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WELCOME To
QPR
Gatekeeper
Training
Name______________
Introductions
• Introduction of speaker
• Introduction of participants by favorite time of year
and why.
Belonging
• Stand up if you
– Like playing basketball
– Participate in traditional dances
– Spend more than 30 minutes a day on the phone
– Have one person you can talk to
To address Suicide we must first speak of it
“Silence is dangerous when we pretend the problem is
not there…communication is a healer to break the
silence.”
Canadian First Nations Elder
Checking In
Suicide can be difficult to talk about
With permission:
Suicide Spoken Here!
Checking In
Suicide is Personal
Many of us are survivors,
who miss our friends and relatives
Some may be attempt survivors
Please take care of yourself during this training!
Big picture
• Think, plan, attempt, die
• 10 million adults think about suicide each year
• 1.2 million plan a method (gun, MVA, etc)
• 750,000 attempt (minimum count).
• Approximately 33,000 die
• 11th leading cause of death
- 3rd for young people (rate has almost tripled since 1950s –
unexpected upturn 2003-2004.
- first for young people in some states
source: National Co morbidity study, CDC and NIMH
Scope of the problem USA
• Range: thoughts, attempts, deaths
• 33,300 completed suicides in US (2006)
• U.S. suicide rates are trending down, not rising
• Exceptions: AI/AN youth are rising
• Rates vary widely by race, gender, geography,
ethnicity, but all deaths have commonalities
Am. Journal of Public Health, McKeown, 2006
For Native Americans/Alaska Natives
• 8th leading cause of death in general
• 5th leading cause for Indian Males
• 2nd cause for ages between 15 to 24
BIA 2001
• 2nd leading cause of death behind unintentional
injuries for Indian youth ages 15-24 residing in IHS
service areas and is 3.5 times higher than the national
average.
• American Indian and Alaska Native young people
ages 15-34 make up 64 percent of all suicides in
Indian country.
“Trends in Indian Health, 2002-2003”
Suicide Attempts General
• Most don’t die in their attempt
• Youth: 100 -200 attempts per 1 completion
• Elder: 4 attempts per 1 completion
• Average: 25 attempts per 1 completion
• 5 million Americans have attempted (est.)
• Reporting problem
- under reporting
- unknown (don’t ask, don’t tell)
Survivors of Suicide
• 6 blood relatives directly affected by each suicide
• Over 5.8 million Americans since 1975
• 1 of every 62 of us is a survivor (5.8million)
• This number does not include colleagues, co-workers, friends,
team or school mates and ex spouses
• If there is a suicide every 16 minutes, there are 6 new
survivors every 16 minutes
• Suicide risk is greater in survivors (e.g., 4-fold increase in
children when a parent dies by suicide)
Suicidal Behavior
•Means someone is in extreme pain and
suffering
•Means complex feelings and behavior
•Involves many reasons and factors
•Means coming at it from many directions
•This training is just one those directions
Some of the broader reasons for
Suicidal Behavior include
• My cultural has been disrupted
• There is a long history of trauma
• My community or family doesn’t feel
– safe, hopeful, supportive, welcoming, etc.
• I personally don’t feel hopeful, supported, happy,
calm, useful, loved, etc.
• ???????
Why do some people want to
die?
Why do some people want to die?
•Feel like I have no
future
•Just want the pain
to go away
Darkness Calls: The Healthy Aboriginal Network
Why do some people want to die?
• Feel that I am a
burden to my family
• Feel that everyone will
be better of without me
Darkness Calls: The Healthy Aboriginal Network
Why do some people want to die?
•See no other
solution to my
problems
Darkness Calls: The Healthy Aboriginal Network
Why do some people want to die?
•Feel like I don’t
belong
•Feel like no one
cares if I live or die
Darkness Calls: The Healthy Aboriginal Network
What can I do to help someone who is
thinking about a
A permanent solution to a
temporary problem?
Before we begin
• You can’t be held responsible for what you didn’t
do/say yesterday based on what you learned
today.
QPR
Ask A Question, Save A Life
©
QPR
Question, Persuade, Refer
©
QPR
•QPR is not about learning to be a
counselor.
•QPR is about offering hope by
getting involved and doing
something.
©
QPR
Suicide Myths and Facts
• Myth
• Fact
• Myth
• Fact
• Myth
• Fact
No one can stop a suicide, it is inevitable.
If people in a crisis get the help they need, they will
probably never be suicidal again.
Confronting a person about suicide will only make them
angry and increase the risk of suicide.
Asking someone directly about suicidal intent
lowers anxiety, opens up communication and lowers the risk
of an impulsive act.
Only experts can prevent suicide.
Suicide prevention is everybody’s business, and
anyone can help prevent the tragedy of suicide
©
QPR
Myths And Facts About Suicide
• Myth
• Fact
• Myth
• Fact
• Myth
• Fact
Suicidal people keep their plans to themselves.
Most suicidal people communicate their intent sometime
during the week preceding their attempt.
Those who talk about suicide don’t do it.
People who talk about suicide may try, or even complete, an
act of self-destruction.
Once a person decides to complete suicide, there is
nothing anyone can do to stop them.
Suicide is the most preventable kind of death, and
almost any positive action may save a life.
How can I help? Ask the Question...
©
QPR
Suicide Clues And Warning Signs
The more clues and signs you notice, the
greater the risk. Take all signs seriously.
©
QPR
Direct 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.”
©
QPR
Indirect Verbal Clues:
• “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.”
• “I’m going to stay with my Grandfather” Who is dead.
©
QPR
Behavioral Clues:
• Has made a suicide attempt in the past
• Acquiring a gun or stockpiling pills
• Is also depressed, moody, feels hopeless
• Putting personal affairs in order
• Giving away prized possessions
• Sudden interest or disinterest in religion or spirituality
• Drug or alcohol abuse, or relapse after a period of recovery
• Unexplained anger, aggression and irritability
©
QPR
Situational Clues:
• Being fired or being expelled from school
• Loss of girl/boyfriend or other important relationship
• Death of a best friend, aunt/uncle, especially if by suicide
• Being told you have a serious or terminal illness
• Sudden unexpected loss of freedom/fear of punishment
• Loss of a favorite counselor, teacher, coach, or supportive
person
• Fear of becoming a burden to others
©
QPR
Tips for Asking the Suicide Question
• If in doubt, don’t wait, ask the question
• If the person avoids or doesn’t answer, be persistent
• Talk to the person alone in a private place
• Allow the person to talk freely, listen more – talk less
• Take plenty of time, listen as if you have all day
• 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
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?”
©
Q
QUESTION
Direct Approach:
• “You know, when someone is as upset as you are, they sometimes
wish they were dead. Are you feeling that way, too?”
• “You look pretty down and upset, 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.
©
How Not to Ask the Question
“You’re not suicidal, are you?”
©
P
PERSUADE
HOW TO PERSUADE SOMEONE TO STAY ALIVE
• Listen to the problem and give them all your
attention
• Remember, suicide is not the problem, only the
solution to what may seem like an impossible
problem
• Do not rush to judgment, take your time
• Offer hope in any form
©
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 BRING BACK HOPE, AND MAKE ALL THE
DIFFERENCE.
©
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.
©
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.
©
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? Elder? Healer? Physician? Teacher?
Counselor? Coach?
• You don’t want to be the only person that knows.
©
For Effective QPR
• Join a Team. Offer to work with friends, teachers,
clergy, counselors, or anyone is going to give the
counseling, support, healing, or treatment to the
suicidal person.
• Follow up with a visit, text, phone call or email, and in
whatever way feels comfortable to you, let the person
know you care about what happens to them. Caring
may save a life.
©
REMEMBER
WHEN YOU APPLY QPR, YOU
GIVE A MESSGAE OF HOPE.
HOPE HELPS PREVENT
SUICIDE.
©
Theory Behind QPR
• Based on the belief and understanding that:
- Those most at risk for suicide:
- usually do not self-refer for counseling
- can be reluctant to get counseling
- often abuse drugs and/or alcohol
- hide or disguise their level of pain, feelings
- go undetected
- go untreated (and remain at risk for suicide)
How QPR Differs from Other Suicide Prevention
Training Programs
• QPR recognizes that even socially isolated individuals
usually have some sort of contact within their
community (e.g., family, doctors, teachers, friends,
someone….
• QPR teaches all groups within each community how
to recognize the “real crisis” of suicide and the
symptoms that go along with it.
How QPR Differs
• QPR addresses high risk people within their own
group and does not require suicidal people to ask for
help,
• QPR offers the increased possibility of intervention
early in the depressive and/or suicidal crisis.
• QPR encourages the gatekeeper to take the individual
directly for help.
How QPR Differs
• QPR stresses action, and active follow-up with each
intervention.
• QPR trained gatekeepers are already involved in the
life of the person at risk for suicide.
• QPR is part of a community wide training approach
that includes advanced suicide risk triage and risk
assessment training for 1st responders and professional
healthcare providers, creating a “culture of safety.”
Suicidal communications
• Suicidal people send warning signs to people in their
existing social personal network of relationships
• Like with CPR, the person next to you might be the
one that saves your life.
• Any person can be placed in the center of the
intervention process: tribal police, nurse, school
teachers, foster parents……..
Training for Everyone
• To create safer communities means training at
all levels:
- QPR Citizen Gatekeeper Training and Instructor
Certification Course
- QPR Suicide Triage Training and Instructor Training
Course for 1st responders (e.g., QPR for Cops)
- QPRT Suicide Risk Assessment training for health
care professionals
- QPRT for physicians and nurses
If someone missed my training session,
what can I do?
•
•
•
•
QPR is available online in a self-paced multimedia, interactive platform with streamed video
(requires broad-band)
15-item post-training quiz and dated hard-copy
certificate
You may blend the online course with a follow up
session for role-play, Q&A, and crisis response
and referral training as you see fit
For a free review of QPR online see our web site.
Think about and share your answers to
the following questions
Think about and share your answers to
the following questions
•If you were feeling suicidal, would you tell
someone?
Think about and share your answers to
the following questions
•If you were feeling suicidal, would you tell
someone?
•Who would you tell?
Think about and share your answers to
the following questions
•If you were feeling suicidal, would you tell
someone?
•Who would you tell?
•Would you come right out and say you were
feeling like killing yourself or would you be less
direct?
Think about and share your answers to
the following questions
•If you were feeling suicidal, would you tell
someone?
•Who would you tell?
•Would you come right out and say you were
feeling like killing yourself or would you be less
direct?
•What would be your reason for telling this
person?
Indirect verbal clues
If you were the friend listening to these statements, what
would you say?
Darkness Calls: The Healthy Aboriginal Network
Non Verbal Clues
If you were the friend looking on, what would you say?
Darkness Calls: The Healthy Aboriginal Network
Role Plays
• Ask the “S” Question
• Be Bold
• Be a Warrior
Resources
The Healthy Aboriginal Network
• The Healthy Aboriginal Network creates comics on health
and social issues for youth. Topics we’ve covered so far are:
Youth health issues
Suicide prevention
Gambling addiction
Diabetes prevention
Staying in school
Standing Together
Darkness Calls
On the Turn
An Invited Threat
Level Up
http://www.thehealthyaboriginal.net/
Resources
Free book for download
• Suicide: The Forever Decision
– qprinstitute.com
Resources
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Ways to get involved
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Contact Information
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Commitment
•What is your commitment?
•What action are you ready to take?