1. Post online training small group practice session and role-plays QPR

2. Q uestion, P ersuade, R efer QPR

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

4. Small Group Questions What do you know, or think you know, about suicide? What do you know, or think you 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 factors? What are some of the protective factors?

5. Your experience with the 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 completing training? Action steps, if any, you have taken since completing training? Did you talk with others about the training? Did you talk with others about the training? Personal impact on you? Personal impact on you?

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

7. Risk Factors Previous suicide attempts Previous suicide attempts Mental disorders – particularly mood disorders such as depression and bipolar disorder Mental disorders – particularly mood disorders such as depression and bipolar disorder Co-occurring mental and alcohol and substance abuse disorders Co-occurring mental and alcohol and substance abuse disorders Family history of suicide Family history of suicide Hopelessness Hopelessness

8. More Risk Factors Impulsive and/or aggressive tendencies Impulsive and/or aggressive tendencies Barriers to accessing mental health and/or substance abuse treatment Barriers to accessing mental health and/or substance abuse treatment Relational, social, work, or financial loss Relational, social, work, or financial loss Physical illness Physical illness Easy access to lethal methods, especially guns Easy access to lethal methods, especially guns

9. More Risk Factors Unwillingness to seek help because of stigma attached to mental and substance abuse disorders and/or suicidal thoughts Unwillingness to seek help because of stigma attached to mental and substance abuse disorders and/or suicidal thoughts Influence of significant people – family members, celebrities, peers who have died by suicide – both through direct personal contact or inappropriate media representations Influence of significant people – family members, celebrities, peers who have died by suicide – both through direct personal contact or inappropriate media representations Cultural and religious beliefs – for instance, the belief that suicide is a noble resolution of a personal dilemma Cultural and religious beliefs – for instance, the belief that suicide is a noble resolution of a personal dilemma Local epidemics of suicide that have a contagious influence Local epidemics of suicide that have a contagious influence Isolation, a feeling of being cut off from other people Isolation, a feeling of being cut off from other people

10. Protective Factors Effective and appropriate clinical care for mental, physical, and substance abuse disorders Effective and appropriate clinical care for mental, physical, and substance abuse disorders Easy access to a variety of clinical interventions and support for help seeking Easy access to a variety of clinical interventions and support for help seeking Restricted access to highly lethal methods of suicide Restricted access to highly lethal methods of suicide Family and community support Family and community support Support from ongoing medical, mental health and substance abuse care relationships Support from ongoing medical, mental health and substance abuse care relationships Learned skills in problem solving, conflict resolution, and nonviolent handling of disputes Learned skills in problem solving, conflict resolution, and nonviolent handling of disputes Cultural and religious beliefs that discourage suicide and support self- preservation instincts Cultural and religious beliefs that discourage suicide and support self- preservation instincts

11. QPR Tips for Asking the Suicide Question If in doubt, don’t wait, ask the question If in doubt, don’t wait, ask the question If the person is reluctant, be persistent If the person is reluctant, be persistent Talk to the person alone in a private setting Talk to the person alone in a private setting Allow the person to talk freely Allow the person to talk freely Give yourself plenty of time Give yourself plenty of time Have your resources handy; QPR Card, phone numbers, counselor’s name and any other information that might help Have your resources handy; QPR Card, phone numbers, counselor’s name and any other information that might help Remember: How you ask the question is less important than that you ask it

12. Q QUESTION Less Direct Approach: 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?” “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?” “Do you ever wish you could go to sleep and never wake up?”

13. Q QUESTION Direct Approach: 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 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?” “You look pretty miserable, I wonder if you’re thinking about suicide?” “Are you thinking about killing yourself?” “Are you thinking about killing yourself?” NOTE: If you cannot ask the question, find someone who can.

14. How NOT to ask the suicide question “You’re not thinking of killing yourself, are you?” “You’re not thinking of killing yourself, are you?” “You wouldn’t do anything stupid would you?” “You wouldn’t do anything stupid would you?” “Suicide is a dumb idea. Surely you’re not thinking about suicide?” “Suicide is a dumb idea. Surely you’re not thinking about suicide?” Q QUESTION

15. P PERSUADE Listen to the problem and give them your full attention Listen to the problem and give them your full attention Remember, suicide is not the problem, only the solution to a perceived insoluble problem Remember, suicide is not the problem, only the solution to a perceived insoluble problem Do not rush to judgment Do not rush to judgment Offer hope in any form Offer hope in any form HOW TO PERSUADE SOMEONE TO STAY ALIVE

16. P PERSUADE 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 yourself until we’ve found some 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.

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

18. Wrap up 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 get involved or take the lead.