Practitioner Perspectives on Mandatory Fitness Evaluations before Firearm Purchase in South Carolina

Rates of firearm-related deaths from suicide and homicide have continued to rise during the last several years. This has prompted large-scale debate over the role of mental illness in gun violence and the need to investigate strategies for reducing harm. Many countries require either some form of mental health evaluation or a simple doctor's note on mental fitness before purchasing a firearm. This study focuses on practitioner attitudes toward this practice in South Carolina and looks to examine the primary factors that may interfere with implementing mandatory fitness evaluations before firearm purchase. Our specific aim was to assess the level of concern that practitioners had with 12 barriers that were identified by the research team as potentially problematic for conducting fitness screenings for gun ownership. Comfort with performing these evaluations also was assessed, including differences in attitudes and comfort level based on the specialty of the practitioner.

A survey was created and dispersed to regional providers in the fields of Family Medicine, Internal Medicine, and Psychiatry. The survey contained questions assessing provider beliefs on the capability and feasibility of fitness evaluations for firearm purchase, comfort in performing such evaluations, and the level of concern with 12 potential barriers to performing evaluations using a Likert scale.

A total of 794 individuals received the survey, with a response rate of 18.9% (150) and a completion rate of 17.4% (138). The majority of respondents (84.7%) believed that implementing mandatory fitness evaluations before firearm purchase is a good idea; however, fewer than half (48%) believed that it is feasible. The most concerning barriers were related to the unreliability of an applicant's self-reporting, concerns over liability, and a large abundance of firearm sales.

Findings from this study indicate that although most respondents viewed mandatory fitness evaluations as a good idea, the act of implementing them was viewed to be less feasible for a variety of factors. Most of the barriers presented were met with at least a moderate level of concern. Although a common practice in many other countries, the United States presents unique challenges when it comes to the potential for implementing mandatory fitness evaluations. This is the first known study to gather practitioners' perspectives on this process. More research is needed on investigating solutions for reducing gun violence and whether the use of fitness evaluations is a viable tool.