Post online training small group Post online training small group practice session and role-playspractice session and role-plays

QPRQPR

QQuestion, uestion, PPersuade, ersuade, RReferefer

QPRQPR

QPRQPR

Suicide Clues And Warning SignsSuicide Clues And Warning Signs

The more clues and signs The more clues and signs observed, the greater the risk. observed, the greater the risk.

Take all signs Take all signs seriously.seriously.

Small Group QuestionsSmall Group Questions

What do you know, or think you What do you know, or think you know, about suicide?know, about suicide?

Who completes suicide?Who completes suicide? What are some of the risk factors?What are some of the risk factors? What are some of the protective What are some of the protective

factors?factors?

Your experience with the Your experience with the training?training?

Comments?Comments? Observations?Observations? Things you would like to discuss?Things you would like to discuss? Action steps, if any, you have taken since Action steps, if any, you have taken since

completing training?completing training? Did you talk with others about the Did you talk with others about the

training?training? Personal impact on you?Personal impact on you?

Suicide Risk and Protective Suicide Risk and Protective FactorsFactors

This list and discussion of Suicide Risk This list and discussion of Suicide Risk and Protective Factors was taken from: and Protective Factors was taken from: U.S. Public Health Service, U.S. Public Health Service, The Surgeon The Surgeon General’s Call To Action To Prevent General’s Call To Action To Prevent Suicide.Suicide. Washington, DC: 1999 Washington, DC: 1999

Risk FactorsRisk Factors

Previous suicide attemptsPrevious suicide attempts Mental disorders – particularly mood Mental disorders – particularly mood

disorders such as depression and bipolar disorders such as depression and bipolar disorderdisorder

Co-occurring mental and alcohol and Co-occurring mental and alcohol and substance abuse disorderssubstance abuse disorders

Family history of suicideFamily history of suicide HopelessnessHopelessness

More Risk FactorsMore Risk Factors

Impulsive and/or aggressive tendenciesImpulsive and/or aggressive tendencies Barriers to accessing mental health Barriers to accessing mental health

and/or substance abuse treatmentand/or substance abuse treatment Relational, social, work, or financial lossRelational, social, work, or financial loss Physical illnessPhysical illness Easy access to lethal methods, especially Easy access to lethal methods, especially

gunsguns

More Risk FactorsMore Risk Factors Unwillingness to seek help because of stigma attached to Unwillingness to seek help because of stigma attached to

mental and substance abuse disorders and/or suicidal mental and substance abuse disorders and/or suicidal thoughtsthoughts

Influence of significant people – family members, Influence of significant people – family members, celebrities, peers who have died by suicide – both celebrities, peers who have died by suicide – both through direct personal contact or inappropriate media through direct personal contact or inappropriate media representationsrepresentations

Cultural and religious beliefs – for instance, the belief Cultural and religious beliefs – for instance, the belief that suicide is a noble resolution of a personal dilemmathat suicide is a noble resolution of a personal dilemma

Local epidemics of suicide that have a contagious Local epidemics of suicide that have a contagious influenceinfluence

Isolation, a feeling of being cut off from other peopleIsolation, a feeling of being cut off from other people

Protective FactorsProtective Factors Effective and appropriate clinical care for mental, Effective and appropriate clinical care for mental,

physical, and substance abuse disordersphysical, and substance abuse disorders Easy access to a variety of clinical interventions and Easy access to a variety of clinical interventions and

support for help seekingsupport for help seeking Restricted access to highly lethal methods of suicideRestricted access to highly lethal methods of suicide Family and community supportFamily and community support Support from ongoing medical, mental health and Support from ongoing medical, mental health and

substance abuse care relationshipssubstance abuse care relationships Learned skills in problem solving, conflict resolution, Learned skills in problem solving, conflict resolution,

and nonviolent handling of disputesand nonviolent handling of disputes Cultural and religious beliefs that discourage suicide Cultural and religious beliefs that discourage suicide

and support self-preservation instinctsand support self-preservation instincts

QPR QPR Tips for Asking the Suicide QuestionTips for Asking the Suicide Question

If in doubt, don’t wait, ask the questionIf in doubt, don’t wait, ask the question If the person is reluctant, be persistentIf the person is reluctant, be persistent Talk to the person alone in a private settingTalk to the person alone in a private setting Allow the person to talk freelyAllow the person to talk freely Give yourself plenty of timeGive yourself plenty of time Have your resources handy; QPR Card, phone numbers, Have your resources handy; QPR Card, phone numbers,

counselor’s name and any other information that might helpcounselor’s name and any other information that might help

Remember: How you ask the question is less Remember: How you ask the question is less important than that you ask itimportant than that you ask it

QQ QUESTIONQUESTION

Less Direct Approach:Less Direct Approach: ““Have you been unhappy lately? Have you been unhappy lately?

Have you been very unhappy lately? Have you been very unhappy lately? Have you been so very unhappy lately that you’ve been Have you been so very unhappy lately that you’ve been thinking about ending your life?” thinking about ending your life?”

““Do you ever wish you could go to sleep and never wakeDo you ever wish you could go to sleep and never wake up?” up?”

QQ QUESTIONQUESTION

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

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

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

““Are you thinking about killing yourself?” Are you thinking about killing yourself?”

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

How NOT to ask the suicide How NOT to ask the suicide questionquestion

““You’re not thinking of killing yourself, are You’re not thinking of killing yourself, are you?”you?”

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

““Suicide is a dumb idea. Surely you’re not Suicide is a dumb idea. Surely you’re not thinking about suicide?”thinking about suicide?”

QQ QUESTIONQUESTION

PP PERSUADEPERSUADE

Listen to the problem and give them Listen to the problem and give them your full attentionyour full attention

Remember, suicide is not the problem, Remember, suicide is not the problem, only the solution to a perceived only the solution to a perceived insoluble probleminsoluble problem

Do not rush to judgmentDo not rush to judgment Offer hope in any formOffer hope in any form

HOW TO PERSUADE SOMEONE TO STAY ALIVE

PP PERSUADEPERSUADE

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

until we’ve found some help?” until we’ve found some help?”

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

RR REFERREFER

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

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

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

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

Wrap upWrap up

REMEMBERREMEMBER

Since almost all efforts to persuade Since almost all efforts to persuade someone to live instead of attempt suicide someone to live instead of attempt suicide

will be met with agreement and relief, will be met with agreement and relief, don’t hesitate to get involved or take the don’t hesitate to get involved or take the

lead.lead.