1. Ask A Question, Save A Life
QPR
In School Settings
Ask A Question, Save A Life

2. Question, Persuade, Refer
QPR
In School Settings
Question, Persuade, Refer

3. QPR QPR is not intended to be a form of counseling or treatment.
In School
QPR is not intended to be a form of counseling or treatment.
QPR is intended to offer hope through positive action.

4. QPR Suicide Myths and Facts
In School
Myth No one can stop a suicide, it is inevitable.
Fact If a young person in a crisis gets 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.

5. QPR Myths And Facts About Suicide
In School
Myth Suicidal young 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...

6. QPR Myths And Facts About Suicide
In School
Myth If a suicidal youth tells a friend, the friend will access help.
Fact Most young people do not tell an adult.
Good Friends Don’t Keep Deadly Secrets!

7. QPR Suicide Clues And Warning Signs The more clues and signs observed,
In School
Suicide Clues And Warning Signs
The more clues and signs observed,
the greater the risk.
Take all signs seriously.

8. QPR In School Strongest Predictors Previous suicide attempt
Current talk of suicide/making a plan
Strong wish to die/preoccupied with death(i.e., thoughts, music, reading)
Depression (hopelessness, withdrawal)
Substance use
Recent attempt by friend or family member

9. QPR In School Verbal Clues: “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.”

10. QPR Indirect or “Coded” Verbal Clues: In School
“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.”

11. QPR Behavioral Clues: In School Past suicide attempt
Getting a gun or stockpiling pills
Giving away prized possessions
Impulsivity/increased risk taking
Unexplained anger, aggression, irritability
Self-destructive acts (i.e., cutting)
Chronic truancy, running away
Perfectionism

12. QPR Situational Clues: In School
Being expelled from school /fired from job
Family problems/alienation
Loss of any major relationship
Death of a friend or family member, especially if by suicide
Diagnosis of a serious or terminal illness
Financial problems (either their own or within the family)
Sudden loss of freedom/fear of punishment
Feeling embarrassed or humiliated in front of peers
Victim of assault or bullying

13. QPR Other Youth Related Clues: In School
Change in interaction with family and friends
Recent disappointment or rejection
Sudden decline or improvement in academic performance
Physical symptoms: eating disturbances, changes in sleep patterns, chronic headaches, stomach problems, menstrual irregularities
Increased apathy

14. QPR Tips for Asking the Suicide Question
In School
If the young person is reluctant, be persistent
Talk to the person alone in a private setting
Allow the person to talk freely
Give yourself plenty of time
If in doubt, don’t wait, ask the question
Have your resources handy: QPR Card, community resources phone numbers and know your school protocol for handling suicide risk
Remember: How you ask the question is less important than that you ask it

15. Q QUESTION HOW TO ASK THE SUICIDE QUESTION
Less Direct Approach:
“Have you been unhappy lately?” “Have you been very unhappy lately?” “Have you been so unhappy lately that you’ve been thinking about ending your life?”
Do you ever wish you could go to sleep and never wake up?”

16. 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 can not ask the question, find someone who can.

17. WAYS NOT TO ASK THE QUESTION
“You’re not thinking about suicide are you?” OR
“You’re just kidding about killing yourself, right?”
Asking in this way encourages a negative response from
the young person you are talking with. It may also imply
that your are frightened by the intensity of their feelings.
Similarly, be aware of your own non-verbal clues.

18. P PERSUADE FOR QPR IN SCHOOL SETTINGS
Listen to the problem and give them your full attention
Remember, suicide is the solution to a perceived insoluble problem. Suicide is not the problem.
Do not rush to judgment
Offer hope in any form

19. P PERSUADE CONT. THEN ASK:
“Will you go with me to talk with your
school counselor?”
Would you like me to tell your school
counselor that you would like to talk to
him or her?”

20. P PERSUADE CONT.
“Are you willing to talk to your counselor within the next minutes?”
If they say “yes” ask them, “Will you promise me not to kill yourself in between now and the time you talk to your school counselor?”
Continue to monitor them closely until the are with the counselor.

21. P PERSUADE CONT.
“If you are unable or unwilling to talk to your counselor, I want you to know that I care enough about you that I will let them know.”
NOTE: The school counselor and/or administrator must be informed if you believe you are seeing suicidal clues or warning signs from a student.

22. R REFER FOR QPR IN SCHOOL SETTINGS
Suicidal young people often believe they cannot be helped, so you may have to do more.
The best “referral” involves taking the person directly to see the school counselor.
The next best “referral” is when the student wants you to talk to the counselor first, or when they agree to talk to the counselor on their own within the immediate future. (The young person should be monitored closely in the interim.)
The third best option is to make sure the student is safe, is under observation by an adult, and then you tell the school counselor the warning signs you have observed.

23. You are being disloyal if you do not!
NOTE:
You are not being disloyal or violating a trust when you share of a young person’s suicidality with a school counselor or administrative staff.
You are being disloyal if you do not!

24. For Effective QPR In School Settings
Say: “I want you to live,” or “I’m on your side and we’ll get through this.”
Communicate with the school counselor and administration.
Get Others Involved. Ask the person who else might help. Family? Friends? Teachers? Brothers? Sisters? Pastors? Priest? Rabbi? Bishop? Physician?

25. For Effective QPR Cont.
Join the Team. Offer to work with other school personnel and concerned members of the community members to help reduce youth suicide.
Follow up with a visit, a phone call, a card, or in whatever way feels comfortable to you, to let the young person know you care about what happens to them. Caring may save a life.

26. REMEMBER Since almost all efforts to persuade a young
person to live instead of attempt suicide
will be met with agreement and relief,
don’t hesitate to get involved.

27. WHEN YOU APPLY QPR,
YOU PLANT THE SEEDS
OF HOPE.
HOPE HELPS PREVENT
YOUTH SUICIDE.

29. Reducing a Suicidal Person’s Access to Firearms – Bonus Module
Recommendations for Gatekeepers
on Reducing Gun Violence
The QPR Institute wishes to thank Elaine Frank and Cathy Barber of Dartmouth and Harvard Universities for their contributions to this QPR gatekeeper training program!
What you are about learn is an approved derivative program from Counseling Access to Lethal Means (CALM) - an AFSP/SPRC Registered Best Practice training program.

32. Sri Lanka & Pesticides
Pesticides are the leading suicide method in Sri Lanka.
Restrictions were placed on sales of the most highly human-toxic pesticides in the mid to late 1990s.
Suicide rates dropped 50% from 1996 to 2005.
Nonfatal poisonings and suicide by other methods did not drop.
In Sri Lanka, as in most of rural Asia, swallowing pesticides is the most common suicide method. (It’s hardly ever used in the U.S.) The most human-toxic pesticides were banned in the mid- to late-90s. Suicides dropped by half, saving 20,000 lives over the period. Nonfatal poisoning didn’t drop, nor did suicides by other methods. So the behavior wasn’t changing. People weren’t less suicidal. Rather, they were less likely to die when they were suicidal.
Gunnell Int’l J of Epidemiology. 32

33. United Kingdom & Domestic Gas
Before 1960, domestic gas was the leading method of suicide in the United Kingdom.
By 1970, almost all domestic gas in the UK was non-toxic.
Suicide rates dropped by nearly a third.
The drop was driven by a drop in gas suicides; non-gas suicides increased slightly.
A similar thing happened in the United Kingdom. The leading suicide method in the UK before 1960 was domestic gas (putting your head in the oven). After a cheaper, nontoxic source of gas was discovered, the toxicity of domestic gas was gradually reduced to virtually zero by The suicide rate dropped by a third, driven by a drop in gas suicides. Non-gas suicides went up a little.
Source: Kreitman 1976, Brit J Prev Soc Med. 33

34. Why Does Reducing Access to Firearms Work to Prevent Suicide?
So WHY????!! How could simply making a suicide method less deadly save lives? After all, if you really want to kill yourself, you can eventually find a way. 34

35. Why Means Matter Suicidal crises are often relatively brief.
Suicide attempts are often undertaken quickly with little planning.
Some suicide methods are far more deadly than others (“case fatality” ranges from 1% for some methods to 85-90% for the most deadly).
90% of those who survive even nearly-lethal attempts do not go on to later die by suicide.
The simple answer is yes, you can eventually find a way. But the acute phase of a suicidal crisis—the period during which a suicidal person is actually ready to pull the trigger or swallow the poison—is often brief, a matter of minutes or hours, not days or weeks. When asked how long the period was between deciding on suicide and actually attempting, 24% of people who nearly died in a suicide attempt said less than five minutes. Only 13% said more than a day. They may have been miserable for a long period or a short period, but the period in which a person will make an attempt is often relatively brief. Some suicide methods are far more deadly than others. Some kill in less than 1% of attempts, others in 90%. The lethality of the method readily at hand during a suicidal crisis can mean the difference between life and death. Putting time and distance between a suicidal person and highly lethal means can save a life. And not just in the short run. Over 70 studies have found that about 90% of people who attempt suicide do not go on years later to later die by suicide – including studies of people using highly lethal methods like jumping in front of a train.
See: for studies examining each of these concepts.

36. Focus on Firearms Firearms are the leading suicide method in the U.S.
Gun owners and their families are at about 3 times higher risk of suicide than non-gun owners.
This isn’t because they’re more suicidal. Gun owners are NO more likely to be mentally ill, to think about suicide, or to attempt suicide.
Rather, they’re simply more likely to die in a suicide attempt.
Sources:
Miller M, Injury Prevention Findings also in ICARIS-2 survey
Betz M, Suicide Life Threat Behavior, Miller M, Injury Prevention, Ilgen M, Psychiatr Serv, Sorenson & Vittes, Eval Rev, 2008.
In the U.S., firearms account for 51% of suicide deaths – more than all other methods combined. Gun owners and their families have a roughly three times higher suicide rate than people who don’t live with guns. The higher risk isn’t because they’re more likely to be suicidal. Gun owners are no more likely than non-gun-owners to screen positive for mental health problems, to report thinking about suicide, or to report having attempted suicide. Rather, they’re more likely to die in a suicide attempt. Firearms have extraordinarily high case fatality, and gun owners are more likely to use guns in their attempts than non-gun-owners.

37. Reducing a Suicidal Person’s Access
A simple step to increase a suicidal person’s safety is to reduce access to firearms at home.
Many counselors and providers and family members of at-risk people don’t think to do this.
This temporary safety intervention is not anti-gun.
A simple step to increase a suicidal person’s safety is to help ensure they don’t have access to guns at home. Many counselors and providers and family members of at-risk people don’t think to do this, assuming that intent is the only thing that matters. (Intent does matter, but means also matter.)

38. Making a Difference
Family and friends can protect a suicidal person by temporarily storing all firearms away from home.
Have a trusted person outside the home hold onto them until the situation improves.
Some storage facilities, police departments, gun clubs, and gun shops will store guns.
If off-site storage isn’t an option:
Lock the guns at home with new locks or combinations.
Keep ammunition out of the home or locked separately.
Or, remove a key component of the guns, e.g., the bolt.
Family members and friends can help protect a suicidal person by temporarily storing any household firearms away from home. One option is to have a trusted person outside the home hold onto the guns until the situation improves. It needs to be someone who can safely handle firearms and who meets any legal requirements in your state. Another option is to store the guns at a facility. Some police departments, gun clubs, and gun shops will temporarily store guns.
For some gun owners whose collections are very large or who object to off-site storage, other options are locking the guns in such a way the vulnerable person has no access to or knowledge of the keys or combinations. Remember, most family members know one another’s hiding places. Keep ammunition out of the home or locked separately, or another alternative is to remove a key component of the guns such as the firing pin.

39. To keep him safe…
… when, as a young man, Abraham Lincoln was depressed and suicidal, a friend said of him, “Lincoln told me that he felt like committing suicide often.” Seeing suicide warning signs, Lincoln’s neighbors mobilized to keep him safe, watching over him, and removing his knives and pistol. They pulled together the same kind of safety net QPR gatekeepers can build today – and which included making sure our President did not have access to the means of suicide.
It was said that when he again became depressed later in life he “dared not carry even a pocket knife… “
Source: Lincoln’s Melancholy, A.W. Shenk, Houghton, Mifflin, Co. 2005

40. For more information
Know the Signs website:
Means Matter website:
Take CALM-Online—free, online course on Counseling on Access to Lethal Means
Request technical assistance from Means Matter
Request an in-person CALM training 40

41. Contact Information
Meghan Boaz Alvarez, M.S., MFT
KCMH Hotline & Access Center Supervisor
Suicide Prevention/Intervention Educator
(661)
Kern County Mental Health Crisis Hotline
With help comes HOPE