The right of American citizens to own, register, and carry firearms has a significant history of federal and/or local regulation dating to the early 18th century.1 With the passage of the federal Gun Control Act of 1968, persons who have been treated for mental illness and/or substance abuse are among a defined group restricted from owning and carrying firearms.2-4 While violence is often portrayed in the media as related to persons with mental illnesses, there are limited research data to support this idea.5
In the past several decades, US firearms legislation has followed high-profile instances of violent acts. The shootings of President Reagan and James Brady in 1981 resulted in the passage and implementation of the Brady Handgun Violence Prevention Act (1994). This Act provides for background checks for handgun sales and a 5-day waiting period. In addition, it provided the impetus for the establishment of the National Instant Criminal Background Check System (NICS).6,7 With the NICS in place (voluntarily by the states), the Federal Bureau of Investigation (FBI) can potentially receive information within minutes as to whether the purchase violates any federal or state laws.
State and federal regulations
A press release by the FBI dated April 9, 2007, noted that only 22 states voluntarily contribute mental health records to the NICS. The system contained only 235,000 mental health records as of January 2006, although it was estimated that 2.7 million people had been involuntarily institutionalized for mental health disorders.8 The Department of Justice noted that the law was not fully implemented because of state fiscal concerns.8 (Table 1 presents a brief overview of firearm restrictions and mental illness data banks.)
A recent review of state and federal firearm laws noted that firearm statutes vary considerably regarding ownership and/or carry restrictions and depend on the manner in which restricted individuals are defined.4,9,10 In all 50 states, as well as Puerto Rico and the District of Columbia, persons prohibited from owning and carrying firearms include those who receive outpatient psychiatric treatment, those who have been civilly committed to treatment settings, and those found not guilty by reason of insanity. Some state statutes further restrict individuals with a history of alcohol or substance abuse. If a state does not have statutes that identify restricted individuals, federal laws provide guidance for prohibiting the sale of firearms to individuals with a specifically defined history of mental illness and substance abuse. And, in states with less restrictive statutes, federal law supersedes state statutes.
In view of the large variance in state laws, it is important that psychiatrists and other physicians review the governing laws of the state or territory in which they practice if asked to provide information to the FBI or other law enforcement officials regarding a patient.
Violent acts capture the nation’s attention and often provide the impetus needed for new laws and regulations that may differentially affect persons with mental illness. In December 2005, a Virginia judge found Seung-Hui Cho, the Virginia Tech gunman, to be mentally ill and a danger to himself. He was directed to undergo outpatient treatment. Because of the judge’s adjudication of dangerousness, Cho would have met the criteria for disqualification on a federal level. However, records of the outpatient commitment were not placed into the Virginia mental health database that forwards information to the NICS. As a result, Cho was able to purchase 2 handguns.
After the shootings on April 16, 2007, that left 32 people dead, Virginia Governor Timothy Kaine issued Executive Order 50, which directed all executive branch employees to consider involuntary outpatient treatment as involuntary admission to a mental health facility (VA Code Ann §37.2-1014). The original law spoke to inpatient admission only; the new law addressed mandated outpatient treatment as well. Therefore, the names of individuals ordered into outpatient treatment would be included in the federal database. The order further directed law enforcement agents to enter records of involuntary outpatient care into the state database and to forward such records to federal law enforcement.11
1. Zimring FE. Firearms and federal law: the Gun Control Act of 1968. J Legal Stud. 1975;4:133-198.
2. Federal Gun Control Act, 18 USC §922 (1968), et seq.
3. Cannon A. Guns and the mentally ill. US News and World Report. April 1, 2002:22.
4. Norris DM, Price M, Gutheil T, Reid WH. Firearm laws, patients, and the roles of psychiatrists. Am J Psychiatry. 2006;163:1392-1396.
5. Appelbaum P. Violence and mental disorders: data and public policy. Am J Psychiatry. 2006;163:1319-1321.
6. Brady Act, 18 USC §922(s1-s6) (1993).
7. NICS Act Record Improvement Program. https://www.cfda.gov/index?s=program&mode=form&tab=step1&id=73b63eff9ff46fd7c8d897c8b90180c0&cck=1&au=&ck=. Assessed October 9, 2009.
8. Federal Bureau of Investigation. Response to inquires on the FBI’s National Instant Criminal Background Check System (press releases). http://www.fbi.gov/pressrel/pressrel07/nics041907.htm. Accessed October 9, 2009.
9. NRA/ILA: Gun Laws: US DOJ Letter on Interstate Firearms Transport. http://www.nraila.org/GunLaws. Accessed October 9, 2009.
10. Price M, Norris DM. National Instant Criminal Background Check Improvement Act: implications for persons with mental illness. J Am Acad Psychiatry Law. 2008;36:123-130.
11. Urbina I. Virginia ends a loophole in gun laws. New York Times. May 1, 2007. http://www.iht.com/articles/2007/05/01/news/gun.php. Accessed October 9, 2009.
12. US Department of Justice. The NICS Improvement Amendments Act of 2007. http://www.ojp.usdoj. gov/bjs/niaa.htm#NICS. Accessed October 9, 2009.
13. Cal Welf & Inst Code §8100–8105 (2004), et seq.
14. Simpson JR. Issues related to possession of firearms by individuals with mental illness: an overview using California as an example. J Psychiatr Pract. 2007;13:109-114.
15. Conn Gen Stat §29-27 (2003), et seq; 53-202 et seq; 53a-211 et seq; 17a-500 et seq.
16. Washington Legislature OKs gun restrictions for mentally ill. The Seattle Times. http://seattletimes. nwsource.com/html/localnews/2009034400_apwaxgrgunsmentallyunstable.html. Accessed October 9, 2009.
17. Wash Rev Code (ARCW) §71.05.240 (2009).
18. Wallace C, Mullen PE, Burgess P. Criminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders. Am J Psychiatry. 2004;161:716-727.
19. Beck JC. Delusions, substance abuse, and serious violence. J Am Acad Psychiatry Law. 2004;32: 169-172.
20. Miller M, Hemenway D. Guns and suicide in the United States. N Engl J Med. 2008;359:989-991.
21. Ilgen MA, Zivin K, McCammon RJ, Valenstein M. Mental illness, previous suicidality, and acess to guns in the United States. Psychiatr Serv. 2008;59:198-200.
22. US Department of Justice. Survey of State Procedures Related to Firearm Sales, Mid-year 2003. http://www.ojp.usdoj.gov/bjs/pub/pdf/ssprfsm03.pdf. Accessed October 9, 2009.
23. Bureau of Alcohol, Tobacco, Firearms and Ex-plosives. Annual Firearms Manufacturing and Ex-port Report. http://www.atf.gov/firearms/stats/afmer/afmer2007.pdf. Assessed October 9, 2009.