.

Among all those who were granted restoration, nearly one in three (n = 79, 30.27%) went on to experience a new gun-disqualifying event in connection with a mental health adjudication, most of those (n = 73) being involuntary commitments. A small number (n = 8, 3.07%) went on to receive a mental incapacity adjudication after their gun rights were restored. Approximately one in ten individuals with restored firearm eligibility (n = 25, 9.58%) received a subsequent temporary detention order followed by voluntary inpatient admissions.

More than one in five individuals (22.99%) with restored gun rights went on to receive a subsequent criminal justice firearm disqualification. Only about half (54.0%) of individuals with restored gun eligibility did not have any subsequent gun disqualification.

Discussion

Our study found that individuals subject to mental-health-related firearm prohibitions were at a substantially heightened risk of harmful actions involving firearms. Suicide rates among this population were approximately five times higher than in the general Virginia population. Nearly half (47%) of firearm suicides involved individuals who had no involuntary commitment history or criminal justice disqualification, meaning they could legally have purchased a firearm on the day they used one to end their life. Stated in reverse, 53 percent were legally prohibited from possessing firearms but still acquired one, highlighting gaps in both the scope and enforcement of firearm prohibitions. Although the study indicates these prohibitions helped prevent gun-related violent crime, particularly when disqualifying records were reported, it also underscores their limitations in suicide prevention.

Data from Everytown for Gun Safety show a sharp increase in the cumulative number of reported gun-disqualifying mental health records in Virginia, rising from 105,782 in 2008 to 292,025 in 2017, with firearm purchase denials increasing from 15 to 488.37 These changes stemmed from policy reforms, including a NICS Act Record Improvement Program (NARIP) grant and enhanced reporting laws, which now ensure automatic submission of involuntary commitment records to the Virginia State Police.

Of relevance to the balance between risk and rights, 55 percent of the study population were subject to firearm prohibitions at some point, with 62 percent of them experiencing at least one criminal arrest. This suggests prohibitions are applied to a population at substantial risk and can also function to reduce that risk; firearm disqualification was associated with a subsequent 35 percent decline in arrests for gun-related crimes.

The study stresses that mental illness alone does not justify firearm prohibitions; restrictions should be based on evidence of dangerousness, as outlined in civil commitment criteria. The American Psychiatric Association’s (APA) 2014 “Resource Document on Access to Firearms by People with Mental Disorders”30 recommended that all states require “a fair opportunity for restoration of the right to purchase a firearm after a suitable waiting period” (Ref. 30, p 3) based on an individualized risk determination.30 In 2018, the APA added further clarification, stating that the process of restoring gun rights must balance “the person’s rights with the need to protect public safety and the person’s own well-being” (Ref. 38, section 4, paragraph d). The APA’s position can be understood to support states having a restoration process that is both equitable and takes account of the potential consequences for public safety.

This study is the first systematic examination of firearm-related adverse outcomes among individuals who regained their gun rights after disqualification because of mental health adjudications. Among 128,090 adults diagnosed with serious mental illness, 70,488 (55%) had a reported firearm disqualification whereas only 261 (.20%) had their rights restored. Those who regained firearm rights were less likely to be arrested for violent crimes after restoration than before (approximately 15% versus 40%).

A somewhat unexpected finding was that individuals who had both mental health and criminal justice disqualifications were overrepresented among those who regained their gun rights, compared with those who only had a mental health prohibitor. This could be explained largely by the demographics of firearm ownership. Males are significantly more likely to own guns39 and also more likely to commit serious crimes with guns, thus forfeiting their legal right to purchase and possess them. Not coincidentally, then, males are overrepresented among those seeking restoration of their gun rights.

Among individuals whose gun rights were restored, 20 percent went on to receive an additional gun prohibition in conjunction with a felony conviction or involuntary commitment. These rates exceed general population averages, highlighting both risks and potential successes of firearm rights restoration policies. Our findings on the likelihood of criminal involvement following restoration of gun rights can thus be viewed from different perspectives. First, in view of the stated legislative goal of restoring gun rights only to persons who are not dangerous to public safety, and in a manner “not contrary to the public interest,” the fact that four out of five restored individuals subsequently avoided being convicted of a felony could be considered a policy success. In terms of absolute risk, approximately one of five individuals with restored rights went on to lose those rights again because of a felony conviction and another one in five were disqualified through subsequent involuntary civil commitment. From a relative risk point of view, these outcomes represent much higher rates than are found in the general population; the prevalence of serious mental illness (a criterion for involuntary mental health commitment) and of felony conviction in the United States are approximately five and eight percent, respectively. Moreover, the negative social impact and cost of violent incidents with a firearm tends to be very high.

The American Psychiatric Association recommends that psychiatrists’ evaluations should inform court hearings for restoration of firearm rights to persons with a disqualifying mental health adjudication record.16,40 The psychiatrist’s role should include assessing an individual’s behavioral health history and current symptoms in connection to risk of harm to self or others, treatment adherence, the impact of treatment on the individual’s condition, and any associated risk of injurious behavior. Scholars have also called for psychiatrists to receive more education and training on laws pertaining to mental health prohibitors and firearm rights.41,–,43 A study in South Carolina revealed that psychiatrists had significant deficits of knowledge regarding the laws that both restrict and restore gun ownership rights for individuals with mental illness.44 These gaps in knowledge may extend to practitioners in other states as well. Education and further research on clinically informed gun rights restoration in psychiatric populations in other states is needed.

Balancing public safety and individual rights in the area of gun ownership remains a complex policy challenge in the United States, perhaps exceptionally so in the case of people who have been legally prohibited from accessing firearms because of a mental health adjudication and then seek to regain their right to purchase and possess firearms. Systematic efforts are needed to ensure due process and adequate consideration of evidence, including clinical evidence when relevant, in all cases involving gun-prohibited individuals with mental illness who are motivated to regain their legal right to access a weapon that can so easily end a life.

Limitations

Our study had several limitations. First, our study results may not generalize to other states with different populations of individuals with mental illness, a greater or lesser problem of gun violence in the community, or distinctive features of both the criminal legal system and the public-sector behavioral health system. Persons who have been hospitalized in the public sector behavioral health system for an acute psychiatric condition clearly do not constitute a representative sample of all people with mental health disorders. Also, our results concerning restoration of gun rights do not necessarily generalize to all disqualified individuals interested in relief from firearm disabilities; it is unknown how many individuals sought restoration of their gun rights and were denied, were discouraged from applying, or gave up in the process. In regard to our information on restoration being limited to a relatively small number of individuals with mental illness who regained their gun rights, we cannot completely assess the fairness of the application process or the overall effectiveness of the policy.

Conclusions

Individuals subject to a mental-health-related firearm prohibition in Virginia were at relatively high risk of engaging in harmful actions against others or self with a firearm. The study provides some evidence that firearm prohibitions were effective if the disqualifying records were reported to the background check database. Study findings give cause for some concern about safety consequences of gun rights restoration in current practice in one state. Future efforts to implement effective and fair policy solutions to reduce gun violence, including gun rights restoration, must focus on evidence of ongoing risk as well as questions of fairness. Evidence-based policies in this important area can save lives while respecting rights.

Footnotes

  • Disclosures of financial or other potential conflicts of interest: None.

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In this Issue

Journal of the American Academy of Psychiatry and the Law Online

Vol. 54, Issue 1

1 Mar 2026

Table of Contents Index by author

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Keywords

firearm disqualification, gun rights restoration, mental health-related adjudications, National Instant Criminal Background Check System, suicide, violence