When we hear about the lost lives after mass shootings in the United States, one of our responses is to think about whether these tragedies could have been prevented. One strategy to consider is whether a gun violence restraining order (GVRO) would have made a difference. California recently became the first state to have a GVRO statute. It enables a concerned family member and/or law enforcement officer to remove guns from individuals who are at risk of being dangerous to themselves or others before a tragedy occurs. As such, it is an important mechanism for temporarily removing firearm access on a case-by-case basis.

The right to keep and bear arms is granted by the Second Amendment. The U.S. Supreme Court has affirmed this right in two recent decisions (D.C. v. Heller [2008] and McDonald v. Chicago [2010]). Both cases involved statutes that prohibited ownership of handguns (in D.C. and in Chicago). The Court ruled that such prohibitions were unconstitutional and that individuals have a constitutional right to possess firearms in the home for self-defense, unless they fit into certain prohibited categories such as being convicted felons or having been civilly committed.

However, many people who might be dangerous are not included in the prohibited categories. GVROs expand the categories for gun-ownership restriction and can be lifesaving. The idea of a GVRO is based on research showing that there are times when individuals are at a heightened risk of violence. For example, this may be when a person has untreated mental illness and is paranoid. It may be when a person is depressed and thinking about suicide. It may be when a person makes threats to hurt others or stalks another person. At these times, it is important to remove access to guns. GVROs are a mechanism to do so.

Part of the impetus for the GVRO law in California came after Eliot Rodgers killed six people and injured 14 others in 2014 in Isla Vista (a college community near the University of California, Santa Barbara). Mr. Rodger’s mother had been very concerned about her son and asked the police to go to his house and evaluate him. The police did not feel that Mr. Rodgers met the criteria for transport to a hospital on an involuntary hold—in part because he denied being a danger to himself or others. Unknown to the police, however, Mr. Rodgers had an arsenal of guns in his home, subsequently used for the mass shooting. The police had no authority to search the home for weapons, even though his mother thought that he was dangerous. A similar scenario happened in Tucson, Ariz. Jared Loughner killed six people and injured 12 others including Congresswoman Gabby Giffords. Mr. Loughner’s parents were so worried about their son that they would take his car keys from him at night so that he couldn’t harm anyone. However, neither the parents nor law enforcement had any mechanism to take his guns away from him.

A GVRO law might have also saved the life of Laura Wilcox. Laura was a 19-year-old student at Haverford College who was working as a receptionist at the front desk of a mental health clinic during her winter break when she and three other people were murdered. The assailant had been stalking one of the women who worked in the clinic. Laura’s parents became spokespersons for GVRO legislation as well as for Laura’s Law, the assisted outpatient treatment law in California that was named after their daughter. I had the opportunity to speak with Mr. and Mrs. Wilcox when we were giving input about a proposed GVRO statute. They told me that Laura’s Law would not have saved their daughter’s life but a GVRO might have. Law enforcement had gone to the home of the perpetrator to evaluate him for an involuntary hold on the basis of dangerousness. He did not meet the criteria for a psychiatric hold, and the police did not have the authority to remove guns from him.

The process for a GVRO in California is that a law enforcement officer or family member can request that a civil court issue a GVRO through a written application and hearing in front of a judge. If the judge agrees, a GVRO is in effect for 21 days. Guns can be removed from individuals for the duration of the order, and they will be temporarily prohibited from purchasing a firearm. Before the GVRO expires, a subsequent hearing will be held in which the person identified as dangerous will have the opportunity to request restoration of gun rights. If the GVRO is upheld, the order prohibiting the purchase and possession of firearms will be extended for up to one year. GVROs are based on the long-standing infrastructure and procedures of emergency protective orders to protect victims of domestic violence. Both include due process protections.

In addition to advocating for GVROs, there are other actions that we can take to decrease gun violence. We should advocate for strategies to increase responsible gun ownership including background checks and waiting periods before gun purchases, closing gun-show and Internet sales loopholes, product-safety regulations, safe-storage requirements, and gun-free college campuses and hospitals. We also should be able to talk to and educate our patients about the dangers of having guns in the home (especially in the presence of children, adolescents, people with dementia, people who abuse children or partners, people with mental illnesses including substance use disorders, and others who are at risk of harming themselves or other persons). Currently, a number of states prevent physicians from asking questions about guns, and such prohibitions need to be ended.

GVROs will not prevent gun violence. However, they may serve as a useful tool that will temporarily keep guns out of the hands of high-risk individuals during periods when they are a danger to themselves or others. ■