Firearms Relief from Disability

[sloop]

I was wondering if anybody has experience with evaluations for relief from disability related to restrictions on firearms rights. I am somewhat interested in doing this type of work in the future and am curious about what would go into such an evaluation as well as the logistics of finding this type of work.

---

Members don't see this ad.

 

[Sushirolls]

Please explain more. Goal to assist in restoration of firearms or to withdraw access?

 

[sloop]

Please explain more. Goal to assist in restoration of firearms or to withdraw access?

To restore firearms rights. Many states have laws that restrict firearms purchase or possession for various time periods if you meet a variety of mental health related criteria. For example, people who have been voluntarily or involuntarily admitted, people who have been found IST or people who have received an NGRI/NCR. Generally these types of restrictions have to involve some sort of due process for the removal of the restrictions which is known as “relief from disability.”

My understanding is that these types of proceedings can involve expert testimony by a psychiatrist, especially when the reasons for the restrictions were mental health related. It seems like in some places the office of mental health often does such evaluations but I have also heard that people also do private evaluations for this sort of thing.

I’ve just never encountered somebody who has done them and was wondering if anybody here had and might be able to go into what that type of work involves.

 

[Sushirolls]

Definitely a niche. Best wishes in the exploration, and hopefully your interest is not politically motivated one way or the other.

 

[sloop]

Definitely a niche. Best wishes in the exploration, and hopefully your interest is not politically motivated one way or the other.

I have personal feelings and beliefs about firearms, as I’m sure most people do. However, my interest honestly just stems from a belief that everybody is entitled to due process. I think that part of due process is an ability to seek and present evidence that might be favorable to oneself. In this area of policy and law, it seems like access to a psychiatric evaluation on the topic would be an important part of due process and fairness.

 

[clausewitz2]

I have personal feelings and beliefs about firearms, as I’m sure most people do. However, my interest honestly just stems from a belief that everybody is entitled to due process. I think that part of due process is an ability to seek and present evidence that might be favorable to oneself. In this area of policy and law, it seems like access to a psychiatric evaluation on the topic would be an important part of due process and fairness.

Your best bet is to find someone who advertises that they do these sorts of evaluations and see if you can pick their brain about how they do it, although this will probably require offering to pay them for their time. If these evaluations end up as part of court filings in your state you could also collect some reports on this from patients you've had that you know had evaluations like this and try to reverse-engineer them a bit. Probably someone offers a CME about this as well.

It seems like the kind of thing where the details of the state regs and case law on this matter a lot so asking locally is more likely to be useful.

 

[Mass Effect]

I have personal feelings and beliefs about firearms, as I’m sure most people do. However, my interest honestly just stems from a belief that everybody is entitled to due process. I think that part of due process is an ability to seek and present evidence that might be favorable to oneself. In this area of policy and law, it seems like access to a psychiatric evaluation on the topic would be an important part of due process and fairness.

I would never take on this kind of liability. Whether due to mental illness or not, whether accidental or intentional, if any of these folks harm someone with a firearm, I wouldn't want my name associated with it.

 

[erg923]

I don't think I would ever want this associated with my professional license, no matter how passionate I might be about the issue. Someone kills someone (kills themselves, or tries to kill someone, or assaults, or rapes, or robs, or holds up a bank, or threatens) after this...someone will be asking you alot of questions. I would be very sure of this. This could get high profile. What is the appeal, exactly?

 

[sloop]

I would never take on this kind of liability. Whether due to mental illness or not, whether accidental or intentional, if any of these folks harm someone with a firearm, I wouldn't want my name associated with it.

Yeah, this could be a concern. I don’t know exactly how much liability there is. At least one state has established immunity for this type of evaluation by statute, but my understanding is that most states don’t have such a provision. I would think that if you’re doing these evaluations as a state employee, you would also enjoy some degree of qualified immunity, though that wouldn’t necessarily be true in private practice. Again, a reason I would want to talk to someone who has actually done these.

 

[sloop]

I don't think I would ever want this associated with my professional license, no matter how passionate I might be about the issues Someone kills someone (tries to kills, or assaults, or rapes, or robs, or holds up a bank, or threatens) after this...someone will be asking you alot of questions. I would be very sure of this. This could get high profile.

I definitely hear what you’re saying, but isn’t this more or less the case for all of forensics (other than certain civil work like testamentary capacity and such)?

 

[erg923]

I definitely hear what you’re saying, but isn’t this more or less the case for all of forensics?

Yes...but no also. Greenlighting someone to be able to carry/possess a deadly weapon that can kill in instant. Seems a bit different and circumscribed. Upside for you low. Downside...very bad.

 

[Mass Effect]

Yeah, this could be a concern. I don’t know exactly how much liability there is. At least one state has established immunity for this type of evaluation by statute, but my understanding is that most states don’t have such a provision. I would think that if you’re doing these evaluations as a state employee, you would also enjoy some degree of qualified immunity, though that wouldn’t necessarily be true in private practice. Again, a reason I would want to talk to someone who has actually done these.

And/or an attorney well-versed in this type of thing. Might consider your malpractice insurer as well.

 

[WisNeuro]

I definitely hear what you’re saying, but isn’t this more or less the case for all of forensics (other than certain civil work like testamentary capacity and such)?

Not really, different areas in forensics/legal carry different liability risks. For example, a lot of people won't touch custody evals. Incidence of board complaints and/or lawsuits are much higher than say, civil IME evals. Higher the risk for harm, the more liability you take on.

 

[Sushirolls]

Yes...but no also. Greenlighting someone to be able to carry/possess a deadly weapon that can kill in instant. Seems a bit different and circumscribed. Upside for you low. Downside...very bad,

Cars crashed into a crowd can kill in an instant and be very deadly. This list is numerous of things with lethal potential that may or may not require a license.

Things that are a right: Our words can kill in an instant, too, like shouting fire or bomb in a populated area, and it, like guns are our right to keep freely.

 

[WisNeuro]

Cars crashed into a crowd can kill in an instant and be very deadly. This list is numerous of things with lethal potential that may or may not require a license.

Things that are a right: Our words can kill in an instant, too, like shouting fire or bomb in a populated area, and it, like guns are our right to keep freely.

Not in all circumstances, lots of laws related to this, some of which are at play here.

 

[erg923]

Cars crashed into a crowd can kill in an instant and be very deadly. This list is numerous of things with lethal potential that may or may not require a license.

Things that are a right: Our words can kill in an instant, too, like shouting fire or bomb in a populated area, and it, like guns are our right to keep freely.

Why do we ask about access to firearms specifically (versus a car, or castor beans, or a pen, or a fork, or gasoline, or Thallium, or an anvil) in a standard outpatient SI/HI risk assessment? Because access to reliable, quick, targeted, and non-labor intensive/convenient lethal means increases the risk of harm (to self and others).

Also, I've never heard of a former mental patient that yelled "fire" or "bomb" as way of committing murder/mass murder. I have heard of ones that used guns.

 

[sloop]

So I think the concern about liability is warranted here, and it’s something I’d like to learn more about.

That said, I feel like this conversation has gotten onto the topic of guns in terms of policy. The only thing I will say about that is that regardless of which side of the aisle you’re on, it seems like the lack of psychiatrists doing these evaluations causes real problems. People who are in favor of gun control are probably interested in enforcing laws that restrict seriously mentally ill people from owning firearms. However, in most (if not all) jurisdictions, people must have a process by which to reclaim their firearm rights. I heard from a local forensic psychiatrist that there used to be one person in my state who did these kinds of evaluations but that person is no longer practicing. If you’re a gun control advocate: what do you think is going to happen when it comes to the attention of the courts that an important aspect of the due process required to enforce these restrictions is fundamentally inaccessible? And if you’re an advocate for gun rights, it seems obviously problematic if the state can take away your rights and you’re just completely unable to seek the type of evidence that might result in the restoration of these rights. To me, it just doesn’t seem like anybody wins in that situation.

I don’t want to jeopardize my ability to practice if these evaluations carry some sort of undue liability such that no psychiatrist will touch them. If that’s the case, though, it seems like there needs to be a change in policy such that some immunity is granted for this type of work.

 

[Bartelby]

I would consider finding out if any attorneys conduct this kind of work and then contact them about your interest in these evaluations, and your qualifications. Also consider contacting the one psychiatrist you mentioned who used to do it, find out why they stopped, and see if they would be willing to share referral sources (presumably they will not see you as a "competitor" if they do not want these evaluations anymore).

Contact your malpractice insurance to make sure that forensic work is covered. Get it in writing if it is not already. You don't want any unpleasant surprises on that front.

The risk for being named in a malpractice suit in forensic practice is relatively low and mainly would come from the people who hired you alleging that you did work that did not meet the relevant standard (the person you are evaluating has standing to sue you in some limited circumstances, but typically your duty is mainly or only to the person who hired you). Also keep in mind that you do not get to decide whether the person retains their gun rights or not, a judge does. I strongly suspect that that means any potential victims who tried to sue you if your opinion led to restoration of gun rights to someone who turned out to be dangerous would find it difficult if not impossible to bring a suit against you (presuming you are honest / do not misrepresent the case).

 

[Bartelby]

And as for licensing concerns keep in mind that of course this is a very politically divisive issue. Even if some potential future victim cannot sue you, they can file a complaint with the medical board. That means that you want to make sure any opinion you offer is well supported and could be defended as reasonable before the board (where some members may have their own strong opinions on this topic). Bottom line though, unless you are engaged in egregious practice I doubt you would lose your license over doing these evaluations.

 

[erg923]

Yeah, this could be a concern. I don’t know exactly how much liability there is. At least one state has established immunity for this type of evaluation by statute,

Yea..... (in the Bill Lumbergh voice from Office Space). Would not make my conscious feel good. You?

We can all take up "issues" in our lives as passions or missions. I just don't know why on earth you would want THIS as one of them when existing psychological science has almost zero empirical literature to fill us with confidence regarding violence recidivism and risk assessment in general?

As an aside. what does the summary statement for this assessment report look like? What does it include? Are there references to empirical literature? What papers/studies exist on this topic? Do we say....."low," "moderate" or "high" risk for gun violence in the future? How is that decided? What are the criteria? Judges love when we say "low," "moderate" or "high..."

 

[Stagg737]

Yeah, this could be a concern. I don’t know exactly how much liability there is. At least one state has established immunity for this type of evaluation by statute, but my understanding is that most states don’t have such a provision. I would think that if you’re doing these evaluations as a state employee, you would also enjoy some degree of qualified immunity, though that wouldn’t necessarily be true in private practice. Again, a reason I would want to talk to someone who has actually done these.

Let's say one state does have immunity. What happens if you restore their rights, they drive to another state without immunity, and kill a bunch of people there? I respect your interest and position, but there's too much gray area with this right now for me to ever be comfortable doing this. I say this as someone very interested in forensics.

I don’t want to jeopardize my ability to practice if these evaluations carry some sort of undue liability such that no psychiatrist will touch them. If that’s the case, though, it seems like there needs to be a change in policy such that some immunity is granted for this type of work.

Yes, tort reform would be nice.

Also keep in mind that you do not get to decide whether the person retains their gun rights or not, a judge does. I strongly suspect that that means any potential victims who tried to sue you if your opinion led to restoration of gun rights to someone who turned out to be dangerous would find it difficult if not impossible to bring a suit against you (presuming you are honest / do not misrepresent the case).

This will depend on the state though. I've of patients in my area who have gone after psychiatrists or physicians for things like involuntary admissions when the judge is the one with final say. I'd guess that this wouldn't hold up in court and that if it was it could be appealed successfully, but is that a stress we'd even want to deal with in the first place?

 

[sloop]

Yea. Would not make my conscious feel good. You?

We can all take up "issues" in our lives as passions or missions. I just don't know why on earth you would want THIS as one of them when existing psychological science has almost zero empirical literature to fill us with confidence regarding violence recidivism and risk assessment in general.

As an aside. what does the summary statement for this assessment this look like? What does it include? Are there references to empirical literature. What papers/studies exist on this topic? Do we say....."low," "medium", or "high" risk for gun violence in the future? How is that decided? What are the criteria? Judges love "low," "medium" and "high" stuff....

I understand that there is not great evidence for risk assessment. At the same time, we’re taking away people’s rights on the basis of their mental health histories. It seems natural that the process to restore those rights would be informed by psychiatric evaluation. What else would you propose? That people who have been voluntarily admitted for over 30 days be indefinitely barred from firearms ownership as a result because no psychiatrist will evaluate them and provide testimony as to whether the circumstances leading to the admission are ongoing or contribute to continuing risk for violence?

I do not know exactly what goes into these evaluations, which was the reason for the thread . . .

I don’t know why you seem to be implying that I’m stupid for caring about this at all or considering the mere possibility of doing this type of work.

Let's say one state does have immunity. What happens if you restore their rights, they drive to another state without immunity, and kill a bunch of people there? I respect your interest and position, but there's too much gray area with this right now for me to ever be comfortable doing this. I say this as someone very interested in forensics.



Yes, tort reform would be nice.



This will depend on the state though. I've of patients in my area who have gone after psychiatrists or physicians for things like involuntary admissions when the judge is the one with final say. I'd guess that this wouldn't hold up in court and that if it was it could be appealed successfully, but is that a stress we'd even want to deal with in the first place?

I suppose, in your example, that if one of the victims were to sue they would try to do so in federal court by claiming diversity jurisdiction. I am not a lawyer, so I don’t know if they would be successful in pursuing it. I also have no idea how likely this is. I mean, you could release a dangerous person from the hospital emergency department and have a similar outcome. Is this really more likely to happen when you’re evaluating some armored car driver with a remote admission? I can see the optics being worse but I’m not totally convinced that this type of evaluation has such an outrageous liability potential. Obviously I’d want to look into it more before performing them, but it’s just not as obvious as I think some people make it out to be.

 

[erg923]

I understand that there is not great evidence for risk assessment. At the same time, we’re taking away people’s rights on the basis of their mental health histories. It seems natural that the process to restore those rights would be informed by psychiatric evaluation. What else would you propose? That people who have been voluntarily admitted for over 30 days be indefinitely barred from firearms ownership as a result because no psychiatrist will evaluate them and provide testimony as to whether the circumstances leading to the admission are ongoing or contribute to continuing risk for violence?

I do not know exactly what goes into these evaluations, which was the reason for the thread . . .

I don’t know why you seem to be implying that I’m stupid for caring about this at all or considering the mere possibility of doing this type of work.


I suppose, in your example, that if one of the victims were to sue they would try to do so in federal court by claiming diversity jurisdiction. I am not a lawyer, so I don’t know if they would be successful in pursuing it. I also have no idea how likely this is. I mean, you release a dangerous person from the hospital emergency department and have a similar outcome. Is this really more likely to happen when you’re evaluating some armored car driver with a remote admission? I can see the optics being worse but I’m not totally convinced that this type of evaluation has such an outrageous liability potential. Obviously I’d want to look into it more before performing them, but it’s just not as obvious as I think some people make it out to be.

I think it is a risk that has little no empirical grounding to overturn on the basis that you are a "mental health professional." Psychiatry, in this scenario, didn't take away anyone's rights to begin with. Their behavior and then a judge did.

 

[sloop]

I think it is a risk that has little no empirical grounding to overturn on the basis that you are a "mental health professional." You didn't take away anyone's rights to begin with.

The law generally presumes that psychiatrists can perform evaluations of risk related to psychiatric illness. The paucity of empirical evidence for the predictive value of risk assessment is likely the product of a variety of logistical problems with studying things like suicide and homicide. Regardless, it is actually clinical practice to routinely perform risk assessments. How else do you decide whether someone needs to be admitted, should be involuntarily admitted, can be discharged, needs a higher level of outpatient care, etc? Also, the courts expect forensic psychiatrists to, as a matter of course, provide opinions as to dangerousness for the purposes of deciding whether or not a person needs commitment pending trial.

So, yes, regardless of the lack of empirical data, there are myriad reasons that risk assessment needs to be performed and it is a reasonable assumption that mental health providers are the most qualified people to do this.

 

[erg923]

So, yes, regardless of the lack of empirical data, there are myriad reasons that risk assessment needs to be performed and it is a reasonable assumption that mental health providers are the most qualified people to do this.

I see.

Tell me about "reasonable assumptions" and the legal system in the US. Tell me abut Daubert Standards....

 

[sloop]

I see.

Tell me about "reasonable assumptions" and the legal system in the US. Tell me abut Daubert Standards....

First of all, the Daubert standard was never intended to be used as a rigid checklist for admissibility. They are guiding principles for consideration and all factors are not required for evidence to be admissible.

Second, there are problems with risk assessment, but those are primarily related to the predictive value of the assessments. This is probably at least partly related to the relative rarity, at least in the short term, of the outcomes of interest. The research has not proven that risk assessment is ineffective, but has simply not found that it is effective. That being said, the components involved in risk assessment involve consideration of risk factors that are firmly established in the scientific literature.

Risk assessment, as I’ve mentioned, is also well accepted in psychiatry. As I’ve noted, whether it is a formulaic checklist of risk factors or a more fluid and informal risk assessment that takes into consideration those factors, this process is commonplace and, in fact, essential to psychiatric practice.

I do believe that a good case for Daubert admissibility could be made for the risk assessment by a psychiatrist.

And again: risk assessment is common in forensics and comes up all the time, particularly in the criminal setting. What exactly do you suppose people are discussing at Clinical Forensic Review Boards when they consider whether to recommend conditional release? Or when they certify an opinion as to dangerousness for an individual who is found IST? You can make the argument that risk assessment does not meet the Daubert standard, but I think you’d then be arguing to toss out evidence that has been widely seen by courts as admissible.

 

[erg923]

I think you are missing the point.

It doesn't matter whether any of this it is "well accepted in psychiatry." There are many, many untested and fuzzy legal and ethical concerns here. See my previous posts. Not the least of which is should medicine butt its nose into something for which they have little scientific evidence to support/justify and had nothing to do with from the start?

 

[clausewitz2]

I think you are missing the point.

It doesn't matter whether any of this it is "well accepted in psychiatry." There are many, many untested and fuzzy legal and ethical concerns here. See my previous posts. Not the least of which is should medicine butt its nose into something for which they have little scientific evidence to support/justify and had nothing to do with from the start?

I am with you on this one. Maybe you do this and there's a high profile shooting and you get sued and ultimately on appeal you are vindicated because you practiced a standard of care type psychiatric risk assessment.

How eager are you to be the test case? How much do you like paying lawyers, and for how many years?

If you recognize someone's name from a famous legal case it was rarely a win in a "quality of life" sense.

 

[Mad Jack]

Yeah, this could be a concern. I don’t know exactly how much liability there is. At least one state has established immunity for this type of evaluation by statute, but my understanding is that most states don’t have such a provision. I would think that if you’re doing these evaluations as a state employee, you would also enjoy some degree of qualified immunity, though that wouldn’t necessarily be true in private practice. Again, a reason I would want to talk to someone who has actually done these.

In my state you would be hung out to dry if anything went wrong, and you'll definitely end up on the national news regardless of where you live

 

[sloop]

I think you are missing the point.

It doesn't matter whether any of this it is "well accepted in psychiatry." There are many, many untested and fuzzy legal and ethical concerns here. See my previous posts. Not the least of which is should medicine butt its nose into something for which they have little scientific evidence to support/justify and had nothing to do with from the start?

What are you talking about? What fuzzy legal or ethical concerns are there?

Courts have dealt with the issue of uncertainty in psychiatry before both generally and with regard to risk assessment/dangerousness. In general, courts give deference to psychiatry, recognizing that many questions within the purview of psychiatry do not have clear-cut black-and-white answers.

Specifically relevant, in Barefoot v. Estelle, Barefoot appealed his death sentence, claiming that psychiatric assessments of dangerousness were unreliable and shouldn't be admitted. The Supreme Court, in that case, denied a stay of execution and held that psychiatrists' opinions as to dangerousness are admissible and that a jury would be able to determine the reliability of such predictions.

Neither petitioner nor the Association suggests that psychiatrists are always wrong with respect to future dangerousness, only most of the time. ​

​

The suggestion that no Psychiatrist's testimony may be presented with respect to a defendant's future dangerousness is somewhat like asking us to disinvent the wheel.​

​

Ake v. Oklahoma also acknowledged the uncertainty involved in psychiatry and found that juries should be allowed to resolve differences in opinion offered by psychiatrists:

Perhaps because there often is no single, accurate psychiatric conclusion on legal insanity in a given case, juries remain the primary fact-finders on this issue, and they must resolve differences in opinion within the psychiatric profession on the basis of the evidence offered by each party. ​

We've discussed Daubert and I think it is a legitimate question whether it overrules Barefoot. As mentioned, there are many reasons that it might not. First, as discussed previously, no one factor is dispositive and the Court did "not presume to set out a definitive checklist or test." Additionally, Daubert concerned federal hearings and it's not clear that the standard applies at the State level or to to the type of administrative hearings that we're talking about here. At the state level, some case law suggests that Daubert does not necessarily apply in all contexts (see Nenno v. State).

Going onto the ethics, I strongly feel that this is all about how you present your testimony and represent the case. I do believe that it would be unethical to claim in court that there is strong evidence to suggest that an individual has a high or low likelihood of being dangerous in the future. However, I think it is ethical if you represent, as I did here, that psychiatric risk assessments have not generally proved reliable but that there are certain characteristics which are risk factors for violence, that a person has certain risk factors, or that certain risk factors have been modified since the circumstances that led to the restriction of their rights. This is different from saying "As a psychiatrist, I can know with certainty that this person is very unlikely to kill someone in the future." I definitely think that there is a way to give ethical testimony on this subject.

 

[clausewitz2]

What are you talking about? What fuzzy legal or ethical concerns are there?

Courts have dealt with the issue of uncertainty in psychiatry before both generally and with regard to risk assessment/dangerousness. In general, courts give deference to psychiatry, recognizing that many questions within the purview of psychiatry do not have clear-cut black-and-white answers.

Specifically relevant, in Barefoot v. Estelle, Barefoot appealed his death sentence, claiming that psychiatric assessments of dangerousness were unreliable and shouldn't be admitted. The Supreme Court, in that case, denied a stay of execution and held that psychiatrists' opinions as to dangerousness are admissible and that a jury would be able to determine the reliability of such predictions.

Neither petitioner nor the Association suggests that psychiatrists are always wrong with respect to future dangerousness, only most of the time. ​

​

The suggestion that no Psychiatrist's testimony may be presented with respect to a defendant's future dangerousness is somewhat like asking us to disinvent the wheel.​

​

Ake v. Oklahoma also acknowledged the uncertainty involved in psychiatry and found that juries should be allowed to resolve differences in opinion offered by psychiatrists:

Perhaps because there often is no single, accurate psychiatric conclusion on legal insanity in a given case, juries remain the primary fact-finders on this issue, and they must resolve differences in opinion within the psychiatric profession on the basis of the evidence offered by each party. ​

We've discussed Daubert and I think it is a legitimate question whether it overrules Barefoot. As mentioned, there are many reasons that it might not. First, as discussed previously, no one factor is dispositive and the Court did "not presume to set out a definitive checklist or test." Additionally, Daubert concerned federal hearings and it's not clear that the standard applies at the State level or to to the type of administrative hearings that we're talking about here. At the state level, some case law suggests that Daubert does not necessarily apply in all contexts (see Nenno v. State).

Going onto the ethics, I strongly feel that this is all about how you present your testimony and represent the case. I do believe that it would be unethical to claim in court that there is strong evidence to suggest that an individual has a high or low likelihood of being dangerous in the future. However, I think it is ethical if you represent, as I did here, that psychiatric risk assessments have not generally proved reliable but that there are certain characteristics which are risk factors for violence, that a person has certain risk factors, or that certain risk factors have been modified since the circumstances that led to the restriction of their rights. This is different from saying "As a psychiatrist, I can know with certainty that this person is very unlikely to kill someone in the future." I definitely think that there is a way to give ethical testimony on this subject.

What does the actual text of the relevant statute/reg say wrt what they want you to certify/attest for the admin judge to make this decision?

 

[whopper]

The APA has stances on firearms but one of those stances is that patients which are stabilized and show an extended duration be given their 2nd Amendment rights back (at least last time I checked and I haven't recently rechecked).

If you're a member simply go to their website. Also lookup on the AAPL database to see if there's any position statements on it.

 

[sloop]

The APA has stances on firearms but one of those stances is that patients which are stabilized and show an extended duration be given their 2nd Amendment rights back (at least last time I checked and I haven't recently rechecked).

If you're a member simply go to their website. Also lookup on the AAPL database to see if there's any position statements on it.

Interesting. I think I found the position statement you described. It does state the following:

A person whose right to purchase or possess firearms has been suspended on grounds related to mental disorder should have a fair opportunity to have his or her rights restored in a process that properly balances the person's rights with the need to protect public safety and the person's own well‐being. Accordingly, the process for restoring an individual's right to purchase or possess a firearm following a disqualification relating to mental disorder should be based on adequate clinical assessment, with decision‐making responsibility ultimately resting with an administrative authority or court.​

Source:
Pinals DA, Appelbaum PS, Bonnie R, Fisher CE, Gold LH, Lee LW. American Psychiatric Association: Position Statement on Firearm Access, Acts of Violence and the Relationship to Mental Illness and Mental Health Services. Behav Sci Law. 2015 Jun;33(2-3):195-8. doi: 10.1002/bsl.2180. PMID: 26095100.

I also found the following resource document which is an interesting read and outlines a lot of the same topics we have been discussing in this thread: https://www.psychiatry.org/File Lib...ertaining-to-Restoring-Access-to-Firearms.pdf

 

[NickNaylor]

I’m a fan of supporting the right to own firearms and own several guns myself, but I agree with others that this seems like a potentially difficult area to practice in with lots of potential liability. I don’t have any particularly concrete advice or tips, but I would proceed cautiously and make sure you’re very aware of what you’re getting yourself into. Consulting with a healthcare attorney probably wouldn’t be a bad idea, in addition to the suggestion of talking with other forensics folks to see how they would approach this topic.

 

[birchswing]

(I am not a doctor, and I have never been around a gun—that I know of.)

I think if you escort them to a gun range on three separate occasions without incident, you should have immunity if you write a favorable report even if the person ultimately ends up using the guns for ill intent. Three separate occasions I think should be enough to observe their behaviors using guns to make any reasonable prediction of future behavior. But I'm not sure that an in-office visit could adequately demonstrate how a person would react once around a gun.

There was another thread recently where someone wrote their patient liked "playing" with their gun while drinking. I can't recall exactly what that entailed.

I know in some European countries, escorts are required for certain types of licenses. For example you can get a gun license that notes a psychological disorder and requires an escort (this wouldn't make much sense in the US--but there the purpose of having the gun is going to a hunting lodge). Much the same a driver's license might say that you require glasses.

 

[WisNeuro]

(I am not a doctor, and I have never been around a gun—that I know of.)

I think if you escort them to a gun range on three separate occasions without incident, you should have immunity if you write a favorable report even if the person ultimately ends up using the guns for ill intent. Three separate occasions I think should be enough to observe their behaviors using guns to make any reasonable prediction of future behavior. But I'm not sure that an in-office visit could adequately demonstrate how a person would react once around a gun.

There was another thread recently where someone wrote their patient liked "playing" with their gun while drinking. I can't recall exactly what that entailed.

I know in some European countries, escorts are required for certain types of licenses. For example you can get a gun license that notes a psychological disorder and requires an escort (this wouldn't make much sense in the US--but there the purpose of having the gun is going to a hunting lodge). Much the same a driver's license might say that you require glasses.

I get the well meaning behind this. But this is like saying taking a pedophile to the park three times without them molesting a kid makes them ok to be around kids alone. Risk assessment, as flawed as it is, involves overall risk over time, not in discrete snippets of time. For example, someone who gets drunk/high often, and gets very violent when high/drunk. If they have multiple arrests for armed threats, and have shown no real attempt to get sober, it doesn't really matter if they can handle a gun at the shooting range in a short sober window. What matters is the likelihood that they will have another violent episode.