Do Extreme Risk Protection Order Laws Reduce Suicide? Evidence from Early Adopters

Abstract

Extreme Risk Protection Order (ERPO) laws, commonly known as "red flag" laws, allow courts to temporarily remove firearms from individuals deemed at risk of self-harm. These policies have attracted substantial policy interest as a means of suicide prevention. I evaluate the effect of early ERPO laws on state-level suicide rates using a staggered difference-in-differences design with the heterogeneity-robust estimator of . Exploiting variation from three states that adopted ERPO laws before 2018 with usable pre-treatment periods—Indiana (2006), California (2016), and Washington (2017)—using a 1999–2017 panel excluding Connecticut (950 state-year observations), I find that ERPO adoption is associated with higher, not lower, suicide rates. The aggregate ATT is 0.53 suicides per 100,000 (SE = 0.19). However, this counterintuitive finding should be interpreted with extreme caution: conventional inference is unreliable with only 3 treated clusters. The standard two-way fixed effects estimate is negative but insignificant ($-$0.43, SE = 0.65). The positive association likely reflects reverse causation—states experiencing rising suicide trends were more likely to adopt ERPOs—rather than a harmful policy effect. Connecticut (treated 2000) is excluded from the main analysis because its law took effect in October 1999, leaving no clean pre-treatment period in the sample. These results highlight the empirical challenges of evaluating policies adopted in response to the very outcomes they target, and do not preclude beneficial effects of ERPOs when measured with firearm-specific outcomes or when implementation intensity is accounted for.