Firearms, mental illness, dementia and the clinican

In reply: There was a transcription error in our article.1 The rate of licensed firearm ownership in Australia in 2001 was indeed 3.9 per 100 people,2 although this is likely to be an underestimate, as unregistered, unlicensed and illegal firearms are not captured by official statistics.

Although the overall rate of homicide by firearm owners is low, we argue that the stakes are high. Other potential adverse outcomes of a person who lacks the capacity to safely handle firearms continuing to have a firearm include accidental injury and suicide.

We acknowledged the ethical implications of doctors having a role in assessing suitability for firearm licences.1 However, there is already an expectation that doctors should notify police when concerns about risk to the community or individuals arise from a patient's access to firearms.3 Risk assessment alone is inadequate, but doctors better meet their obligations when risk assessment is combined with capacity assessment.

Older adults are more likely to have complex cognitive and physical comorbid conditions that affect their ability to safely use a firearm. Screening is important, and doctors will use their clinical judgement to identify patients who may need a closer examination of their capacity in relation to firearm access.