Preventing Teen Suicide Through Extreme Risk Protection Orders

October 2, 2020

As National Suicide Prevention Month comes to a close, it’s important to recognize that the issue of youth suicide doesn’t go away when September ends. Nationally, the suicide rate among persons aged 10 to 24 increased 57.4%, from 6.8 per 100,000 in 2007 to 10.7 in 2018. Just under 7,000 people ages 10 to 24 died by suicide in 2018. Almost half of youth suicides—47%—were firearm suicides [1]. Youth suicide, and access to guns, is an issue of increasing concern during the pandemic. Increases in suicidal ideation among youth [2] and gun sales [3] have been reported since March.

Suicide prevention remains a challenge. We have a tool that has shown promise in reducing suicide: extreme risk laws, also known as extreme risk protection orders (ERPO). ERPOs are designed to prevent gun violence before it happens. These civil orders enable the temporary removal of firearms from a person at risk of violence against themselves or others. When it comes to youth and ERPO, what often comes to mind is mass shootings in school settings, where ERPO may be preventive. However, suicide is much more common—it is the second leading cause of death among youths and young adults.

Suicide is often an impulsive act. Youth suicide attempts tend to be even more impulsive than adult suicide attempts. It makes practical sense to work with family members of youth and young adults with suicidal ideation and behaviors, depression, anxiety, psychotic symptoms, conduct disorder, substance misuse and other mental health concerns to let them know about these risks. Sometimes families are educated about the signs and symptoms of suicide risk, but don’t believe that their child would use their firearms—or they may be unwilling to secure or remove their firearms when their child is at elevated suicide risk.

In the 19 states and Washington, D.C., where ERPO is law, law enforcement and, in most states (like Maryland), family members can use ERPO to temporarily remove guns so that youth don’t have easy access to guns when they are most at risk. This is an important prevention strategy with the potential to save lives.

Clinicians in many healthcare settings are screening for suicide risk. Often patients who screen positive receive a risk assessment asking about access to lethal means. In combination with training for health professionals on lethal means counseling (i.e., assessing whether the individual at risk for suicide has access to a firearm and working with them and their family to limit their access), ERPO can be an effective tool to protect youth and young adults at high risk.

Maryland is currently one of two states in which clinicians are authorized as ERPO petitioners. (Clinicians are also eligible to petition in Hawaii as well as the District of Columbia.) Our 2019 survey of physicians at the Johns Hopkins Hospital revealed opportunities to use ERPO to reduce patients’ risk of violence. Most of the physicians surveyed were not aware of ERPO, but after learning more about it, almost all (92%) said they had seen a patient who would qualify for an ERPO, and 60% said they would be “very or somewhat likely” to file an ERPO petition for a patient “at extreme risk of violence or suicide.”

ERPO can be a life-saving tool to intervene when young people are at risk of harming themselves. Let’s remember that—not just in September, but all year long.

To learn more about Maryland’s ERPO law, visit  



  1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2020) [Sept 25]. Available from URL:
  2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2020) [Sept 25]. Available from URL:

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