Mental Health Emergency Detentions and Access to Firearms Jon S. Vernick, Emma E. McGinty, and Lainie Rutkow
Introduction
Civil Commitment
Following the tragic shootings in Newtown (Connecticut), Aurora (Colorado), Isla Vista (California) and others, increased national attention has focused on the relationship between mental illness and gun violence. While some have called for enhanced regulation of firearm possession by persons with mental illness, others have argued that such actions would be ineffective and enhance stigma associated with mental illness while discouraging treatment seeking. Against this background, the Supreme Court and lower federal courts have wrestled with the impact of the U.S. Constitution’s Second Amendment on federal, state, and local gun laws. In 2008, in District of Columbia v. Heller, the Supreme Court ruled that the Second Amendment granted an individual right to own guns that was infringed by a law essentially banning handgun ownership in Washington, D.C. But the Court also concluded that certain longstanding restrictions — including on possession of firearms by the “mentally ill” — were “presumptively lawful.”1 The Heller Court, however, left many questions unanswered, including what types of mental health status constitutionally can be used to deny gun ownership. This article addresses one issue regarding mental health and guns: can a temporary, emergency mental health detention (as opposed to a full-blown involuntary commitment) disqualify a person from gun ownership? We review the epidemiologic evidence and recent case law.
Involuntary civil commitment refers to the process of hospitalizing an individual, against his or her will, for the purpose of receiving psychiatric care. States determine the standards for civil commitments, which can be temporary emergency detentions or longer-term involuntary commitments.2 An emergency detention refers to a short-term (typically 24 to 72 hours) involuntary hospitalization, during which an individual receives psychiatric care.3 These detentions occur to prevent an individual from imminently harming himself or others, and they provide an opportunity for mental health professionals to conduct an assessment and determine the need for ongoing psychiatric care.4 States generally provide limited procedural protections for individuals temporarily confined against their will, justified by the exigent circumstances and limited duration of the detention.5 In most states, an individual may be released from an emergency detention if he or she is found to no longer pose a danger to themselves or others due to a mental health condition.
Jon S. Vernick, J.D., M.P.H., is a Professor at the Johns Hopkins Bloomberg School of Public Health. Emma E. McGinty, Ph.D., M.S., is an Assistant Professor at the Johns Hopkins Bloomberg School of Public Health. Lainie Rutkow, J.D., Ph.D., M.P.H., is an Associate Professor at the Johns Hopkins Bloomberg School of Public Health.
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Mental Health Status and Violence Contrary to the impression given by some in the media following highly-publicized shootings, most persons with mental illness — including serious mental illnesses like schizophrenia — are never violent.6 In addition, the vast majority of violence in the U.S. — an estimated 96% — is not attributable to mental illness.7 However, research indicates that during certain highrisk periods, small subgroups of individuals with serious mental illness are at increased risk of committing violence toward others.8 Research shows that the same factors that increase risk of violence toward oneself and othjournal of law, medicine & ethics
Vernick, McGinty, and Rutkow
ers in the overall U.S. population — including substance abuse, childhood trauma and victimization, and unemployment — increase risk of violence among persons with mental illness.9 However, the prevalence of these factors, particularly substance abuse, is elevated among persons with mental illness. For example, a 2009 study using a national sample of Americans found that 46% of persons with schizophrenia had a lifetime history of a comorbid substance use disorder, compared with 15% of the overall U.S. population.10
(ATF) later issued regulations specifying that persons involuntarily committed to inpatient psychiatric care, persons found incompetent to stand trial or acquitted because of mental illness, persons placed under legal conservatorship because of mental illness, and persons involuntarily committed to outpatient psychiatric care are prohibited from purchasing or possessing guns.17 Left unclear, however, is whether the restrictions apply to temporary emergency detentions. This is precisely the issue addressed by a recent federal appeals court decision.
By determining that 922(g)(4) should not be read to exclude handgun ownership for those individuals who have been subject to temporary, ex parte detentions, the Court in Rehlander essentially avoided having to squarely address the question of whether such a prohibition would, in fact, violate the Second Amendment under all circumstances. As a result, the Court did not have to wrestle with the epidemiological evidence for the relationship between certain mental health conditions and violence or suicide. But this is an issue likely to come up again in future cases. Some persons with serious mental illness are at particularly increased risk of committing violence toward others during two high-risk periods: untreated firstepisode psychosis and the period surrounding psychiatric hospitalization.11 In a meta-analysis, Large and Nielsen concluded that 35% of individuals experiencing first-episode psychosis committed violence toward others, compared with about 3% of the general U.S. population without mental illness.12 Rates of violence toward others range from 15%-20% among voluntary inpatients and from 21%-50% among involuntarily committed inpatients.13 Unlike the relationship between mental illness and violence toward others, there is a clear and direct link between mental illness and suicide. An estimated 47-74% of suicides are attributable to mental illness.14 Depression and bipolar disorder are the mental illnesses most strongly associated with suicide.15
Federal Firearms Law and Mental Health Status Although it remains difficult to predict future violence based on mental health status, federal firearm law is specific. Under the 1968 Gun Control Act, 18 U.S.C. §922 (g)(4), persons who are “adjudicated mentally defective” or “committed to any mental institution” are prohibited from purchasing and possessing firearms.16 The Bureau of Alcohol, Tobacco and Firearms
United States v. Rehlander In March 2007, Nathan Rehlander was involuntarily hospitalized, based on “suicidal impulses,” under a Maine law allowing an emergency procedure for temporary hospitalization.18 That law permits hospitalization, under an ex parte procedure, without a hearing including full due process protections (such as counsel and a right to question evidence).19 In December 2008, police responding to an assault complaint found Mr. Rehlander with a handgun. He was indicted in 2009 for violating the federal law (§922(g)(4)). In federal court, Rehlander argued that the indictment violated his Second Amendment rights. Specifically, he argued that a temporary hospitalization under an ex parte proceeding should not justify a permanent bar to his right to own a gun established by Heller. Some prior courts had concluded that a temporary detention did satisfy the requirements of §922(g) (4), but Rehlander argued that this was before Heller was decided in 2008.20 The Second Circuit Court of Appeals agreed with Rehlander and dismissed his indictment. Although the Second Circuit acknowledged the language from Heller finding “longstanding prohibitions on the possession of firearms by…the mentally ill” to be presumptively lawful, the Court concluded that this did not apply to a temporary hospitalization.21 The Court emphasized the limited procedural protections in Maine for a
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short-term emergency hospitalization compared with the substantial due process protections of a full-blown involuntary commitment. The Court also reasoned that “this would be a different case” if §922(g)(4) permitted only a temporary denial of the right to own a gun, or if the state of Maine had some meaningful process for Rehlander to demonstrate that he no longer posed a risk to himself or others and thereby regain his rights.22
Conclusion By determining that 922(g)(4) should not be read to exclude handgun ownership for those individuals who have been subject to temporary, ex parte detentions, the Court in Rehlander essentially avoided having to squarely address the question of whether such a prohibition would, in fact, violate the Second Amendment under all circumstances. As a result, the Court did not have to wrestle with the epidemiological evidence for the relationship between certain mental health conditions and violence or suicide. But this is an issue likely to come up again in future cases. In 2013, the Consortium for Risk-Based Firearm Policy released its report, Guns, Public Health, and Mental Illness: An Evidence Based Approach for State Policy. Among its recommendations, the Consortium wrote that: “Current state law should be strengthened to temporarily prohibit individuals from purchasing or possessing firearms after a short-term involuntary hospitalization. Concurrently the process for restoration of firearm rights should be clarified and improved.”23 Enactment of this type of provision in a state would create a state analog to 922(g)(4), but make it clearly applicable to temporary commitments. Two important differences from the Rehlander case, however, would be the temporary nature of the prohibition and the possibility for rights to be restored. Whether these differences are sufficient to assure the constitutionality of the provision remains to be decided by future cases. References
1. District of Columbia v. Heller, 554 U.S. 570, 626 (2008); J. S. Vernick, L. Rutkow, D. W. Webster, and S. P. Teret, “Changing the Constitutional Landscape for Firearms: The U.S. Supreme Court’s Recent Second Amendment Decisions,” American Journal of Public Health 101, no. 11 (2011): 2021-2026. 2. J. S. Bonovitz and J. C. Bonovitz, “Emergency Detention of the Mentally Ill,” Journal of Psychiatry 9, no. 4 (1981): 423-429. 3. A. Baumgarten, “Medical Treatment Demands Medical Assessment: Substantive Due Process Rights in Involuntary Commitments,” University of California, Davis Law Review 45 (December 2011): 597-628. 4. T. L. Hafemeister and A. J. Amirshahi, “Civil Commitment for Drug Dependency: The Judicial Response,” Loyola Los Angeles Law Review 26 (November 1992): 39-104. 5. J. S. Vernick, M. Gakh and L. Rutkow, “Emergency Detention of Persons with Certain Mental Disorders During Public Health Disasters: Legal and Policy Issues,” American Journal of Disaster Medicine 7, no. 4 (2012): 295-302.
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6. J. Swanson, E. E. McGinty, S. Fazel, F. Bandiera, and M. Mays, “Mental Illness and Reduction of Gun Violence and Suicide: Bringing Epidemiological Research to Policy,” Annals of Epidemiology (2014), available at (last visited February 17, 2015). 7. J. W. Swanson, C. E. Holzer, V. K. Ganju, and R. T. Jono, “Violence and Psychiatric Disorder in the Community: Evidence from the Epidemiologic Catchment Area Surveys,” Hospital & Community Psychiatry 41, no. 7 (1990): 761-770. 8. J. Y. Choe, L. A. Teplin, and K. M. Abram, “Perpetration of Violence, Violent Victimization, and Severe Mental Illness: Balancing Public Health Outcomes,” Psychiatric Services 59, no. 2 (2008): 153-164; M. M. Large and O. Nielssen, “Violence in First-episode Psychosis: A Systematic Review and Meta-analysis,” Schizophrenia Research 125, no. 2 (2011): 209-220; E. E. McGinty, D. W. Webster, and C. L. Barry, “Gun Policy and Serious Mental Illness: Priorities for Future Research and Policy,” Psychiatric Services 65, no. 1 (2014): 50-58. 9. K. R. Conner, C. Cox, P. R. Duberstein, L. Tian, P. A. Nisbet, and Y. Conwell, “Violence, Alcohol, and Completed Suicide: A Case-Control Study,” American Journal of Psychiatry 158, no. 10 (2001): 1701-1705; R. N. Parker, “Alcohol and Violence: Connections, Evidence and Possibilities for Prevention,” Journal of Psychoactive Drugs Supp. 2 (2004): 157-163; T. J. Joiner, N. Sachs-Ericsson, L. Wingate, J. S. Brown, M . D. Anestis, and E. A. Selby, “Childhood Physical and Sexual Abuse and Lifetime Number of Suicide Attempts: A Persistent and Theoretically Improtant Relationship,” Behaviour Research and Therapy 45, no. 3 (2007): 539-547. 10. E. B. Elbogen and S. C. Johnson, “The Intricate Link between Violence and Mental Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions,” Archives of General Psychiatry 66, no. 2 (2009): 152-161. 11. A. Buchanan, “Risk of Violence by Psychiatric Patients: Beyond the ‘Actuarial Versus Clinical’ Assessment Debate,” Psychiatric Services 59, no. 2 (2008): 184-190; S. Fazel, J. P. Singh, H. Doll, and M. Grann, “Use of Risk Assessment Instruments to Predict Violence and Antisocial Behaviour in 73 Samples Involving 24827 People: Systematic Review and Meta-analysis,” BMJ 345 (2012): e4692. 12. See Large and Nielssen, supra note 8; Swanson et al., supra note 7. 13. See Choe, supra note 8. 14. J. T. Cavanagh, A. J. Carson, M. Sharpe, and S. M. Lawrie, “Psychological Autopsy Studies of Suicide: A Systematic Review,” Psychological Medicine 33, no. 3 (2003): 395-405; Z. Li, A. Page, G. Martin, and R. Taylor, “Attributable Risk of Psychiatric and Socioeconomic Risk Factors for Suicide from Individuallevel, Population-based Studies: A Systematic Review,” Social Science and Medicine 72, no. 4 (2011): 608-616. 15. Z. Rihmer, “Suicide Risk in Mood Disorders,” Current Opinion in Psychiatry 20, no. 1 (2007): 17-22; Z. Rihmer and K. Kiss, “Bipolar Disorders and Suicidal Behaviour,” Bipolar Disorders 4, Supp. 1 (2002): 21-25. 16. 18 U.S.C. § 922 (g)(4) (2014). 17. 27 C.F.R. § 478.11 (2014); J. R. Simpson, “Bad Risk? An Overview of Laws Prohibiting Possession of Firearms by Individuals with a History of Treatment for Mental Illness,” Journal of the American Academy Psychiatry and the Law 35, no. 3 (2007): 330-338. 18. United States v. Rehlander, 666 F. 3d 45, 47 (1st Cir. 2012). 19. Me. Rev. Stat. tit. 34-B, 3683(1)-(3). 20. United States v. Chamberlain, 159 F. 3d 656 (1st Cir 1998); United States v. Waters, 23 F. 3d 29 (2d Cir. 1994). 21. District of Columbia v. Heller, 554 U.S. 570, 626 (2008). 22. United States v. Rehlander, 666 F. 3d 45, 49 (1st Cir. 2012). 23. Consortium for Risk-Based Firearm Policy, Guns, Public Health, and Mental Illness: An Evidence Based Approach for State Policy (2013), Washington, D.C., available at (last visited February 17, 2015).
journal of law, medicine & ethics
Copyright of Journal of Law, Medicine & Ethics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Introduction
Civil Commitment
Following the tragic shootings in Newtown (Connecticut), Aurora (Colorado), Isla Vista (California) and others, increased national attention has focused on the relationship between mental illness and gun violence. While some have called for enhanced regulation of firearm possession by persons with mental illness, others have argued that such actions would be ineffective and enhance stigma associated with mental illness while discouraging treatment seeking. Against this background, the Supreme Court and lower federal courts have wrestled with the impact of the U.S. Constitution’s Second Amendment on federal, state, and local gun laws. In 2008, in District of Columbia v. Heller, the Supreme Court ruled that the Second Amendment granted an individual right to own guns that was infringed by a law essentially banning handgun ownership in Washington, D.C. But the Court also concluded that certain longstanding restrictions — including on possession of firearms by the “mentally ill” — were “presumptively lawful.”1 The Heller Court, however, left many questions unanswered, including what types of mental health status constitutionally can be used to deny gun ownership. This article addresses one issue regarding mental health and guns: can a temporary, emergency mental health detention (as opposed to a full-blown involuntary commitment) disqualify a person from gun ownership? We review the epidemiologic evidence and recent case law.
Involuntary civil commitment refers to the process of hospitalizing an individual, against his or her will, for the purpose of receiving psychiatric care. States determine the standards for civil commitments, which can be temporary emergency detentions or longer-term involuntary commitments.2 An emergency detention refers to a short-term (typically 24 to 72 hours) involuntary hospitalization, during which an individual receives psychiatric care.3 These detentions occur to prevent an individual from imminently harming himself or others, and they provide an opportunity for mental health professionals to conduct an assessment and determine the need for ongoing psychiatric care.4 States generally provide limited procedural protections for individuals temporarily confined against their will, justified by the exigent circumstances and limited duration of the detention.5 In most states, an individual may be released from an emergency detention if he or she is found to no longer pose a danger to themselves or others due to a mental health condition.
Jon S. Vernick, J.D., M.P.H., is a Professor at the Johns Hopkins Bloomberg School of Public Health. Emma E. McGinty, Ph.D., M.S., is an Assistant Professor at the Johns Hopkins Bloomberg School of Public Health. Lainie Rutkow, J.D., Ph.D., M.P.H., is an Associate Professor at the Johns Hopkins Bloomberg School of Public Health.
76
Mental Health Status and Violence Contrary to the impression given by some in the media following highly-publicized shootings, most persons with mental illness — including serious mental illnesses like schizophrenia — are never violent.6 In addition, the vast majority of violence in the U.S. — an estimated 96% — is not attributable to mental illness.7 However, research indicates that during certain highrisk periods, small subgroups of individuals with serious mental illness are at increased risk of committing violence toward others.8 Research shows that the same factors that increase risk of violence toward oneself and othjournal of law, medicine & ethics
Vernick, McGinty, and Rutkow
ers in the overall U.S. population — including substance abuse, childhood trauma and victimization, and unemployment — increase risk of violence among persons with mental illness.9 However, the prevalence of these factors, particularly substance abuse, is elevated among persons with mental illness. For example, a 2009 study using a national sample of Americans found that 46% of persons with schizophrenia had a lifetime history of a comorbid substance use disorder, compared with 15% of the overall U.S. population.10
(ATF) later issued regulations specifying that persons involuntarily committed to inpatient psychiatric care, persons found incompetent to stand trial or acquitted because of mental illness, persons placed under legal conservatorship because of mental illness, and persons involuntarily committed to outpatient psychiatric care are prohibited from purchasing or possessing guns.17 Left unclear, however, is whether the restrictions apply to temporary emergency detentions. This is precisely the issue addressed by a recent federal appeals court decision.
By determining that 922(g)(4) should not be read to exclude handgun ownership for those individuals who have been subject to temporary, ex parte detentions, the Court in Rehlander essentially avoided having to squarely address the question of whether such a prohibition would, in fact, violate the Second Amendment under all circumstances. As a result, the Court did not have to wrestle with the epidemiological evidence for the relationship between certain mental health conditions and violence or suicide. But this is an issue likely to come up again in future cases. Some persons with serious mental illness are at particularly increased risk of committing violence toward others during two high-risk periods: untreated firstepisode psychosis and the period surrounding psychiatric hospitalization.11 In a meta-analysis, Large and Nielsen concluded that 35% of individuals experiencing first-episode psychosis committed violence toward others, compared with about 3% of the general U.S. population without mental illness.12 Rates of violence toward others range from 15%-20% among voluntary inpatients and from 21%-50% among involuntarily committed inpatients.13 Unlike the relationship between mental illness and violence toward others, there is a clear and direct link between mental illness and suicide. An estimated 47-74% of suicides are attributable to mental illness.14 Depression and bipolar disorder are the mental illnesses most strongly associated with suicide.15
Federal Firearms Law and Mental Health Status Although it remains difficult to predict future violence based on mental health status, federal firearm law is specific. Under the 1968 Gun Control Act, 18 U.S.C. §922 (g)(4), persons who are “adjudicated mentally defective” or “committed to any mental institution” are prohibited from purchasing and possessing firearms.16 The Bureau of Alcohol, Tobacco and Firearms
United States v. Rehlander In March 2007, Nathan Rehlander was involuntarily hospitalized, based on “suicidal impulses,” under a Maine law allowing an emergency procedure for temporary hospitalization.18 That law permits hospitalization, under an ex parte procedure, without a hearing including full due process protections (such as counsel and a right to question evidence).19 In December 2008, police responding to an assault complaint found Mr. Rehlander with a handgun. He was indicted in 2009 for violating the federal law (§922(g)(4)). In federal court, Rehlander argued that the indictment violated his Second Amendment rights. Specifically, he argued that a temporary hospitalization under an ex parte proceeding should not justify a permanent bar to his right to own a gun established by Heller. Some prior courts had concluded that a temporary detention did satisfy the requirements of §922(g) (4), but Rehlander argued that this was before Heller was decided in 2008.20 The Second Circuit Court of Appeals agreed with Rehlander and dismissed his indictment. Although the Second Circuit acknowledged the language from Heller finding “longstanding prohibitions on the possession of firearms by…the mentally ill” to be presumptively lawful, the Court concluded that this did not apply to a temporary hospitalization.21 The Court emphasized the limited procedural protections in Maine for a
2014 public health law conference: intersection of law, policy and prevention • spring 2015
77
JL ME SUPPLEMENT
short-term emergency hospitalization compared with the substantial due process protections of a full-blown involuntary commitment. The Court also reasoned that “this would be a different case” if §922(g)(4) permitted only a temporary denial of the right to own a gun, or if the state of Maine had some meaningful process for Rehlander to demonstrate that he no longer posed a risk to himself or others and thereby regain his rights.22
Conclusion By determining that 922(g)(4) should not be read to exclude handgun ownership for those individuals who have been subject to temporary, ex parte detentions, the Court in Rehlander essentially avoided having to squarely address the question of whether such a prohibition would, in fact, violate the Second Amendment under all circumstances. As a result, the Court did not have to wrestle with the epidemiological evidence for the relationship between certain mental health conditions and violence or suicide. But this is an issue likely to come up again in future cases. In 2013, the Consortium for Risk-Based Firearm Policy released its report, Guns, Public Health, and Mental Illness: An Evidence Based Approach for State Policy. Among its recommendations, the Consortium wrote that: “Current state law should be strengthened to temporarily prohibit individuals from purchasing or possessing firearms after a short-term involuntary hospitalization. Concurrently the process for restoration of firearm rights should be clarified and improved.”23 Enactment of this type of provision in a state would create a state analog to 922(g)(4), but make it clearly applicable to temporary commitments. Two important differences from the Rehlander case, however, would be the temporary nature of the prohibition and the possibility for rights to be restored. Whether these differences are sufficient to assure the constitutionality of the provision remains to be decided by future cases. References
1. District of Columbia v. Heller, 554 U.S. 570, 626 (2008); J. S. Vernick, L. Rutkow, D. W. Webster, and S. P. Teret, “Changing the Constitutional Landscape for Firearms: The U.S. Supreme Court’s Recent Second Amendment Decisions,” American Journal of Public Health 101, no. 11 (2011): 2021-2026. 2. J. S. Bonovitz and J. C. Bonovitz, “Emergency Detention of the Mentally Ill,” Journal of Psychiatry 9, no. 4 (1981): 423-429. 3. A. Baumgarten, “Medical Treatment Demands Medical Assessment: Substantive Due Process Rights in Involuntary Commitments,” University of California, Davis Law Review 45 (December 2011): 597-628. 4. T. L. Hafemeister and A. J. Amirshahi, “Civil Commitment for Drug Dependency: The Judicial Response,” Loyola Los Angeles Law Review 26 (November 1992): 39-104. 5. J. S. Vernick, M. Gakh and L. Rutkow, “Emergency Detention of Persons with Certain Mental Disorders During Public Health Disasters: Legal and Policy Issues,” American Journal of Disaster Medicine 7, no. 4 (2012): 295-302.
78
6. J. Swanson, E. E. McGinty, S. Fazel, F. Bandiera, and M. Mays, “Mental Illness and Reduction of Gun Violence and Suicide: Bringing Epidemiological Research to Policy,” Annals of Epidemiology (2014), available at (last visited February 17, 2015). 7. J. W. Swanson, C. E. Holzer, V. K. Ganju, and R. T. Jono, “Violence and Psychiatric Disorder in the Community: Evidence from the Epidemiologic Catchment Area Surveys,” Hospital & Community Psychiatry 41, no. 7 (1990): 761-770. 8. J. Y. Choe, L. A. Teplin, and K. M. Abram, “Perpetration of Violence, Violent Victimization, and Severe Mental Illness: Balancing Public Health Outcomes,” Psychiatric Services 59, no. 2 (2008): 153-164; M. M. Large and O. Nielssen, “Violence in First-episode Psychosis: A Systematic Review and Meta-analysis,” Schizophrenia Research 125, no. 2 (2011): 209-220; E. E. McGinty, D. W. Webster, and C. L. Barry, “Gun Policy and Serious Mental Illness: Priorities for Future Research and Policy,” Psychiatric Services 65, no. 1 (2014): 50-58. 9. K. R. Conner, C. Cox, P. R. Duberstein, L. Tian, P. A. Nisbet, and Y. Conwell, “Violence, Alcohol, and Completed Suicide: A Case-Control Study,” American Journal of Psychiatry 158, no. 10 (2001): 1701-1705; R. N. Parker, “Alcohol and Violence: Connections, Evidence and Possibilities for Prevention,” Journal of Psychoactive Drugs Supp. 2 (2004): 157-163; T. J. Joiner, N. Sachs-Ericsson, L. Wingate, J. S. Brown, M . D. Anestis, and E. A. Selby, “Childhood Physical and Sexual Abuse and Lifetime Number of Suicide Attempts: A Persistent and Theoretically Improtant Relationship,” Behaviour Research and Therapy 45, no. 3 (2007): 539-547. 10. E. B. Elbogen and S. C. Johnson, “The Intricate Link between Violence and Mental Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions,” Archives of General Psychiatry 66, no. 2 (2009): 152-161. 11. A. Buchanan, “Risk of Violence by Psychiatric Patients: Beyond the ‘Actuarial Versus Clinical’ Assessment Debate,” Psychiatric Services 59, no. 2 (2008): 184-190; S. Fazel, J. P. Singh, H. Doll, and M. Grann, “Use of Risk Assessment Instruments to Predict Violence and Antisocial Behaviour in 73 Samples Involving 24827 People: Systematic Review and Meta-analysis,” BMJ 345 (2012): e4692. 12. See Large and Nielssen, supra note 8; Swanson et al., supra note 7. 13. See Choe, supra note 8. 14. J. T. Cavanagh, A. J. Carson, M. Sharpe, and S. M. Lawrie, “Psychological Autopsy Studies of Suicide: A Systematic Review,” Psychological Medicine 33, no. 3 (2003): 395-405; Z. Li, A. Page, G. Martin, and R. Taylor, “Attributable Risk of Psychiatric and Socioeconomic Risk Factors for Suicide from Individuallevel, Population-based Studies: A Systematic Review,” Social Science and Medicine 72, no. 4 (2011): 608-616. 15. Z. Rihmer, “Suicide Risk in Mood Disorders,” Current Opinion in Psychiatry 20, no. 1 (2007): 17-22; Z. Rihmer and K. Kiss, “Bipolar Disorders and Suicidal Behaviour,” Bipolar Disorders 4, Supp. 1 (2002): 21-25. 16. 18 U.S.C. § 922 (g)(4) (2014). 17. 27 C.F.R. § 478.11 (2014); J. R. Simpson, “Bad Risk? An Overview of Laws Prohibiting Possession of Firearms by Individuals with a History of Treatment for Mental Illness,” Journal of the American Academy Psychiatry and the Law 35, no. 3 (2007): 330-338. 18. United States v. Rehlander, 666 F. 3d 45, 47 (1st Cir. 2012). 19. Me. Rev. Stat. tit. 34-B, 3683(1)-(3). 20. United States v. Chamberlain, 159 F. 3d 656 (1st Cir 1998); United States v. Waters, 23 F. 3d 29 (2d Cir. 1994). 21. District of Columbia v. Heller, 554 U.S. 570, 626 (2008). 22. United States v. Rehlander, 666 F. 3d 45, 49 (1st Cir. 2012). 23. Consortium for Risk-Based Firearm Policy, Guns, Public Health, and Mental Illness: An Evidence Based Approach for State Policy (2013), Washington, D.C., available at (last visited February 17, 2015).
journal of law, medicine & ethics
Copyright of Journal of Law, Medicine & Ethics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
