By Emalee Gillis, NAMI Spokane Blog Editor.
According to Sabrina Votava, suicide prevention educator and speaker at the recent Let’s Talk Suicide Conference in Spokane, WA, QPR is like CPR for suicide prevention. Just as people trained in CPR help to save thousands of lives each year, people trained in QPR learn how to recognize the warning signs of a suicide crisis and how to ask the suicide Question, Persuade the person to get help, and then Refer someone to help.
The first step in QPR is to identify the signs of suicide in a friend, associate or loved one. A warning sign might in the form of a direct verbal clue like “I wish I were dead.” or “I’m going to end it all.” The sign might come in an indirect verbal clue like “My family would be better off without me.” or “I can’t go on anymore.” Or, the sign could come in a behavioral clue like making funeral plans or giving away money or prized possessions. Situational clues focus on fear and loss and include a sudden rejection by a loved one or death of someone close to them, especially if by suicide or accident.
The next step is to make the decision to act. Because suicide is such a taboo subject, asking the suicide question may seem awkward or difficult. But, 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. It is a myth that asking the suicide question can put the idea of suicide in their head. Asking the question does not increase risk.
The “Q” stands for “Question.” First, find a private spot to talk. The question can be asked indirectly like “Have you had thoughts of dying? or “Do you ever wish you could go to sleep and never wake up?” Alternatively, the question can be asked more directly like “Are you thinking about suicide?”
A “no” to the question is followed by a request to let the questioner know if the loved one or friend starts thinking about suicide later. An unclear answer is followed by more prodding questions. A “yes” to the suicide question puts the subject of suicide on the table for discussion. Research has shown repeatedly that once people are asked if they are thinking of suicide, they feel relief, not distress. A chance to go on living has been offered. By asking the suicide question, we provide a ray of light where there has been utter darkness.
The next step is to listen giving full attention to the speaker. Listen for the problems that death by suicide would solve. Confirm your guesses and suspicions with questions. If you get nods or yeses, you have helped that person to begin finding a way to live.
The “P” in QPR stands for Persuasion. The goal of persuasion is simple. All we want to accomplish is for the person to agree to get some help. You might ask, “Will you let me help you make an appointment with….” It is often a good idea to ask the person to agree to go on living and make a recommitment to life. You could say, “I want you to live. Won’t you please stay alive until we can get you some help?” Persuasion works best when you focus on healthy solutions to problems not the suicide solution and when you accept the reality of the person’s pain, but offer alternatives. Collaborate with the person and assure them of your ongoing support.
If persuasion fails, call your mental health center, local hotline or emergency services. If you believe someone is in the process of making a suicide attempt, call 911.
“R” in QPR stands for refer. To refer means to connect your friend or loved one with a competent local mental health professional or to a known and trusted resource. Most suicidal people who agree to get help will act in good faith and get the help they need. However, because of the stigma associated with accepting counseling or professional help for disorders of the brain, some people may not follow through. That is why the QPR Institute recommends that, if possible, you physically take the person to someone who can help. Some suicidal people will want to talk to someone they already know – a pastor, priest, doctor or school nurse. If agreeable to the person thinking about suicide, you should accompany him or her to that trusted resource.
The QPR Institute recommends actions to make suicide hard. Most people in American use a firearm to kill themselves. Research shows that perhaps the most effective intervention is to ensure the removal of the means of suicide, especially a gun. Ask your friend or loved one in simple terms if they own or have access to a gun. Arrange to move the firearm to another location. Some police stations will agree to store the firearm during a crisis.
Simply put, removing the means to suicide – gun, rope, car keys, knives, poisons, and medications – makes an impulsive decision to end one’s life more difficult. The intervention buys precious time to get some rest, get professional help and one day soon pass beyond this rough patch on the long road of life.
If in doubt, act! Reach out! Don’t wait! Ask a question, save a life!
Resource numbers:
Suicide Crisis and Lifeline: 988
Crisis Text Line: Text 741741
The Trevor Project for LGBTQ+ 866-488-7386
Training in QPR is available through FailSafe for Life. The training dives deeper into approaching someone who may be considering suicide and goes beyond the basic concepts described in this article.
Sabrina Votava, LMHC is the founder of FailSafe for Life and an educator on suicide prevention/ intervention for nearly 20 years. She is certified to teach several suicide prevention programs and her passion is evident in her trainings.
Emalee Gillis is a writer and blog editor. She is the author of the memoir Adventures on the Path to Living Well with a Mental Illness and has a related TEDx Talk.