Gun violence kills about ninety people every day in the United States, a toll measured in wasted and ruined lives and with an annual economic price tag exceeding $200 billion. Some policy makers suggest that reforming mental health care systems and improving point-of-purchase background checks to keep guns from mentally disturbed people will address the problem. Epidemiological research shows that serious mental illness contributes little to the risk of interpersonal violence but is a strong factor in suicide, which accounts for most firearm fatalities. Meanwhile, the effectiveness of gun restrictions focused on mental illness remains poorly understood. This article examines gun-related suicide and violent crime in people with serious mental illnesses, and whether legal restrictions on firearm sales to people with a history of mental health adjudication are effective in preventing gun violence. Among the study population in two large Florida counties, we found that 62 percent of violent gun crime arrests and 28 percent of gun suicides involved individuals not legally permitted to have a gun at the time. Suggested policy reforms include enacting risk-based gun removal laws and prohibiting guns from people involuntarily detained in short-term psychiatric hospitalizations.

Outpatient commitment is the legal practice of using civil court orders to mandate mental health treatment in the community for certain adults with serious and chronic mental illnesses. In this chapter, we examine the historical context in which the practice of outpatient commitment emerged in the United States. We discuss the controversial nature of outpatient commitment, examining the assumptions and perspectives of those on either side of ongoing arguments about whether the practice is legitimate, fair, and effective. In the final section of the chapter, we discuss whether, and under what conditions, outpatient commitment may be ethical. We discuss a useful conceptual framework for disentangling the various types of considerations involved in determining whether public policies are ethical. The framework identifies four principles relevant to ethical decision making in the context of outpatient commitment: (1) respect for autonomy, (2) non-maleficence, (3) beneficence, and (4) justice.

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During the last 30 years, new ways of legally mandating psychiatric treatment for patients living in the community have emerged. Changes to law and practice have occurred in various jurisdictions and cultures. The simultaneous introduction in a range of settings of new approaches to mandating community treatment suggests that there may be shared causes for these changes. This chapter reviews the experience of mandated community treatment in the United States, Australia, and the United Kingdom. For each of these countries, we examine the measures and prevalence of their use, the evidence for their effectiveness, and the most likely explanation of any differences between the results in their jurisdiction and experience elsewhere.