1. GATEKEEPER TRAINING Question Persuade Refer

2. VIDEO QPR Institute

3. The Bridge Story Three miles long Opened in 1937 Longest suspension bridge in the world until 1964 Second most used suicide site in the world 245 feet above rocky water What bridge is it?

4. 2012 40,600 2011 39,518 2010 38,364 2009 36,909 2008 36,065 2007 34,598 2006 33,300 attributed to suicide 40,000 deaths annually

5. 1 suicide every 13 minutes OR 111 suicides every day Timing of USA Suicides

6. (age 15-24) commit suicide each year (2012) at a rate of one suicide every two hours 4,872 young people

7. Rank & Cause Number of deaths 1. Diseases of the heart 599,711 2. Malignant neoplasms (cancer) 582,623 3. Chronic obstructive pulmonary diseases 143,489 4. Cerebrovascular diseases (stroke) 128,546 5. Accidents 127,792 6. Alzheimer’s Disease 83,637 7. Diabetes mellitus 63,932 8. Pneumonia and influenza 50,636 9. Nephritis, nephrosis 45,622 10. Suicide 40,600 Ranking 10th in the USA Suicide is a leading cause of death

8. 25 attempts for each documented death (Note: 40,000 suicides translates into 1,000,000 attempts annually) Estimates of an attempted Suicide

9. It is estimated that there are 6 survivors for each death by suicide Number of Suicide survivors Note: A “suicide survivor” is someone who has lost a loved one to death by suicide

10. 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

11. 4,395,480 suicide survivors 732,580 deaths by suicide Survivors in the US population

12. QPR Q uestion, P ersuade, R efer © What Can We Do?

13. QPR is not intended to be a form of counseling or treatment. QPR is intended to offer hope through positive action. © QPR

14. 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

15. 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. How can I help? Ask the Question... © Suicide Myths and Facts

16. 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

17. Risk Factors for Suicide Previous suicide attempts Family history of suicidal behavior Recent losses: death of family member, relative, or friend Social isolation, withdrawal from family and friends History of Mental Illness Drug or Alcohol Abuse Exposure to violence in the home or social environment History of trauma Loss of social status Engaging in violent or self- destructive behaviors Chronic physical illness Confusion about sexual orientation Homelessness Loss of social status Victim of humiliation/bullying Access to lethal means such as firearms or medication Diagnosis of depression or other mood disorder * Not a QPR Slide

18. “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.” © Direct Verbal Clues

19. Any previous suicide attempt Acquiring a gun or stockpiling pills Co-occurring depression, moodiness, 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 © Behavioral Clues:

20. Being fired or being expelled from school A recent unwanted move Loss of any major relationship Death of a spouse, child, or best friend, especially if by suicide Diagnosis of a serious or terminal illness Sudden unexpected loss of freedom/fear of punishment Anticipated loss of financial security Loss of social status Loss of a cherished therapist, counselor or teacher Fear of becoming a burden to others © Situational Clues:

21. Depression & Suicide Depression often goes untreated or undiagnosed and sometimes results in suicide 25-50% of persons with manic-depression attempt suicide 1 in 5 persons with this illness die by suicide Of all those who die by suicide, more than 2/3rds suffer from depression or manic-depressive illness Depression 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

22. Time to ask Tips for Asking the Suicide Question 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 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!

23. 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?” ©

24. 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. ©

25. How not to ask the question © “You’re not suicidal, are you?” “You wouldn’t do anything crazy would you?”

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

27. 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. ©

28. 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 ©

29. 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 ©

30. 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. ©

31. What else?

32. Develop a resource list for your community County Mental Hygiene Mobile Integration Team School Support staff Hospitals/In-patient Services Local/County Suicide Prevention Coalition Local Suicide Prevention Support Groups Youth Supports Law Enforcement

33. Resources for anyone Suicide Prevention Lifeline 1-800-273-TALK Websites: www.suicideprevntionlifeline.org www.afsp.org www.sprc.org www.omh.ny.gov To become certified in QPR visit: http://www.qprinstitute.com/about-qpr

34. Safety Plan

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

36. Heather Morgan, MSEd., RHEd Tioga County Public Health Educator Tioga County Suicide Coalition QPR Instructor * ASIST Certified morganh@co.tioga.ny.usmorganh@co.tioga.ny.us * 607-687-8637 Contact Questions?