Transcript Slide 1

Suicide Prevention Services
Definition of Suicide
1.
2.
Intent to kill self.
“Succeed” in that intent.
5 Levels of Suicidation
1.
2.
3.
4.
5.
Suicidal Feelings
Suicidal Impulses
Suicide Attempts
Completed Suicides
Victim-Precipitated Suicides
Society’s Attitude Toward Suicide
Society’s Attitude Toward Suicide
1.
Depicted as “good and admirable”
Egyptian“Dispute of the Man with his Soul.”
Ancient Gaul & Germanic Tribes:
Taking one’s life would ensure happiness in
the next world.
Fortress of Masada
In 73 A.D. 964 Jews took their own lives in preference to
capture & enslavement by the Romans.
Plato (428-347 B.C.)
Opposed to suicide, EXCEPT when ordered by the
state and in extreme cases of poverty, sorrow,
or disgrace.
Society’s Attitude Toward Suicide
1.
2.
Depicted as “good and admirable.”
Condemned.
St. Augustine (354-430 A.D.)
-“destestable & damnable wickedness.”
-“it’s homicide.”
563 A.D.- Council of Braga
Suicide is condemned by the church.
Middle Ages
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Indignities heaped upon the corpse.
Confiscation of survivor’s goods and land.
Society’s Attitude Toward Suicide
1.
2.
3.
Depicted as “good and admirable.”
Condemned.
Accepted as a Problem.
Jean Pierre Fairet (1794-1870)
Published scholarly work in 1822.
John Stuart Mill
(1806-1873)
Herbert Spencer
(1820-1903)
“If suicide would increase the happiness of others,
then man is allowed to take his own life.
Catholic Church
Forbids Suicide but assumes the victim was
not in possession of his/her faculties.
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19
Century Medicine
Concluded that a person who took his
own life was insane.
Society’s Attitude Toward Suicide
1.
2.
3.
4.
Depicted as “good and admirable.”
Condemned.
Accepted as a Problem.
Regarded as an act that can be investigated
scientifically.
People who talk about suicide rarely commit suicide.
Myth.
The tendency towards suicide is inherited and
passed on from one generation to another.
Myth.
The suicidal person wants to die and feels
there is no turning back.
Myth.
There is little correlation between
alcohol and suicide.
Myth.
If a person struggles with suicidal impulses once,
he/she will continue to struggle with
suicidal impulses forever.
Myth.
You should never talk about suicide
to a depressed person:
you could give her ideas.
Myth.
Suicidal persons rarely seek medical help.
Myth.
Suicide usually happens without warning on the
spur of the moment.
Myth.
Every “True” suicide leaves a note.
Myth.
PREVENTION
Warning Signs of Suicidation
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Verbal Clues
– Direct
– Indirect
Non Verbal Behavioral Clues
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Direct Behavioral
– Self-Destructive actions
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Attempts
Indirect Behavioral
Situational Clues: “Cries Out”
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Prior to surgery
Loss of a loved one
Loss of Money, prestige, job
Sickness, serious illness
Changes in life situation: moving
Perceived failure of counseling
Success, Promotion, increased responsibility
Emotional Clues
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Change in personality
Signs of Clinical Depression
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Future looks bleak
No way to change future
Feels Apprehension
Feels Despondent
Ordinary tasks difficult to perform
Difficulty in simple decisions
Lack of energy
Physical complaints
Insomnia
Those most susceptible to
self destruction:
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Prior attempt
Threat
Chronic illness/isolation
Bereavement
Financial Stress
Domestic Difficulties
Severe Depression
Psychosis
Alcoholism
Drugs
Family History
Factors influencing suicidal potential
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Age and Sex
THE plan
Stress symptoms
Emotional symptoms
Resources
Lifestyle
Communication
Reactions of those around him/her
In dealing with a stable person, we are:
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Highly responsive
Active
In dealing with a unstable person, we are:
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Slower
More thoughtful
Remind him he has weathered similar crises in
the past
Main Goals
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Help restore order
Assist in reestablishing
relationships with a stable person
Intervention
The Caregiver
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Attitude of the helper
Moralizer
Angry
When intervention is indicated:
1.
2.
3.
Where does the intervention begin and end?
Who intervenes?
How does one intervene?
The helper needs an unshakable
attitude of acceptance:
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Verbal
Non-Verbal
Putting disquieted person at ease
Building Trust
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Begins immediately
Is ongoing
Must be consistent
The Art of communicating
The Art of communicating
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The despondent person may need verbal advice
The Art of communicating
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1st task: Identify the source of distress
The Art of communicating
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Client needs to diagnose his problem in words.
Clarify how he handled similar situations
Decide on coping methods that have worked
Discover what still matters to him
The Art of communicating
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Client needs to diagnose his problem in words.
Help of the Caregiver can be received
differently:
-Religious affiliation
-Manipulative behavior
-Pathologically manipulative behavior
Techniques of Intervention
1.
2.
3.
4.
5.
6.
Focus on current hazard and crisis
Gain clear perception of hazard and crisis
Reduce any immediate danger
Evaluate client’s need for medication
Evaluate client’s need to have someone present
Mobilize client’s internal and external
resources
Implement a plan of action
Implement a plan of action
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Caregiver helps client decide what to do
Caregiver decides what “he” should do
Help those around the client know how to help the client
What if the plan bogs down
Decide what follow up is appropriate and who will do it
Once client has agreed to and worked on the plan, stay
firm and consistent and help to reguide and redirect if
necessary
Transfer pf client to other caregiver
Conclude
Postvention
Survivors feelings
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Embarrassment & Shame
Guilt
Denial
Hostility
Depression and sadness
Stages of Grief
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Shock
Anger
Denial
Bargaining
Acceptance
The funeral
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The wake and funeral are necessary
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1st step of grieving process
Viewing of the reality of death
We can no longer deny what we see before us
Offers the opportunity to be comforted and to comfort
Helps process denial into acceptance of reality
Clergyman needs to focus on the positive years, not
just the one final act
What friends can do
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Keep in touch
Help the family to mobilize resources
Offer to contact a survivor outreach group or team
Suicide is the cruelest death of all
for those who remain.
“Suicide is self-murder. It’s homicide.
It is against the 6th commandment and
the worst crime of all.”
What people can bring to those who grieve
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Their best authentic self
Natural conversation
– Speak of the deceased
– Listen
– Ask them to tell their story
– Be silent with them
– Cry with them
– Don’t ask why
Pathological Grief- a death for which one is
so completely unprepared has a more
devastating impact than the loss of life
from a chronic disease.
When grief work is not done
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Survivor may suffer morbid distress
characterized by delayed & pathological
reactions
Develops symptoms of agitated depression &
bodily affliction
Obsessive-compulsive behavior
May become self destructive
The reaction is so intensive and prolonged
that it jeopardizes physical and mental
well-being of the person.
There is much we don’t know about suicide but we
do know there is a limit to a load any person can
handle. At that moment, death appeared the only
alternative to his troubled life.
Survivors may go through
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Withdrawal
Self-medication
Flight into activity
The survivor needs time to think through
which activities can bring him some
degree of purpose.
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Starts slowly
Move carefully
Transform any errors of the past into a
loving memorial by more noble behavior
in the future
GOAL
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To assimilate the grief experience and
grow because of it and through it.
Past failures need not doom a person forever. The
willingness to build the temple of tomorrow’s dreams on
the grave of yesterday’s bitterness is the greatest
evidence of the unquenchable spirit that fires the
soul of man.
Periods of recovery
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Resuscitation
Resynthesis
Renewal
Principles for underlying postvention
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Family members need to accept the suicide in
their own time
Help family to understand PTSD and the crisis
Teach family members that grief is self-limiting
Teach family members how children grieve
Teen Suicide
This is probably the worst time to be growing up
since the middle ages when the bubonic plague
created chaos.
Suicide in the young can always be tied to:
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A sense of loss
A sense of failure
2008-2009
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World hunger
Unemployment
Economic Collapse
War
Threat of Nuclear War
???
Adolescence
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Time of rapid changes
Expectations of transitioning into adulthood
Greater Social Freedom
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2.
3.
4.
5.
6.
More choices
Fewer limitations
Lack of ability to cope with these social changes
Drugs, Alcohol, Sexual Pressure
Pressure to achieve in school
Pressure from parents to choose the “right” way
Statistics
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2nd leading killer of 12-24 year old
100-200 attempts for every completion
1 out of 11 high school students had
attempted in the past 12 months (2003)
6000 per year
5-8X as many girls as boys attempt
Boys succeed 4X more often
What is Suicide to a kid?
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Peace & Escape
Protest & Rage
A way to “get” the parents
Media
Media
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Heavy influence: TV, movies, magazines, internet
Adolescents face
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Divorce
Family conflict
Parental pressure to achieve
Moving
Break-up of romance
Set impossible standards for self
Want to assume grown-up responsibility beyond their
years
Lack of emotional support
Quick to despair
Suicidal Teen
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Low self-esteem
Perfectionism
Loner
Hostile
Confused
What to do for a friend
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LISTEN to him
Show concern
Ask direct questions
Don’t feel you can supply the answers to
his life
Don’t explain why life is worth living
Don’t go by a false code of honor
Adolecents with higher risk
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Physical handicap or illness
Learning disabled
Behavior disordered
Gender identity issues
After breakup of a relationship of major
importance
Death of a parent in childhood
Intervention
1.
2.
Use hospitalization LAST
Crisis intervention type of therapy
-Focus on the acute situation that lead to this
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Engage the Adolescent quickly
Accept her where she is
Be available
Follow up on any missed appointments
Offer self as a role model
Make aware of needs to modify confidentiality where
suicide is concerned
Family involvement
Help to lower stress, decrease isolation from others and
become actively involves in problem solving
Goals
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Help to cope with normal activities
Rejoin social structures
Handle stress in a healthy manner
Become oriented to environment
Become organized enough to meet own needs
QPR Statistics
31,000 deaths annually
1998
30,575
1997
30,535
1996
30,903
1995
1994
1993
1992
31,284
31,142
31,102
30,484
attributed to suicide
Timing of USA suicides
1 suicide every 17 minutes
OR
84 suicides every day
4,135 young people
(age 15-24)
commit suicide each year
at a rate of
one suicide every two hours
Suicide is a leading cause of death
Rank & Cause
1. Diseases of the heart
2. Malignant neoplasms
3. Cerebrovascular diseases
4. Chronic obstructive pulmonary diseases
5. Accidents
6. Pneumonia and influenza
7. Diabetes mellitus
8. SUICIDE
9. Nephritis, nephrosis
10. Chronic liver disease and cirrhosis
Number of deaths
724,859
541,532
158,448
112,584
97,835
91,871
64,751
30,575
26,182
25,192
Ranking 11th in the USA 2003
National ranking and rate of suicide
01 Nevada
02 Alaska
03 Wyoming
04 Montana
05 Arizona
06 New Mexico
07 Oregon
08 Idaho
09 Utah
10 Maine
11 South Dakota
12 Colorado
13 Florida
13 Vermont
15 Oklahoma
16 Tennessee
17 Arkansas
22.7
21.0
18.1
17.9
17.2
17.1
16.6
16.4
16.0
15.8
15.6
15.4
14.6
14.6
14.1
13.7
13.6
18
19
20
21
21
23
23
25
26
27
28
29
30
31
31
31
34
35
Kentucky
Alabama
New Hampshire
West Virginia
Missouri
Washington
Kansas
Nebraska
Virginia
Mississippi
Indiana
South Carolina
Iowa
Pennsylvania
North Carolina
Wisconsin
North Dakota
Louisiana
13.4
13.1
13.0
12.8
12.8
12.4
12.4
12.3
12.2
12.0
11.8
11.7
11.5
11.4
11.4
11.4
11.3
11.0
USA Total Rate 11.3
36
36
38
39
39
41
41
41
41
44
45
46
47
47
49
50
51
Georgia
10.8
Texas 10.8
California
10.5
Ohio
9.9
Michigan
9.9
Hawaii
9.7
Minnesota
9.7
Maryland
9.7
Minnesota
9.7
Delaware
9.1
Rhode Island
8.7
Illinois
8.6
Massachusetts
8.2
Washington D.C. 8.2
Connecticut
7.8
New York
7.5
New Jersey
7.2
Estimates on attempted suicide
25 attempts for each documented death
(Note: 31,000 suicides translates into 775,000 attempts annually)
Number of suicide survivors
It is estimated that there are
6 survivors
for each death by suicide
Note: A “suicide survivor” is someone who has lost
a loved one to death by suicide
The ratio of 6 survivors per suicide
means there are:
6 new survivors every 17 minutes
OR
504 new survivors each day
Survivors in the U.S. population
4,395,480
suicide survivors
5
4
3
732,580
deaths by suicide
2
1
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
0
1 of every 62 Americans
is estimated to be a suicide survivor
The Many Paths to Suicide
“Triggers or Final Straws”
Biological
Genetic
Load
Sex
Crisis in
Relation
Poison
Loss of
Freedom
Gun
Age
Personal/Psychological
Fired/
Expelled
Loss of
Parent
Culture
Shock/
Shift
Values
Religion
Beliefs
Drugs
or
Alcohol
Illness
Environmental
Season
of year
Geography
Urban
vs.
Rural
• All “Causes” are real.
• Hopelessness is the common pathway.
• Break the chain anywhere = prevention.
Model
for
Suicide
Major
Loss
?
Increasing
Hopelessness
Contemplation
of Suicide
as Solution
WALL OF RESISTANCE
Race
Child
Abuse
Cause of
Death
Proximal Risk Factors
Fundamental Risk
Factors
Hanging
Autocide
Jumping
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Wall of Resistance to Suicide
Counselor or therapist
Good health
Duty to others
Medication Compliance
Others?
Fear
Job Security or Responsibility Support of significant
for children
Job Skills
other(s)
Difficult Access
Positive
A sense of
to means
Self-esteem
HOPE
Religious
Calm
AA or NA
Pet(s)
Prohibition
Environment
Sponsor
Best
Safety
Treatment
Friend(s)
Agreement
Availability
-- Sobriety -Protective Factors
The Lethal Triad
Upset Person
Firearm
Alcohol/drugs
When these three are present—risk of violence is high.
QPR
Ask A Question, Save A Life
©
QPR
Question, Persuade,
Refer
©
QPR
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QPR is not intended to be a form of
counseling or treatment.
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QPR is intended to offer hope through
positive action.
©
QPR
Suicide Myths and Facts
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Myth No one can stop a suicide, it is inevitable.
Fact
If 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.
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
QPR
Myths And Facts About Suicide
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Myth
Suicidal 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...
©
QPR
Suicide Clues And Warning Signs
The more clues and signs observed, the
greater the risk. Take all signs seriously.
©
QPR
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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
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“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.”
©
QPR
Behavioral Clues:
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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
©
QPR
Situational Clues:
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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 a cherished therapist, counselor or teacher
Fear of becoming a burden to others
©
QPR
Tips for Asking the Suicide Question
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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.
©
Q
QUESTION
Less Direct Approach:
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“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?”
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“Do you ever wish you could go to sleep and never wake
up?”
©
Q
QUESTION
Direct Approach:
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“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?”
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“You look pretty miserable, I wonder if you’re thinking
about suicide?”
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“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
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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
©
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.
©
R
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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
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Say: “I want you to live,” or “I’m on your
side...we’ll get through this.”
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Get Others Involved. Ask the person who
else might help. Family? Friends?
Brothers? Sisters? Pastors? Priest? Rabbi?
Bishop? Physician?
©
For Effective QPR
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Join a Team. Offer to work with clergy,
therapists, psychiatrists or whomever is going to
provide the counseling or treatment.
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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.
©
REMEMBER
WHEN YOU APPLY QPR, YOU PLANT THE
SEEDS OF HOPE. HOPE HELPS PREVENT
SUICIDE.
©