Reflections on the First Decade of ERPO Laws: History,Lessons Learned,and Thoughts for the Future

Introduction

As of 2025, more than half of the United States (U.S.) population lives in states with access to Extreme Risk Protection Orders (ERPOs). ERPO laws, commonly referred to as “red flag laws,” establish a civil restraining order that temporarily prohibits people who are behaving dangerously and at risk of engaging in violence from purchasing and possessing firearms. Twenty-two states, the District of Columbia, and the Virgin Islands all have ERPO laws in place. Legislatures in almost every state, as well as the U.S. Congress have considered ERPO bills. Uptake of these laws has now generated enough high-quality research to support this Special Issue. Understanding how these laws came into existence provides an essential foundation for the articles that follow. The story of ERPOs also offers broader lessons about how the strategic pairing of science and advocacy can produce evidence-informed policies and chart a path forward in addressing some of our most pressing public health challenges.

For more than a decade, we—together with a growing band of colleagues—have traveled the country engaging communities in conversations about ERPOs. In the early years, those discussions centered on the rationale and emerging evidence for the laws. More recently, they have focused on how people on the front lines of responding to personal crises in homes, schools, workplaces, and neighborhoods can use ERPOs in practice. This implementation theme—whether and how ERPO laws are being applied, and to what end—shapes both the outcomes in communities’ experience and the measures researchers can study. Thus, it is critical to understand both the origin story and current state of ERPO implementation as the science of ERPO continues to evolve. We invite you to read our account of the history of ERPO policy in the U.S., to consider this background alongside the articles in this special issue, and to reflect on how the transformation of ERPO from an idea into state policy informs best practice for ERPO implementation, the readiness of the field for hypothesis testing research, and how this experience might inform the path for other evidence-based policy innovations in public health.

ERPO: Moving Science to Policy and Practice

Responding to a Problem and Developing a Solution

On December 14, 2012, 20 young children and 6 of their teachers were murdered at Sandy Hook Elementary School in Newtown, Connecticut. In the days and weeks following this horrendous tragedy, a national conversation reemerged about America’s gun violence problem. Prominent voices were heard from across a deepening political fault line: On one side, lawmakers pointed to lives lost because of easy access to guns and called for more restrictive gun laws. Lawmakers on the other side blamed “mental illness” and advocated for efforts to increase access to mental health care. This debate preceded the Sandy Hook shooting, but the horror that transpired at the school rocketed the issue to the forefront of political conversations.

In March 2013, in response to this debate, and in an effort to address rising rates of violence, including mass violence and suicide, the Educational Fund to Stop Gun Violence (Educational Fund), a non-profit organization, partnered with a group of researchers to organize a meeting of academics, clinicians, advocates, and law enforcement professionals with expertise in gun violence prevention and mental health. The group convened for 2 days at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland to examine the empirical evidence at the intersection of mental illness and gun violence, and to situate what is known about that relationship within the context of other violence risk factors.

At the end of the 2-day meeting, the group agreed that the available evidence supported several conclusions: (1) Most people with mental illnesses do not engage in interpersonal violence, and most violence is caused by factors other than mental illness. (2) At certain times, such as the period surrounding a psychiatric hospitalization or first episode of psychosis, small subgroups of individuals with serious mental illness are at elevated risk of violence. (3) Mental illnesses such as depression, particularly in combination with concerning use of alcohol or other drugs, significantly increase suicide risk; death by suicide accounts for more than half of gun deaths in the United States. ¹ The group further agreed on a guiding principle for future policy recommendations: Legal restrictions on access to firearms should be based on evidence of risk (e.g., history of domestic violence, reckless alcohol use, threats of self-harm or harm to others), not solely on mental illness diagnoses – a poor statistical predictor of interpersonal violence.^{1 -3}

Before leaving Baltimore, the group also agreed to craft policy recommendations based on these principles. One of the resulting recommendations was for states to adopt ERPO policies (originally named a Gun Violence Restraining Order or GVRO) that would create a civil court order with due process protections and allow for the temporary dispossession of firearms from people who are at risk of harming themselves or others. This ERPO recommendation was a direct response to a need identified by meeting participants for an upstream mechanism to intervene when dangerous behaviors reveal a path toward violence, and no legal tools exist to address the elevated lethality when firearms are available to people traveling on such paths.

In the months following the meeting, attendees continued to dialog and eventually articulated recommendations. ⁴ Through this process, the group adopted the name “Consortium for Risk-Based Firearm Policy,” (Consortium) and the Educational Fund committed to staffing the Consortium. Details of the meeting are documented elsewhere. ¹ An ERPO working group formed and drafted the ERPO recommendation, and looked to 2 types of existing state laws for inspiration. First, evidence that the risk of intimate partner homicides—especially those involving guns—is significantly reduced in states where a civil domestic violence protection order (DVPO) confers a temporary prohibition on firearm purchase and possession moved the group to consider expanding the DVPO model to be responsive to other types of dangerous behaviors. Second, at the time, 2 states had enacted laws authorizing risk-based, time-limited firearm removal through a civil court process—Connecticut in 1999 and Indiana in 2006. The Connecticut and Indiana laws were also the basis for recommendations issued by the Maryland Governor’s Task Force to Study Access of Individuals with Mental Illness to Regulated Firearms published in January 2013. ⁵ Connecticut’s risk warrant law was also a topic of discussion among a separate group of California gun violence prevention advocates in the years leading up to the Baltimore meeting. ⁶ Both the DVPO and early risk-based gun removal laws were responsive to indicators that violence is likely imminent; balanced due process protections with violence risk; and prioritized early opportunities to intervene and prevent harm. As such, both laws influenced the final Consortium ERPO recommendation. ⁴

Disseminating and Educating the ERPO Recommendation

The ERPO recommendation was 1 of 3 included in a Consortium report for state policymakers released in November 2013, and introduced at a public forum at the University of Virginia in Charlottesville. ⁴ The following month, the Consortium released a companion report of federal policy recommendations at a Congressional staff briefing on Capitol Hill. ⁴ To raise awareness about ERPO and the other Consortium recommendations, the Educational Fund developed and directed a strategy for disseminating the recommendations through the Consortium. At the center of this approach were partnerships with state and local interest groups who served as hosts for educational forums beginning in 2014. Many of these early contacts were initiated by organizations and individuals known to the Educational Fund or to Consortium members; some were new. Often educational forums were motivated by a mass shooting in communities where the forums took place.

The first example of this strategy occurred in California, the first state to enact an ERPO law based on the Consortium’s recommendation. The 2014 multiple casualty shooting near the University of California, Santa Barbara provided the immediate impetus for action and illustrated how ERPO could have been used to intervene with someone behaving dangerously and at risk of violence. Before the shooting, the perpetrator’s family had raised concerns that prompted a welfare check by law enforcement who determined he did not meet the criteria for detention, and they lacked the authority to search for or remove firearms. Governor Brown signed the ERPO bill into law in September 2014, following extensive groundwork by the Consortium in collaboration with the bill’s sponsor. One example of this groundwork was an op-ed in the Los Angeles Times by Consortium member Renee Binder, professor of psychiatry at the University of California, San Francisco and then president-elect of the American Psychiatric Association. ⁷ In the months leading up to the bill’s passage, the Educational Fund partnered with California advocates to host public forums in Los Angeles (July 8, 2014) and San Francisco (July 10, 2014), where ERPO was a central focus.

Between November 2013 when the Consortium released its recommendations and this writing, members of the Consortium participated in educational forums co-hosted with state and local interest groups in more than 15 states and the District of Columbia.

As this dissemination strategy evolved, the Educational Fund adapted the Consortium’s original report to complement the educational forums in each state. These tailored reports included state-level descriptions of the epidemiology of gun violence and local shootings that may been prevented with an ERPO law, as well as an analysis of the state’s laws’ alignment with the Consortium recommendations.

These educational forums provided stakeholders with an opportunity to engage with the ERPO recommendation in the context of the gun violence problem locally, and with people invested in solutions at the community level who had authority to help realize those solutions. National experts complemented these local perspectives by reviewing and emphasizing the evidence. As uptake of ERPO gained momentum, Consortium members and Educational Fund staff shared experiences of enacting and implementing ERPO laws from other states and localities. They followed a panel discussion format with brief presentations from the experts, leaving ample time for questions and comments from the audience (Table 1) and ending with an invitation from the local host to continue the conversation about next steps for realizing change.

Table 1.

Consortium Educational Forum Logistics.

Location	Community site, arranged by local co-hosts
Duration	Typically 2 h
Format	1 h panel presentation followed by 1 h of audience questions submitted on index cards and read by moderator
Panelists	Consortium members (moderator, presenters for the Consortium recommendations) and local partners (discuss state law, local gun violence, and local resources)
Panel expertise	Multi-disciplinary, including legal, law enforcement, lived experience, policy, psychiatry/mental health, and public health
Audience	Open to the public and publicized by host partner

Research on the implementation and impact of the existing ERPO-like laws in Connecticut and Indiana proceeded in parallel, and Consortium members engaged in that work discussed preliminary results with state lawmakers and local implementers. The first results estimating a suicide prevention effect of Connecticut’s “risk warrant” law were published in 2017, ⁸ and this new evidence was immediately incorporated into educational forum discussions. These findings included what would become the widely cited estimate that one life was saved for every 10 to 20 gun-removal actions. ⁸ Complementary findings from Indiana in 2019 and from a 4 state analysis in 2025 followed, with an additional analysis using different methods also concluding that the laws in Connecticut and Indiana were associated with reductions in gun-related suicide.^{9 -11}

As co-hosts for educational forums, the Educational Fund and local partners invited media to attend and facilitated interviews with the participants. With some forums, media outreach included editorial board meetings with local partners, Educational Fund staff, and Consortium members. The role of researchers at the forums, and during interactions with local stakeholders and the media was to connect the evidence with the policy recommendations (including ERPO) being discussed.

Following the forums, Educational Fund staff and Consortium researchers responded to questions and technical assistance requests that included bill drafting, meeting with legislators and other stakeholders, sharing data and experiences from other states, and testifying at hearings. Consortium researchers and Educational Fund staff also connected stakeholders across state lines, creating opportunities to learn from one another and build networks among those interested in ERPO.

Researchers from the Consortium engaged in dissemination efforts outside of the Consortium-driven strategy. Over the more than 10 years reflected in this history, researchers from the Consortium and Educational Fund staff spoke about ERPO at professional meetings, responded to media inquiries, met with stakeholder groups, testified at hearings, participated in national expert panels, wrote papers for the peer-reviewed literature, and placed op-eds. Consortium members used ERPO as a teaching case in courses, and the dissemination efforts provided field experiences for graduate students.

At the time of this writing, 20 states, the District of Columbia, and the Virgin Islands have ERPO laws in place based on the Consortium’s recommendation (CA, CO, DE, FL, HI, IL, MA, ME, MI, MN, MD, NV, NJ, NM, NY, OR, RI, VA, VT, WA), adding to the Connecticut and Indiana risk warrant laws that informed this policy intervention.

Supporting Implementation and Evaluation of ERPO Laws

With the growth in the number of ERPO states, the focus of the Consortium shifted to include implementation and the processes and infrastructures needed to realize ERPO in practice. Support from the Bloomberg American Health Initiative and the Joyce Foundation provided the resources for the Consortium to co-host with the Educational Fund, the Johns Hopkins Center for Gun Policy and Research, and the Alliance for Gun Responsibility (a non-profit partner based in Washington State) representatives from law enforcement agencies in Seattle, Washington; Montgomery County, Maryland; Pinellas County, Florida; and San Diego, California who were pioneering ERPO implementation and law enforcement agency representatives who were early in their processes of ERPO uptake. This 2019 meeting in Baltimore included researchers who were conducting some of the initial analyses of ERPO data. They provided rates of ERPO use across jurisdictions and early indicators of variation in ERPO uptake, and emphasized the importance of intentional implementation efforts. This meeting provided a venue for information sharing across jurisdictions, continued to connect ERPO research and practice, encouraged networking among those on the front lines of ERPO implementation, and demonstrated the value of intentional implementation efforts. At the meeting Consortium members from the Johns Hopkins Bloomberg School of Public Health and the Educational Fund launched a website to serve as a repository for ERPO information, including video interviews featuring meeting attendees discussing ERPO implementation in their jurisdictions, state summaries of ERPO laws, media coverage of ERPO use, and research. Subsequent gatherings resulted in new ERPO recommendations published in 2020, ¹² and in 2023 the Consortium, in partnership with Everytown for Gun Safety, again convened ERPO implementers from around the country in Baltimore to inform the report, Promising Approaches for Implementing Extreme Risk Laws: A Guide for Practitioners and Policymakers. ¹³

The growing momentum supporting ERPO implementation coincided with the 2022 Bipartisan Safer Communities Act that included dedicated funds to support ERPO implementation at the state level and the establishment of a national training and technical assistance provider. ¹⁴ In 2023, the newly created Johns Hopkins Center for Gun Violence Solutions (reflecting a merger between the Johns Hopkins Center for Gun Policy and Research and the Educational Fund) launched the ERPO Resource Center (ERC) in collaboration with the U.S. Department of Justice, Bureau of Justice Assistance after successfully competing for the cooperative agreement. The ERC provides training and technical assistance to support ERPO implementation in states and localities. ¹⁵ The ERC team, in collaboration with subject matter experts (including Consortium members and ERPO implementers), conducted more than 75 trainings in 16 states and the District of Columbia and at multiple national conferences that reached over 4100 ERPO implementers between March 2023 and December 2025.

While ERPO implementation efforts were underway, additional research efforts also took hold, providing insight into the “formulation and passage of ERPO laws, legal analyses of ERPO laws, ERPO implementation, and evaluations of ERPO laws.” ¹⁶ Funding from foundations, states, and the federal government supported these efforts and allowed for researchers to respond to the rapidly evolving ERPO policy landscape. Some of those efforts are reflected in the 8 articles included in this special issue. With regard to implementation, Swanson and Bonnie ¹⁷ offer a typology of 1 category of ERPO impact that receives little attention in the literature—ERPO as a tool that may or may not be used intentionally for deflection or diversion from the criminal justice system—and make the case for the importance of considering this consequence of ERPO in future research and practice. Geller and Cantrell ¹⁸ draw from implementation science to provide an adapted framework for approaching ERPO implementation, offering insights for how to systematically consider and engage in implementation. These 2 theoretical reflections on ERPO applications complement state-level examples of ERPO implementation in practice. Mason et al present a review of ERPO petitions in Lake County, Illinois and identify areas where ERPO implementation efforts can be improved—notably by increasing witness appearance at the second ERPO hearing. ¹⁹ Cantrell et al. ²⁰ also look to Lake County, Illinois as an example of how site visits are used by the ERC to work with ERPO implementers to address training and technical assistance needs that support early implementation efforts or the more nuanced needs that may result from the type of analysis presented by Mason et al. Two articles by Valek et al. provide insight into Oregon’s ERPO implementation experience. In the first paper, qualitative interviews with law enforcement highlight the important role of training and education for ERPO implementation efforts and are one solution to the varied nature of state-wide implementation explored in the second contribution by this research team.^21,22 In Maryland, where ERPO implementation is occurring statewide, Aassar et al. ²³ examine urbanicity and find ERPO use to be highest in suburban communities and document that variations in the types of dangerous behaviors described in urban areas are more likely to be interpersonal compared to non-urban areas where self-harm more often motivates ERPO petitions. An examination of respondent arrest rates across different timepoints in the ERPO process in Washington state reveals that arrests are highest immediately prior to ERPO petitions and lowest after ERPOs conclude. Schleimer et al. ²⁴ point to arrests that occur while EPRO is in effect as opportunities for greater intervention with social supports to address the underlying causes of the dangerous behaviors that lead to ERPO petitions being filed and granted by the court.

Considering the ERPO Case

The Consortium’s experience with ERPO policy development, dissemination, implementation, and research offers guidance for how researchers can strategically and systematically undertake efforts to translate evidence to inform policy and practice. The 10 lessons that follow provide a path forward to greater use of evidence in legislating solutions to public health problems, and a clear role for practitioners and researchers in implementation and evaluation efforts to inform intervention efforts.

Lead and Follow with Evidence

The Consortium’s first task was to review the evidence and develop a shared understanding of the relationship between mental illness and gun violence. Researchers and research drove this process. With that consensus established, the Consortium developed 3 recommendations—including for states to enact ERPO laws. As researchers and practitioners gained experience with ERPO laws and new evidence became available, Consortium members incorporated that new evidence into their ERPO presentations and writing. Throughout the more than 10 years documented in this commentary, evidence and researchers defined how the Consortium framed the problem, developed solutions to the problem, and disseminated recommendations.

Provide Policy Options

Policymakers, advocates, and other interest groups engaged in the policy process need ideas for policies that are responsive to problems. Disseminating evidence that defines a problem without identifying a policy solution misses an opportunity to incorporate evidence into the policy process. Only after the ERPO recommendation was ready for release did the Consortium share its framing of the problem. Dangerous behaviors as a key indicator of violence risk and a missed opportunity to intervene was the problem, and the ERPO policy recommendation offered a ready solution.

Disseminate Problem and Policy Recommendation with a Unified, Authoritative, Multi-Disciplinary Coalition

Through the Consortium and Educational Fund efforts, advocates and policymakers heard a clear, consistent message from multiple sources about the potential of ERPO to reduce gun violence. This socializing of the problem and policy solution served to build a base of informed support for ERPO. With few exceptions, this message was not seriously challenged, leaving policymakers with a policy option that was responsive to constituent demands and the problem.

Prepare for Opportunities

The Consortium, through the Educational Fund, organized state-level dissemination efforts in response to requests from local interest groups seeking effective strategies for reducing gun violence. ERPO provided a ready policy option supported by national experts and grounded in evidence. Having a policy solution and experts available when states were ready to consider new policy ideas allowed for an effective response to state- and local-level interest.

Recognize Multiple Roles for Researchers in the Evidence to Policy Translation Process

Researchers helped define the problem and propose a viable evidence-informed policy solution. They also contributed to efforts to educate interest groups, including policymakers, community members, advocates, and potential implementers about ERPO. This experience provides examples of concrete, substantive roles for researchers throughout the policy process.

Recognize Multiple Roles for Advocates and Allied Professionals

The Consortium relied on existing evidence and input from multiple disciplines to inform the ERPO recommendation, including mental health groups, gun violence survivors, public health and gun violence prevention advocates, and law enforcement. In turn, these advocates and allied professionals became invested in the Consortium process and helped bring the recommendation to policymakers, the media, and other interested organizations. The combination of academic and non-academic partners created a powerful partnership to drive policy change and implementation.

Respond to Interest Groups

Interest from groups across the U.S. drove the ERPO dissemination strategy. Responsiveness to that interest provided state and local groups with knowledge about the ERPO recommendation and alignment with gun violence in their communities, and the local context of gun violence prevention policy reforms.

Tailor Evidence to the Local Audience

Understanding the local context and incorporating that context into dissemination strategies was critical to ensuring dissemination was relevant to local interests. Incorporating local data, survivors’ stories, and policies into dissemination messages became standard practice for how the Educational Fund connected researchers within the Consortium with local groups.

Value Researchers’ Contribution to the Practice of Translation

The role of evidence in the ERPO case relied on participation by faculty from academic institutions. Faculty should be encouraged, rewarded, and supported by their academic homes when engaging in evidence to policy translation work. Institutional recognition of translation contributions by appointments and promotions committees would likely encourage more faculty to participate in such efforts.

Prepare for, Consider, and Prioritize Implementation

The variation in ERPO uptake within and across states is a reminder that implementation is part of the policy process and requires attention and intention. The Consortium’s shift to embrace a supportive role for implementers through research and technical assistance informed the larger effort now underway with the Johns Hopkins ERPO Resource Center. As researchers look to evaluate the impacts of ERPO policies, consideration of whether, to what extent, and how ERPOs are being implemented is a critical, yet often overlooked factor.

Conclusion

Twenty-two states, the District of Columbia, and the Virgin Islands have ERPO-style laws in place. With the exception of 2 states (Connecticut and Indiana) this legislative activity occurred in the 13 years since the Sandy Hook massacre. That ERPO laws could receive such a reception in diverse states across the country, Congress would fund state and local ERPO implementation initiatives, and public and private sector funders would support research to track and measure the impact of these laws is a testament to the power of research and advocacy to create opportunities for policy change. Evidence can inform advocacy and policy, and evidence can be used to drive policy change and inform implementation practice. The contributions of the Consortium for Risk-Based Firearm Policy to the current state of ERPO policy provide lessons for future public health policy efforts to address gun violence, and the many other challenges that prevent people and communities from thriving. Importantly, the history of ERPO laws demonstrates the opportunities that exist for people, through evidence and advocacy, to make our communities safer for all.