How ERPO Navigators Helped Prevent Potential Harm

Psychiatrist and core faculty member of the Johns Hopkins Center for Gun Violence Solutions, Dr. Paul Nestadt, is trained to identify when patients pose a risk to themselves or others.  

One tool Dr. Nestadt uses to help limit the harm that individuals can cause in times of crisis is called an Extreme Risk Protection Order (ERPO), commonly known as a “red flag” law. These orders prohibit a person who has been identified to pose a risk of harm to themselves or others from purchasing or possessing a firearm.  

Dr. Nestadt helped to build a pilot program which sends “Gun Violence Navigators” to clinical settings in Baltimore to provide support and guidance in filing ERPOs, which need to be submitted to a judge for review. 

Recently, a patient was hospitalized with paranoid delusions regarding police surveillance, reporting that he planned to “shoot someone” though he did not possess a firearm and had no one in mind. The patient’s symptoms were treated and he was discharged to outpatient care, but the Navigators were called in to Johns Hopkins Hospital to help file an ERPO for this patient who remained at elevated risk. 

The patient did well at first but experienced a significant setback a few weeks later. He experienced suicidal thoughts and went to a gun store to purchase a firearm and end his life. Thankfully, the ERPO was in place and the store was unable to sell him a firearm. The patient had time to stabilize, and he returned to the hospital to reengage in treatment.  

This is one of many powerful examples of how ERPOs can work in the real world to protect and save lives.