Extreme Risk Protection Order (ERPO) laws
Extreme Risk Protection Order (ERPO) laws, also called red flag laws, temporarily restrict firearm access for individuals who are at risk of harming themselves or others. Typically, family members or law enforcement officers petition a civil court for an ERPO, requesting the removal of firearms or prohibiting firearm purchases for an individual. Individuals who are at risk of harming themselves or others are known in petitions as “respondents”. A judge reviews the petitioner’s evidence, including proof of threats or acts of violence or severe mental health conditions linked to violent behavior, and issues an order. Firearms currently in the possession of the respondent are held by authorities while the order is active. The specific criteria for who can file a petition and the duration and type of order vary by state: some states, for example, have expanded eligible petitioners to mental health professionals and school administrators1, 2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced suicide
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced gun violence
Reduced mass shootings
What does the research say about effectiveness?
Extreme Risk Protection Order (ERPO) laws are a suggested strategy to prevent firearm suicide3. Available evidence suggests that states with ERPO laws may have greater reductions in firearm suicides than states without laws4, 5, including firearm suicides among older adults6, 7. However, additional evidence is needed to confirm effects8.
A study based on data from four states – California, Connecticut, Maryland, and Washington – suggests that about one suicide death may be prevented for every 17 ERPO petitions9. ERPO petitions filed by health professionals may reduce firearm suicides, with a greater reduction for white respondents compared to respondents from other racial groups10. ERPO petitions are also associated with reduced firearm homicide, especially among petitions filed by a respondent’s family members10. Overall, the effect of ERPO laws on firearm-related interpersonal violence is unclear11. Available studies report no associations between ERPO laws and mass shootings12, 13, 14.
To enhance the preventive impact of ERPOs, experts recommend broadening who can file ERPO petitions to include ex-spouses and extended family members, monitoring for racially equitable procedures by documenting respondent demographic information in petitions, and integrating provision of mental health treatment or counseling for a respondent15, 16. Training and education on ERPO process guidelines for law enforcement and potential petitioners, including mental health and medical professionals and social workers, as well as support for such petitioners with an ERPO liaison, a coordinator, or a legal expert are also recommended17, 18, 19, 20. Health professionals are more likely to use ERPOs if they work with social workers or crisis line workers during the petitioning process21.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact Extreme Risk Protection Order (ERPO) laws can have on disparities in firearm suicide and violence. Available research suggests that the lack of respondent demographic information in many current ERPO petitions makes it difficult to monitor procedures and firearm relinquishment decisions for racial equity15.
Overall, the majority of ERPO petitioners are law enforcement officers; the majority of respondents in petitions are white males24. Available studies indicate differences in perceptions and use of ERPO laws between racial and ethnic groups. In California, Black and Hispanic individuals are less supportive of ERPO laws and less likely to petition an ERPO for their family members than white and Asian individuals25. Non-white respondents are less likely to appear at a court hearing to have their guns returned26. Researchers recommend providing court advocates and legal assistance for ERPO respondents and petitioners regardless of their income level, race and ethnicity25. For fair procedures, court decisions on ERPO petitions should be based on clear and convincing evidence and additional professional evaluation of respondents, especially regarding mental health concerns19, 27.
Firearm deaths disproportionally affect populations by race and ethnicity, age, gender, poverty level, and urbanization level. In 2020, the firearm homicide rate was highest among Black people (27 per 100,000 individuals), about 13 times higher than white people. Both American Indian and Alaska Native people and white people had higher suicide rates, more than twice that of Black and Hispanic people. Individuals ages 25-44 and males had the highest firearm homicide rates compared to other age groups and females. Counties with higher poverty rates had higher firearm homicide and suicide rates than counties with lower poverty rates28. In 2020, firearm suicide rates for rural counties were 2.1 times higher than large metropolitan counties29. Regarding firearm ownership, males, white people, and residents of rural areas are more likely to own firearms than females, other racial and ethnic groups, and residents of urban or suburban areas30.
What is the relevant historical background?
The first gun control policy was passed by a European colony in 1619, which banned the sale or gift of firearms to Native Americans. This was a controversial policy because firearm trading was profitable and Native Americans were sometimes allies against colonial adversaries31. The addition of the Bill of Rights to the U.S. Constitution in 1791 included the Second Amendment, which states that, “A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed”32. The varied interpretations of the Second Amendment have shaped firearm regulations ever since it was ratified.
Through the early 1930s, there was wide variation in state gun laws: major forms of state gun policies addressed hunting, militia, and gun carrying restrictions, with less attention given to firearm sale bans31. The National Firearms Act was passed in 1934 to control firearm transactions and possession of unregistered firearms, in recognition of increased crime rates and public safety concerns33. Connecticut first enacted the Extreme Risk Protection Order (ERPO) law in 1999. Since the U.S. experienced a surge of mass shootings and school shootings in the 2010s, more states have adopted ERPO laws in support for public safety34. Between 2009 and mid-2022, about 280 mass shootings (i.e., firearm homicides in which four or more people were shot and killed) took place, involving more than 1,570 deaths and over 1,000 people injured34. ERPO laws, partially modeled on Domestic Violence Restraining Orders (DVROs)10, gained political support from even pro-gun advocates in that the laws target a specific small set of the population who are at risk of harming others35.
Equity Considerations
- Does your state have ERPO laws? If so, what evidence is needed to prove risk when filing an ERPO in your state? What education and training are needed to prevent biased petitions and decision making?
- How do stigma and systematic barriers prevent individuals, including health professionals, from petitioning a court for an ERPO?
- Are there mental health treatments or counseling for individuals with mental health concerns in your community to address underlying issues contributing to the need for an ERPO? How can a court system work better with a mental health service system to provide services to the individuals with an ERPO?
Implementation Examples
As of 2024, 21 states and Washington, D.C. have Extreme Risk Protection Order (ERPO) laws. Sixteen states and Washington, D.C. allow law enforcement and family or household members to petition courts for ERPOs. Maryland, Michigan, and Washington, D.C. also allow mental health providers to submit a petition other than law enforcement and family members; Massachusetts also allows school administrators and certain health care professionals to petition1, 22.
As of 2024, the U.S. Centers for Disease Control and Prevention (CDC) is funding a 3-year project to develop and evaluate an ERPO implementation guidance for law enforcement agencies23.
Implementation Resources
‡ Resources with a focus on equity.
ERPO Resource center - Johns Hopkins Bloomberg School of Public Health. (n.d.). The National Extreme Risk Protection Order (ERPO) Resource Center. Retrieved July 23, 2025.
Everytown-Guide ER Laws - Parsons, C., Bengall, R., Zale, C., Geller, L., & Cantrell, S. (2023). Promising approaches for implementing extreme risk laws: A guide for practitioners and policymakers. Everytown for Gun Safety Action Fund.
EFSGV-REIA‡ - The Educational Fund to Stop Gun Violence (EFSGV). Racial equity impact assessment tool for gun violence prevention (REIA).
Footnotes
* Journal subscription may be required for access.
1 GLC-ERPO - Giffords Law Center (GLC). (n.d.). Extreme Risk Protection Orders. Retrieved July 22, 2025.
2 Everytown-ER - Everytown for Gun Safety Action Fund. (n.d.). Extreme Risk Laws. Retrieved July 22, 2025.
3 APA-ERPO 2021 - American Psychological Association (APA). (2021). Extreme risk protection orders: An evidence-based approach to preventing suicide (PsycEXTRA Dataset).
4 Dalafave 2021 - Delafave, R. (2021). An empirical assessment of homicide and suicide outcomes with red flag laws. Loyola University Chicago Law Journal, 52(3), 867.
5 Kivisto 2018 - Kivisto, A. J., & Phalen, P. L. (2018). Effects of risk-based firearm seizure laws in Connecticut and Indiana on suicide rates, 1981–2015. Psychiatric Services, 69(8), 855–862.
6 Saadi 2020 - Saadi, A., Choi, K. R., Takada, S., & Zimmerman, F. J. (2020). The impact of gun violence restraining order laws in the U.S. and firearm suicide among older adults: A longitudinal state-level analysis, 2012–2016. BMC Public Health, 20(1), 334.
7 Betz 2024 - Betz, M. E., Frattaroli, S., Knoepke, C. E., Johnson, R., Christy, A., Schleimer, J. P., Pear, V. A., McCarthy, M., Kapoor, R., Norko, M. A., Rowhani-Rahbar, A., Ma, W., Wintemute, G. J., Swanson, J. W., & Zeoli, A. M. (2024). Extreme risk protection orders in older adults in six U.S. states: A descriptive study. Clinical Gerontologist, 47(4), 536–543.
8 RAND-Agniel 2024 - Agniel, D. (2024, July 16). Effects of Extreme Risk Protection Orders on Suicide. RAND.
9 Swanson 2024 - Swanson, J. W., Zeoli, A. M., Frattaroli, S., Betz, M., Easter, M., Kapoor, R., Knoepke, C., Norko, M., Pear, V. A., Rowhani-Rahbar, A., Schleimer, J. P., & Wintemute, G. J. (2024). Suicide prevention effects of Extreme Risk Protection Order laws in four states. The Journal of the American Academy Psychiatry and the Law, 52(3), 327-337.
10 Gu 2025 - Gu, W., Greenwood, B. N., Agarwal, R., & Nestadt, P. S. (2025). The impact of extreme risk protective orders on firearm fatalities. American Journal of Preventive Medicine, 69(2).
11 Zeoli 2025 - Zeoli, A. M., Frattaroli, S., Aassar, M., Cooper, C. E., & Omaki, E. (2025). Extreme risk protection orders in the United States: A systematic review of the research. Annual Review of Criminology, 8, 485–504.
12 Siegel 2020b - Siegel, M., Goder-Reiser, M., Duwe, G., Rocque, M., Fox, J. A., & Fridel, E. E. (2020). The relation between state gun laws and the incidence and severity of mass public shootings in the United States, 1976–2018. Law and Human Behavior, 44(5), 347-360.
13 Gius 2024 - Gius, M. (2024). Relationship between red flag laws and mass shootings. Atlantic Economic Journal, 52, 31-38.
14 RAND-Jose 2024 - Jose, R. (2024, July 16). Effects of Extreme-Risk Protection Orders on mass shootings. RAND.
15 Rakshe 2024 - Rakshe, S., Valek, R., Teichman, R., Freeman, K., DeFrancesco, S., & Carlson, K. F. (2024). Five years of extreme risk protection orders in Oregon: A descriptive analysis. Psychological Reports, 00332941241248599.
16 Larosiere 2021 - Larosiere, M. & Greenlee, J. G. S. (2020-2021). Red flag laws raise red flags of their own. The Law & Psychology Review, 45, 155-168.
17 Lindley 2024 - Lindley, L. C., Beebe, L. H., Davis, H. A., Policastro, C. N., & Svynarenko, R. (2024). Healthcare professionals and Extreme Risk Protection Orders: A concise review. Journal of Trauma Nursing, 31(4), 224-230.
18 Wortzel 2023 - Wortzel, H. S., Simonetti, J. A., Knoepke, C. E., Simpson, J. R., Brar, L., Westmoreland, P., & Matarazzo, B. B. (2023). Extreme Risk Protection Orders: Legislative intent and clinician guidance. Journal of Psychiatric Practice, 29(6), 480-488.
19 Barnard 2024 - Barnard, L. M., Batta, N., McCarthy, M., Thies, K., Robinson, C., Schultze, M., Betz, M. E., & Knoepke, C. E. (2024). Implementation of Extreme Risk Protection Orders in Colorado from 2020 to 2022: Firearm relinquishment and return and petitioner characteristics. Preventive Medicine Reports, 44, 102800.
20 Conrick 2023a - Conrick, K. M., Porter, S. F., Gause, E., Prater, L., Rowhani-Rahbar, A., Rivara, F. P., & Moore, M. (2023). Integration of Extreme Risk Protection Orders into the clinical workflow: Qualitative comparison of clinician perspectives. PLOS ONE, 18(12), e0288880.
21 Conrick 2023b - Conrick, K. M., Davis, A., Rooney, L., Bellenger, M. A., Rivara, F. P., Rowhani-Rahbar, A., & Moore, M. (2023). Extreme Risk Protection Orders in Washington State: Understanding the role of health professionals. Journal of the Society of Social Work and Research, 14(2), 185-209.
22 Everytown-ER Fact sheet - Everytown for Gun Safety Action Fund. (n.d.). Extreme Risk Laws. Retrieved July 22, 2025.
23 CDC Firearm grants 2024 - U.S. Centers for Disease Control and Prevention (CDC). (2024, July 2). RFA-CE-22-004: Research grants to prevent firearm-related violence and injuries.
24 Barnard 2025 - Barnard, L.M., Betz, M.E., Frattaroli, S., Knoepke, C. E., Christy, A., Schleimer, J. P., Pear, V. A., McCarthy, M., Kapoor, R., Norko, M. A., Rowhani-Rahbar, A., Ma, W., Wintemute, G. J., Swanson, J. W., Easter, M. M., & Zeoli, A. M. (2025). Extreme risk protection order use in six U.S. states: A descriptive study. Injury Epidemiology, 12(30).
25 Pear 2022a - Pear, V. A., Schleimer, J. P., Aubel, A. J., Buggs, S., Knoepke, C. E., Pallin, R., Shev, A. B., Tomsich, E., Wintemute, G. J., & Kravitz-Wirtz, N. (2022). Extreme risk protection orders, race/ethnicity, and equity: Evidence from California. Preventive Medicine, 165, 107181.
26 Swanson 2020 - Swanson, J. W. (2020). The color of risk protection orders: gun violence, gun laws, and racial justice. Injury Epidemiology, 7(46).
27 Kopel 2021 - Kopel, D. B. (2020-2021). Red flag laws: Proceed with caution. Law & Psychology Review, 45, 39-86.
28 Kegler 2022 - Kegler SR, Simon TR, Zwald ML, et al. Vital Signs: Changes in firearm homicide and suicide rates - United States, 2019–2020. Morbidity and Mortality Weekly Report (MMWR). 2022;71:656-663.
29 JHCGVS 2022 - Johns Hopkins Center for Gun Violence Solutions (JHCGVS). A Year in Review: 2020 Gun Deaths in the U.S. 2022.
30 Pew-Schaeffer 2024 - Schaeffer, K. (2024, July 24). Key facts about Americans and guns. Pew Research Center.
31 Spitzer 2017 - Spitzer R. Gun law history in the United States and Second Amendment rights. Law and Contemporary Problems. 2017;80(2):55-83.
32 CONAN-Second Amendment - The Constitution Annotated (CONAN). Second Amendment: Right to bear arms.
33 ATF-NFA - Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF). National Firearms Act (NFA).
34 EBSCO-Issitt 2024 - Issitt, M. (2024). Red-flag laws: Overview. EBSCO.
35 Shen 2019 - Shen, C. (2019). A triggered nation: An argument for Extreme Risk Protection Orders. UC Law Constitutional Quarterly, 46(3), 683-712.
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