PERSPECTIVES Firearm Laws: A Primer for Psychiatrists Marilyn Price, MD, and Donna Marie Norris, MD Persons with mental illness or substance abuse have been perceived by the public to pose an increased risk of violence to themselves and others. As a result, federal and state laws have restricted the right of certain categories of persons with mental illness or substance abuse to possess, register, license, retain, or carry a firearm. Clinicians should be familiar with the specific firearm statutes of their own states, which describe the disqualifying mental health/substance abuse history and the role and responsibility of the psychiatrist in the process. State statutes vary widely in terms of the definitions of, and reporting requirements relating to, prohibited persons with mental illness or substance abuse. States also vary in the duration of the prohibition and in the timing of the appeals process. Some of the statutes have specific provisions for the removal of a firearm when a prohibited person is identified. States may maintain a mental health database that is used to determine firearm eligibility and may forward information to the National Instant Criminal Background Check System. The National Instant Criminal Background Check System Improvement Amendments Act of 2007 will likely increase the number of persons identified as belonging to the prohibited class. (HARV REV PSYCHIATRY 2010;18:326–335.) Keywords: firearm, guns, homicide, legislation, suicide, violence The public perception is that persons with mental illness or substance use disorders are dangerous to both themselves and others. 1−4 Media coverage of high-profile shootings by persons with mental illness further fuels this belief. As a result, federal and state legislation has been enacted to limit From the Department of Psychiatry, Harvard Medical School (Drs. Price and Norris); Law and Psychiatry Service, Massachusetts Gen- eral Hospital, Boston, MA (Dr. Price); Program in Psychiatry and the Law, Harvard Medical School, Beth Israel Deaconess Hospital, Boston, MA (Dr. Norris). Original manuscript received 22 December 2009, accepted for pub- lication subject to revision 16 February 2010; revised manuscript received 13 June 2010, accepted for publication subject to revision 28 June 2010; final manuscript received 12 July 2010. Correspondence: Marilyn Price, MD, Massachusetts General Hospi- tal, Law and Psychiatry Service, 15 Parkman St., WAC 812, Boston, MA 02114-3117. Email: mprice3@partners.org  c 2010 President and Fellows of Harvard College DOI: 10.3109/10673229.2010.527520 the ability of persons with mental illness or substance abuse to purchase, possess, register, obtain licensure, retain, or carry a firearm. 5−8 The laudable goal of firearm legislation is to reduce the rates of homicide and suicide by firearms. The strategy of those who have drafted legislation has often been to tar- get classes of persons considered at high risk of violence to self and others, and then to prohibit those individuals from gaining legal access to firearms. 5−8 This tactic of tar- geting only what the public perceives as high-risk groups has widespread appeal, especially since that excludes from regulation the approximately 30%–40% of adults who live in residences that contain firearms; a public consensus con- cerning a more generalized approach to reducing firearm accessibility is not forthcoming. 9−12 Statutes prohibiting access to firearms for categories of persons with mental illness have generally been adopted in the wake of high-profile shootings. 5,7,8,13,14 Nevertheless, while the link between mental illness and suicide is well established, the relationship between mental illness and serious violence against others continues to be debated. 5 It is unclear whether firearm legislation aimed at persons with mental illness will prove to be an effective tool in de- creasing the incidence of gun-related violence. A determined 326