State laws that restrict people with mental illness, including substance
use problems, from gaining access to firearms differ widely across the nation,
according to a review of these laws in the August American Journal of
The laws differ in their definition of mental illness, type and duration of
gun restriction, and reporting practices on the part of physicians caring for
these patients, according to the report.
This diversity is why psychiatrists must familiarize themselves with the
laws governing the state in which they practice regarding the licensure,
purchase, possession, and carrying of firearms, lead author Donna Norris,
M.D., told Psychiatric News.
"We as psychiatrists should be prepared to deal with these issues,
whether we practice in rural or inner-city areas," said Norris, APA's
secretary-treasurer and an assistant professor of psychiatry at Harvard
When Norris and her colleagues began to review the state laws in 2000, only
19 states had legislation restricting gun ownership for people with mental
illness, she noted. But by the end of the review in 2005, 43 states,
Washington, D.C., and Puerto Rico had laws prohibiting people with mental
illness from obtaining firearm licensure, 36 states and Puerto Rico had
similar prohibitions for those with substance use problems, and 31 states,
Washington D.C., and Puerto Rico had similar prohibitions for those with
Twenty states and Washington, D.C., have databases containing information
submitted by courts or mental health treatment facilities on people with
mental illness. In California, for instance, people who have been admitted to
a psychiatric hospital and ruled a danger to themselves or others must be
reported to the local law enforcement agency by an attending health care
professional, according to the report.
"In most jurisdictions, law enforcement authorities have access to
these mental health data and can use them to determine legal access to
firearms," the report stated.
The flurry of legislation may be related to isolated incidents of violence
perpetrated by people with mental illness using guns and the firestorm of
publicity often generated as a result, noted Norris.
She found that many of the variations between state laws prohibiting people
with mental illness from legally obtaining or carrying firearms depended on
each state's definition of restricted individuals.
According to the report, individuals who are restricted from gun ownership
include those who currently receive outpatient psychiatric treatment, those
who have been civilly committed to treatment, and those who have been declared
not guilty by reason of insanity. Some are prohibited because they have a
history of alcohol or substance abuse.
The laws vary in their range of restrictiveness. In Pennsylvania, for
example, prohibitions extend to those who have been "adjucated as an
incompetent," been committed to receive psychiatric care on an inpatient
unit, or been convicted of driving under the influence of alcohol or a
controlled substance on three or more occasions within a five-year period.
Texas law prohibits the ownership and carrying of guns by those with
certain psychiatric diagnoses, including schizophrenia, delusional disorder,
bipolar disorder, chronic dementia, dissociative identity disorder,
intermittent explosive disorder, and antisocial personality disorder. In
addition, gun restrictions are in place for five years following an
involuntary psychiatric hospitalization, inpatient or residential treatment
for substance abuse, diagnosis of alcohol or drug dependence, or diagnosis of
mental illness by a licensed physician.
Patients in certain states who wish to apply for permission to purchase,
possess, or transfer a handgun must present with their application a written
affidavit from their psychiatrist or physician. In Massachusetts, for
instance, this affidavit must state that the physician is aware of the
patient's mental illness and the patient is not disabled by the illness"
in a manner that should prevent the applicant from possessing a
firearm, rifle, or shotgun...." The statute goes on to specify that if
the applicant has been treated for drug or alcohol addiction, he or she must
have been "cured" of the addiction by a licensed physician to own
"There is some risk attached to this responsibility," Norris
noted. "Can you really testify that the patient is `cured,' and what
does this really mean?" she asked.
In Rhode Island, a restricted person must be pronounced "cured"
by a physician for at least five years to be considered a "mentally
stable person and a proper person to possess firearms." For handgun
licensure in Oklahoma, individuals who have been treated for mental illness
must have their physician testify that they have been mentally stable for at
least 10 years.
Psychiatrists may also have other duties. In California and Colorado,
psychiatrists treating inpatients must report gun possession to local law
enforcement or judicial authorities.
In states with no specified restrictions, federal law takes effect. The
Federal Gun Control Act "prohibits the transfer of any firearm to any
person who... is an unlawful user of or addicted to any controlled substance
[or] has been adjucated as a mental defective or committed to a mental
In an editorial appearing in that same issue of American Journal of
Psychiatry, Paul Appelbaum, M.D., chair of APA's Council on Psychiatry
and Law, noted that the variability in statutes across the United States poses"
a dilemma for advocates for persons with mental disorders, including
psychiatrists and their national organizations.... But given that only a tiny
fraction of violence, including gun violence, is perpetrated by persons with
mental disorders, efforts that center disproportionately on restricting their
access reflect a deeply irrational public policy."
Appelbaum also expressed concern about the creation of databases that
accumulate information about people with mental illness and can be assessed by
states before the sale of a firearm. Such access may threaten the
confidentiality of psychiatric treatment.
"Whether singling out persons with mental disorders, including
substance abuse problems, for restrictions with regard to gun purchases is an
effective means of protecting the public cries out for careful
assessment," he said.
"Firearm Laws, Patients, and the Roles of Psychiatrists"
is posted at<http://ajp.psychiatryonline.org/cgi/content/full/163/8/1392>.▪