DURHAM, N.C. -- People with serious mental illnesses who use guns to commit suicide are often legally eligible to purchase guns, despite having a past record of an involuntary mental health examination and brief hospitalization, according to a new Duke Health analysis.

The study, released in the June issue of Health Affairs, looked at gun use, violent crime and suicide among 81,704 people diagnosed with schizophrenia, bipolar disorder, or major depression in Florida’s Miami-Dade and Pinellas counties over 10 years starting in 2002.

Over that time, 254 study subjects committed suicide -- nearly four times the average suicide rate of the general adult population in Florida during the same period. 

Of the 50 people who used a gun to kill themselves, 72 percent were legally eligible to buy guns at the time of their deaths. The other 28 percent were not supposed to have or buy a gun, but used one to take their own lives.

Although this study is limited to a specific population -- adults involved in the public behavioral health system -- the findings can guide federal and state efforts to more precisely tailor mental-health related legal restrictions to reduce gun violence, the authors said. The study relied on a large volume of court and health records to examine the gun rights of people with serious mental health conditions and whether limits on their gun access could reduce violent crime and suicide involving guns.  

“There is a lot of focus on people with mental illness in the discussion of gun violence prevention, and that’s both wrong and right,” said lead author Jeffrey W. Swanson, Ph.D., professor in the Department of Psychiatry and Behavioral Sciences at Duke.

“Our federal gun regulations pertaining to mental illness prohibit lots of people from accessing firearms who are not violent, and never will be,” Swanson said. “At the same time, they fail to identify some people who will be violent or suicidal. With these data, we can improve criteria for restrictions that might actually reduce gun violence, but also carefully balance risk and rights.” 

The data showed slightly higher than average violent crime arrest rates among adults in the study, but found their use of guns in those crimes (13 percent) was lower than in a comparable population from the same community (24 percent). Of the arrests for violent gun-related crimes observed in the study, two-thirds involved adults who were already prohibited from accessing a gun, pointing to problems with background checks and enforcement.

The study’s findings suggest some suicides and violent crimes with guns could be prevented by a law many states have already enacted -- blocking the sale of new guns by federally licensed dealers to people who have been involuntarily held during a mental health crisis, but were not committed against their will.

About 26 percent of people in the study had previously been through an involuntary mental health evaluation during a crisis or similar incident, but still could own or buy guns under Florida laws at the time. 

“These individuals have already been identified during a previous mental health crisis, Swanson said. “They haven’t been committed, but we know they’re at increased risk of harming themselves or others. This is a lost public health opportunity in many states. States could say, let’s use these mental health records that already exist to separate that individual from guns, at least temporarily.” 

After the study period, Florida enacted a law to prevent the sale of guns to some people who had a mental-health crisis but were not involuntarily committed. But that law doesn’t address the problem of guns already in their reach, Swanson said. Other states, such as California, do address weapons already in the home with gun violence restraining orders, which can block new gun purchases but also allow law enforcement to remove existing weapons from people deemed by a judge to be at high risk of harming themselves or others. 

“The study in Florida is one piece of the puzzle, and we want to continue to build evidence from different states to draw a better picture of how these laws work under different conditions,” Swanson said. “We live in a country where private gun ownership is cherished, constitutionally protected, and very prevalent. Gun violence is a challenging problem in the U.S., and one that requires a lot of careful thinking and research to bring evidence to bear for these policies.”

In addition to Swanson, study authors include Michele M. Easter; Allison G. Robertson; Marvin S. Swartz; Kelly Alanis-Hirsch; Daniel Moseley; Charles Dion; and John Petrila.

The research received funding from the National Science Foundation, the Robert Wood Johnson Foundation program in Public Health Law Research, the Brain and Behavior Research Foundation and the Elizabeth K. Dollard Charitable Trust. The authors cited no conflicts of interest.