GATEKEEPER TRAINING

Question Persuade Refer

VIDEO

QPR Institute

The Bridge Story

Three miles long Opened in 1937Longest suspension bridge in the world until 1964Second most used suicide site in the world245 feet above rocky waterWhat bridge is it?

2012 40,6002011 39,518

2010 38,3642009 36,9092008 36,065

2007 34,5982006 33,300

attributed to suicide

40,000 deaths annually

1 suicide every 13 minutes

OR

111 suicides every day

Timing of USA Suicides

(age 15-24)commit suicide each year (2012)

at a rate ofone suicide every two hours

4,872 young people

Rank & Cause Number of deaths1. Diseases of the heart 599,7112. Malignant neoplasms (cancer) 582,6233. Chronic obstructive pulmonary diseases 143,4894. Cerebrovascular diseases (stroke) 128,5465. Accidents 127,7926. Alzheimer’s Disease 83,637 7. Diabetes mellitus 63,9328. Pneumonia and influenza 50,6369. Nephritis, nephrosis 45,62210. Suicide 40,600

Ranking 10th in the USA

Suicide is a leading cause of death

25 attempts for each documented death(Note: 40,000 suicides translates into 1,000,000 attempts annually)

Estimates of an attempted Suicide

It is estimated that there are

6 survivorsfor each death by suicide

Number of Suicide survivors

Note: A “suicide survivor” is someone who has lost a loved one to death by suicide

6 new survivors every 13 minutes

OR

667 new survivors each day

The ratio of six survivors per suicide means there are:

In loving memory of those

lost to suicide

0

1

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4

51977

1979

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1983

1985

1987

1989

1991

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1995

1997

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2005

2007

4,395,480suicide survivors

732,580deaths by suicide

Survivors in the US population

Question, Persuade, Refer

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What Can We Do?

QPR is not intended to be a form of counseling or treatment.

QPR is intended to offer hope through positive action.

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QPR

Myth No one can stop a suicide, it is inevitable.Fact If people in a crisis get the help they need, they will

probably never be suicidal again.Myth Confronting a person about suicide will only make them

angry and increase the risk of suicide.Fact Asking someone directly about suicidal intent

lowers anxiety, opens up communication and lowers the risk of an impulsive act.

Myth Only experts can prevent suicide.Fact Suicide prevention is everybody’s business, and

anyone can help prevent the tragedy of suicide

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Suicide Myths and Facts

Myth Suicidal people keep their plans to themselves.Fact Most suicidal people communicate their intent sometime

during the week preceding their attempt.Myth Those who talk about suicide don’t do it.Fact People who talk about suicide may try, or even complete,

an act of self-destruction.Myth Once a person decides to complete suicide, there is nothing

anyone can do to stop them.Fact Suicide is the most preventable kind of death, and almost

any positive action may save a life.

How can I help? Ask the Question...©

Suicide Myths and Facts

Suicide clues and warning signs

Talk about suicide or a plan for suicide Have a preoccupation with death and

dying Are making statements of

hopelessness, helplessness, or worthlessness

Say things like, “I wish I were dead,” “I shouldn’t have been born,” “I won’t be a problem for you much longer”

Talk about feeling trapped or in unbearable pain, or being a burden to others

Show a loss of interest in usual activities

Have changes with appetite and/or sleep

Have trouble concentrating, difficulty with school work or work.

Show marked personality changes, or frequent changes of mood

Act angry, anxious, agitated, or are behaving recklessly

Are isolating or distancing themselves from family and/or friends

Start giving away prized possessions

  * Not a complete QPR Slide

Risk Factors for Suicide

Previous suicide attemptsFamily history of suicidal behavior Recent losses: death of family

member, relative, or friendSocial isolation, withdrawal from

family and friendsHistory of Mental IllnessDrug or Alcohol AbuseExposure to violence in the home

or social environmentHistory of traumaLoss of social status

  

Engaging in violent or self-destructive behaviors

Chronic physical illnessConfusion about sexual

orientationHomelessnessLoss of social statusVictim of

humiliation/bullyingAccess to lethal means

such as firearms or medication

Diagnosis of depression or other mood disorder

  

* Not a QPR Slide

“I’ve decided to kill myself.”“I wish I were dead.”“I’m going to commit suicide.”“I’m going to end it all.”“If (such and such) doesn’t

happen, I’ll kill myself.”

“I’m tired of life, I just can’t go on.”

“My family would be better off without me.”

“Who cares if I’m dead anyway.”

“I just want out.”“I won’t be around much

longer.”“Pretty soon you won’t have

to worry about me.”

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Direct Verbal Clues

Any previous suicide attemptAcquiring a gun or stockpiling pillsCo-occurring depression, moodiness, hopelessnessPutting personal affairs in orderGiving away prized possessionsSudden interest or disinterest in religionDrug or alcohol abuse, or relapse after a period of recoveryUnexplained anger, aggression and irritability

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Behavioral Clues:

Being fired or being expelled from schoolA recent unwanted moveLoss of any major relationshipDeath of a spouse, child, or best friend, especially if by suicideDiagnosis of a serious or terminal illnessSudden unexpected loss of freedom/fear of punishmentAnticipated loss of financial securityLoss of social statusLoss of a cherished therapist, counselor or teacherFear of becoming a burden to others

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Situational Clues:

Depression & Suicide

Depression often goes untreated or undiagnosed and sometimes results in suicide

25-50% of persons with manic-depression attempt suicide1 in 5 persons with this illness die by suicideOf all those who die by suicide, more than 2/3rds suffer from

depression or manic-depressive illnessDepression is highly treatable and 7 out 10 patients will improve

with the help of psychotherapy and the new and improved drug treatments

* Not a QPR Slide

Time to ask

Tips for Asking the Suicide QuestionIf in doubt, don’t wait, ask the questionIf the person is reluctant, be persistentTalk to the person alone in a private settingAllow the person to talk freelyGive yourself plenty of timeHave your resources handy; QPR Card, phone numbers, counselor’s

name and any other information that might helpRemember:

How you ask the question is less important than that you ask it!

Q: QUESTION

Less Direct Approach:

“Have you been unhappy lately? Have you been very unhappy lately? Have you been so very unhappy lately that you’ve been thinking about ending your life?” “Do you ever wish you could go to sleep and never wake up?”

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Q: QUESTION

Direct Approach:“You know, when people are as upset as you seem to be,

they sometimes wish they were dead. I’m wondering if you’re feeling that way, too?”

“You look pretty miserable, I wonder if you’re thinking about suicide?”

“Are you thinking about killing yourself?”

NOTE: If you cannot ask the question, find someone who can.

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How not to ask the question

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“You’re not suicidal, are

you?”

“You wouldn’t do anything crazy would you?”

P: PERSUADE

Listen to the problem and give them your full attentionRemember, suicide is not the problem, only the solution to

a perceived insoluble problemDo not rush to judgmentOffer hope in any form

HOW TO PERSUADE SOMEONE TO STAY ALIVE

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P: PERSUADE

Then Ask:Will you go with me to get help?”“Will you let me help you get help?”“Will you promise me not to kill yourself

until we’ve found some help?”

YOUR WILLINGNESS TO LISTEN AND TO HELP CAN REKINDLE HOPE, AND MAKE ALL THE DIFFERENCE.

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R: REFER

Suicidal people often believe they cannot be helped, so you may have to do more.

The best referral involves taking the person directly to someone who can help.

The next best referral is getting a commitment from them to accept help, then making the arrangements to get that help.

The third best referral is to give referral information and try to get a good faith commitment not to complete or attempt suicide. Any willingness to accept help at some time, even if in the future, is a good outcome. ***Help the person develop a Safety plan

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Remember

Since almost all efforts to persuade someone to live instead of attempt suicide will be met with agreement and relief, don’t hesitate to

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For effective QPR

Say: “I want you to live,” or “I’m on your side...we’ll get through this.”Get Others Involved. Ask the person who else might help. Family?

Friends? Brothers? Sisters? Pastors? Priest? Rabbi? Bishop? Physician?

Join a Team. Offer to work with clergy, therapists, psychiatrists or whomever is going to provide the counseling or treatment.

Follow up with a visit, a phone call or a card, and in whatever way feels comfortable to you, let the person know you care about what happens to them. Caring may save a life.

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What else?

Develop a resource list for your community

County Mental HygieneMobile Integration Team

School Support staffHospitals/In-patient Services

Local/County Suicide Prevention CoalitionLocal Suicide Prevention Support Groups

Youth SupportsLaw Enforcement

Resources for anyone

Suicide Prevention Lifeline 1-800-273-TALK

Websites: www.suicideprevntionlifeline.org

www.afsp.orgwww.sprc.org

www.omh.ny.gov

To become certified in QPR visit:http://www.qprinstitute.com/about-qpr

Safe

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WHEN YOU APPLY QPR, YOU PLANT THE SEEDS OF HOPE.

HOPE HELPS PREVENT SUICIDE.

Heather Morgan, MSEd., RHEdTioga County Public Health Educator

Tioga County Suicide CoalitionQPR Instructor * ASIST Certified

morganh@co.tioga.ny.us * 607-687-8637

Contact

Questions?