Mental Health-Related Prohibitions

Many firearms prohibitions are based on individuals’ use of various mental health-related interventions, despite little evidence to support that mental illness is a major contributor to violence.

Mental illness is the cause of relatively little interpersonal gun violence in the United States. Mass shootings, which are many Americans’ main concern about gun violence, comprise less than 1% of firearm deaths annually¹ and are often assumed to be failures of the mental health system. However, researchers estimate that only a minority (perhaps 20%) of mass shooters have been diagnosed with a serious mental illness (SMI) that contribute to their actions.^2,3 Most violence is due to a complex interaction of social, economic, and environmental factors.

Mental Illness, Violence, and Suicide

Population studies have shown that people with SMI are somewhat more likely to commit violent acts than people without SMI, but the large majority are not violent towards others. Further, only a small proportion of interpersonal violence that occurs in the general population can be attributed to serious mental illness alone; one frequently cited estimate is 4%. Most violence is attributable to other risk factors, such as substance abuse, exposure to violence, or childhood trauma.⁴ Primary care and mental health clinicians will nonetheless be asked to evaluate patients making threats of violence for mental health concerns and should be aware of what mental health interventions are available, and how those may affect firearms access.

The association between suicide and mental illness is much stronger than that between interpersonal violence and mental illness. Almost half of suicide decedents have a diagnosis of a mental illness,⁵ although the majority of people with mental illness don’t die by suicide. Because firearms account for more than half of all suicides in the US,¹ and access to lethal means is a suicide risk factor, clinicians who work in settings where they may encounter suicidal patients should consider firearm access when evaluating such patients.

Mental Health Treatment and Firearm Prohibitions

While firearm owners are often wary that seeking mental health care may result in a loss of their Second Amendment rights, voluntary outpatient treatment by a therapist or a psychiatrist will generally not result in any reporting that would affect a person’s ability to purchase or legally own a gun. One exception to this is if the person makes a specific threat or is deemed to be dangerous by the clinician; in such cases, the therapist may have a duty to protect potential victims or to inform the authorities. California’s “Tarasoff” duty and New York’s Secure Ammunitions and Firearms Enforcement (SAFE) Act are two examples of state-level laws that can affect firearm rights under these circumstances.

The process of receiving involuntary psychiatric care may result in firearm removals and/or prohibitions at both the state and federal levels. Being placed on an emergency hold, being admitted to a psychiatric facility, and having a psychiatric commitment certified in court can each affect a person’s right to have, own, or purchase a gun depending on the jurisdiction.^6,7 Because of variations in the practices and capacities of local mental health systems, these events do not always happen in a consistent and predictable manner.

Despite the number of prohibitions tied to the mental health system, research has shown that mental health-related prohibitions are generally not effective at preventing firearms access for those with SMI.⁸ Among people with SMI who died by firearm suicide, nearly three-quarters had no mental health-related firearm prohibitions (i.e. a civil commitment certified at a hearing); however, more than half had been on a non-disqualifying emergency psychiatric hold. The use of risk-based criteria to determine who should be prohibited, and prohibitions for people who are involuntarily detained on short-term psychiatric holds, may be more effective.

Emergency Psychiatric Holds

In most states, law enforcement officers and mental health professionals can place a patient on an emergency 72-hour hold (known as a “5150” in California) if, due to a mental illness, they are determined to pose a danger to themselves (DTS) or a danger to others (DTO).⁹ Though dangerousness is usually a criteria for detention, this process is designed to connect people who need them to mental health services, not to prevent violence in their communities. In most states, an emergency or short-term mental health hold does not trigger a firearm prohibition and may not result in a psychiatric commitment or further mental health involvement, so if there is concern for firearm-related harm, other interventions should be considered as an adjunct to treatment.⁶ In California, these holds may allow for temporary removal of firearms in a person’s possession at the time the petition is served.¹⁰ Only the state of Washington prohibits firearm possession or ownership after an emergency mental health hold, and this prohibition lasts for six months.¹¹

Inpatient Hospitalization

Emergency psychiatric holds initiate with someone being evaluated in an emergency room or crisis setting and may result in the person being released from their hold or admitted to a psychiatric hospital for further treatment. Six states (Connecticut, California, Georgia, New Jersey, North Dakota, Tennessee) and Washington, DC prohibit firearm possession by people who have been admitted to a psychiatric hospital involuntarily. In certain circumstances and jurisdictions, a voluntary admission to a hospital may also be prohibiting. Most states, however, follow the federal law and enact a prohibition once someone has had their commitment certified by a hearing officer or judge at the commitment hearing.⁷

Psychiatric Commitment

The Gun Control Act of 1968 prohibits firearm purchase or ownership by anyone “committed to a mental institution,” in reference to the commitment hearings that usually happen a few days into a hospital admission, and allow the patient due process for their involuntary detention. Their mental health hold is reviewed by a legal official, usually a judge or hearing officer. If the official finds clear and convincing evidence that the person meets criteria to be involuntarily hospitalized, they are considered to have been “committed to a mental institution,” triggering an indefinite firearms prohibition at the federal level.¹²

If the judge does not certify the person’s commitment and instead releases them, an indefinite federal prohibition would not ensue (though a state prohibition from an admission for dangerousness might still stand). Because of variations in each county’s system and practices, these court hearings may happen days or even weeks after the emergency hold was originally applied. Many patients are treated and discharged before reaching that point, regardless of how ill or potentially dangerous they were on initial presentation. Many with more chronic psychiatric illness but lower potential for suicide or violence may be more likely to remain in the hospital until their hearing. Because of its lack of specificity for dangerousness, the commitment hearing is not a particularly accurate checkpoint in the mental health system for prohibiting dangerous people from owning firearms.

Other Mental Health-Related Prohibitions

A psychiatric commitment is not the only path in the mental health system that can result in a firearms prohibition. People who are placed on a mental health conservatorship or ordered to outpatient treatment by a court (in California, under Laura’s Law¹³; in New York, under Kendra’s Law¹⁴) are prohibited. Through the criminal court system, a person who is found incompetent to stand trial or not guilty by reason of insanity, or who is adjudicated as a mentally disordered sex offender, is also prohibited. These all fall under the criterion of “adjudicated as a mental defective” in the federal Gun Control Act.⁷

What You Can Do

If a clinician suspects that someone poses a risk of harm to themself or someone else and would benefit from involuntary mental health treatment, they or an emergency mental health provider or law enforcement officer can file for an emergency mental health hold. However, while an emergency detention may result in temporary separation from their weapons, it does not trigger a firearm prohibition at the state or federal level and should not be relied upon to remove firearm access in the long term.

Thus, if ongoing access to firearms is a concern (e.g., the person’s suicidality or thoughts of harming others are expected to continue), the clinician should consider other methods of reducing access to lethal means. If the patient is willing to collaborate, safe storage or temporary transfer may be appropriate; if not, and there is an imminent risk, civil protective orders can be used as an adjunct to a mental health hold.¹⁶

Page last updated March 2026.

For more information, see these peer-reviewed articles.

Barnhorst, A., & Kagawa, R. M. C. (2018). Access to firearms: When and how do mental health clients become prohibited from owning guns? Psychological Services.

Swanson, J. W., McGinty, E. E., Fazel, S., et al. (2015). Mental illness and reduction of gun violence and suicide: Bringing epidemiologic research to policy. Annals of Epidemiology.

Traylor, A., Price, J. H., Telljohann, S. K., et al. (2010). Clinical Psychologists’ Firearm Risk Management Perceptions and Practices. Journal of Community Health.

Norris, D. M., Price, M., Gutheil, T., et al. (2006). Firearm Laws, Patients, and the Roles of Psychiatrists. American Journal of Psychiatry.

Simon, R. I. (2006). The myth of “imminent” violence in psychiatry and the law. University of Cincinnati Law Review.

Sherman, M. E., Burns, K., Ignelzi, J., et al. (2001). Firearms Risk Management in Psychiatric Care. Psychiatric Services.