1. Ask A Question, Save A Life QPR

2. Question, Persuade, Refer 1. Question a person about suicide 2. Persuade the person to get help 3. Refer the person to the appropriate resource QPR

3.  QPR is not intended to be a form of counseling or treatment.  QPR is intended to offer hope through positive action.  QPR is intended to teach those who are in a position to recognize the warning signs, clues and suicidal communications of people in trouble to ACT vigorously to prevent a possible tragedy QPR

4.  MythNo one can stop a suicide, it is inevitable.  FactIf 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.  FactAsking 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. SUICIDE: MYTHS AND FACTS

5.  MythSuicidal people keep their plans to themselves.  FactMost suicidal people communicate their intent sometime during the week preceding their attempt.  Myth Those who talk about suicide don’t do it.  FactPeople 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. SUICIDE: MYTHS AND FACTS

6. Suicide Warning Signs The more warning signs observed, the greater the risk. Some warning signs are obvious, some are subtle, but take all signs seriously! SUICIDE WARNING SIGNS

7. Direct verbal suicide warning signs:  “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.” SUICIDE WARNING SIGNS

8. Indirect warning signs:  “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.” SUICIDE WARNING SIGNS

9. Behavioral suicide warning signs:  Any previous suicide attempt  Acquiring a gun or stockpiling pills (maybe)  Co-occurring depression, moodiness, or expressions of hopelessness  Putting personal affairs in order  Giving away prized possessions  Sudden interest or disinterest in religion  Drug or alcohol abuse, or relapse after a period of recovery  Unexplained anger, aggression and irritability SUICIDE WARNING SIGNS

10. Situational warning signs:  Being fired or being expelled from school  About to be arrested  A recent unwanted move  Loss of any major relationship  Death of a spouse, child, or best friend, especially if by suicide SUICIDE WARNING SIGNS

11. Situational warning signs:  Diagnosis of a serious or terminal illness  Sudden unexpected loss of freedom (being arrested)  Fear of punishment or public humiliation  Anticipated loss of financial security  Loss of a cherished therapist, counselor or teacher  Fear of becoming a burden to others SUICIDE WARNING SIGNS

12.  If in doubt, don’t wait, ask the question  If the 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 - they may not say they are suicidal right away  Have your resources handy: phone numbers, names, and know how you are going to get them to help  Be bold QPR

13. Because suicide is such a taboo subject, asking the “S” question may, at first, seem awkward or difficult, like asking the other “S” (sex) question. But the truth is that you may be the best person, in the best possible position to recognize the warning signs of a suicide crisis and to prevent suicide. Just as you have the courage to apply the Heimlich Maneuver to help a stranger choking on a piece of meat, so too can you apply QPR to someone considering suicide. Q: QUESTION

14. Here are some guidelines for applying QPR:  Plan a time and place to ask the “S” question.  Try to get the person alone or in some private setting.  A QPR intervention may take up to an hour, so give yourself plenty of time. Many people who’ve just been asked if they are thinking of suicide have a great need to talk. Listening skills will be discussed in a moment Q: QUESTION

15. There are several ways to ask the “S” question. You can begin by acknowledging the person’s distress. 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?”  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? Q: QUESTION

16. More Direct Approach:  “Have you ever wanted to stop living?”  “You look pretty miserable. Are you thinking of killing yourself?”  “Are you thinking about suicide?”

17. Q: QUESTION If none of these questions sound “like you,” then please use whatever phraseology works best for you. A bit of practice in asking the “S” question helps. The most important step in QPR is asking the question. It is the hardest step, but also the most helpful to someone considering suicide. Perhaps you feel only a professional person should ask such a delicate question. Not so. Suicide prevention is everybody’s business.

18. Q: QUESTION Research has repeatedly shown that once a person has been asked if they are thinking of suicide, they feel relief, not distress. Anxiety decreases while hope increases. A chance to go on living has been offered. It is almost as if, by asking the “S” question we provide a ray of light where there has been utter darkness. Asking the suicide question does not increase risk

19. Because a life may be at stake, if you can’t ask the suicide question, find someone who can! Q: QUESTION

20. How not to ask the suicide 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. Q: QUESTION

21. P: PERSUADE Persuading someone not to end his or her life and to get help begins with the simple act of listening. Listening can be life saving. Listen first, then persuade.

22. P: PERSUADE Listening When someone is feeling suicidal and needs to be persuaded to get help, the gift of listening becomes priceless. To become a better listener, consider that listening means:  Giving your full attention  Not interrupting and only speaking when the other person has finished  Not rushing to judgment or condemnation  Taming your own fear so that you can focus on the other person

23. P: PERSUADE Persuade the person to get help Then ask:  Will you go with me to see a counselor? (Or a priest, psychologist, etc.)  Will you let me help you make an appointment with…?  Will you promise me…”

24. P: PERSUADE Then ask: (continued)  “Are you willing to talk to your counselor within the next 10-15 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. The goal of persuasion is simple. All we want to accomplish is for the person to say yes and that they will get some help.

25. P: PERSUADE What if they refuse to get help?  “Are you willing to talk to your counselor within the next 10-15 minutes?”  If they say “yes” ask them, “I want you to live. 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. The goal of persuasion is simple. All we want to accomplish is for the person to say yes and that they will get some help.

26. P: PERSUADE Ask yourself a simple question: If you were angry or depressed or terribly upset and not thinking clearly, would you want those who love you to stand by while you killed yourself? NO. Just as you wouldn’t allow a friend to die if they were drowning, neither would you stand by and do nothing for someone prepared to commit suicide.

27.  Refusal to accept help doesn’t mean QPR failed. In fact, the opposite is true. The laws do not permit anyone to kill themselves without first receiving the benefits of treatment.  Suicide is not an acceptable solution. Mental health professionals believe significant danger exists, a court could order him to receive inpatient treatment.  When confronting a friend with QPR, remember that is it is better to have an angry friend than a dead one. P: PERSUADE

28. Persuasion works best when you do the following:  Persist in statements that suicide is not a good solution.  Focus on solutions to the problems, not the suicide solution  Accept the reality of the person’s pain, but then offer alternatives  Offer hope in any form and in any way P: PERSUADE

29. Reduce the risk by making suicide difficult  Some suicidal persons are impulsive  It is always helpful to remove firearms, car keys, medications and other means by which a person may injure or even kill themselves  By simply restricting access to the means of suicide, you may buy the time needed for the pain to pass, for a solution to be found and for hope to be rekindled P: PERSUADE

30. How to refer someone for help  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 reinforce how helpful talking to someone can be. R: REFER

31.  Because of the stigma associated with accepting counseling or professional help for disorders of the brain or emotional problems, some people will not follow through and see a professional. This is why we recommend that, if possible, you physically take the person to someone who can help. R: REFER

32. Love-Line (Sarang - Jonwha) Counselling Centre Shingongduk-dong 9-22 Mapo-gu SEOUL Hotline: (2) 715 8600 Hotline: (2) 716 8600 Hotline: (2) 717 8600 Hotline: (2) 718 8600 Website: counsel24.com/ Seoul Suicide Hotline SEOUL Contact by: Phone Hotline: (02) 916-9191

33. R: REFER Love-Line (Sarang - Jonwha) Counselling Centre Shingongduk-dong 9-22 Mapo-gu SEOUL Hotline: (2) 715 8600 Hotline: (2) 716 8600 Hotline: (2) 717 8600 Hotline: (2) 718 8600 Website: counsel24.com/ Seoul Suicide Hotline SEOUL Contact by: Phone Hotline: (02) 916-9191

34. R: REFER Finding the Courage to Act To help you act with courage, here are some things to remember:  Don’t worry about being disloyal  Don’t worry about breaking a trust  Don’t worry about not having sufficient information to call for help  If you personally, don’t feel comfortable asking the question, find someone who can and share your concerns and fears with them  Reach out! Don’t wait! Do something!

35. R: REFER Tips for Effective QPR  To broaden the safety net for someone at risk of suicide, ask the suicidal person, “Who else would you like to know that you’re feeling this way?”  With the suicidal person’s permission, you may let them know what is going on. Keep a close watch on them. The Seeds of Hope When you apply QPR you plant the seeds of hope. Applying QPR brings a personal crisis out of the dark and into the light. Hope begins with you!

36. 1. Choose a partner 2. Identify who will portray person in crisis and who will portray Gatekeeper 3. Gatekeepers: You will be talking with someone you already know from your work 4. Gatekeepers: Listen to the problem, find out what’s going on and then ask the question. PRACTICE