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GATEKEEPER TRAINING
Question Persuade Refer
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VIDEO
QPR Institute
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The Bridge Story
Three miles long Opened in 1937Longest suspension bridge in the world until 1964Second most used suicide site in the world245 feet above rocky waterWhat bridge is it?
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2012 40,6002011 39,518
2010 38,3642009 36,9092008 36,065
2007 34,5982006 33,300
attributed to suicide
40,000 deaths annually
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1 suicide every 13 minutes
OR
111 suicides every day
Timing of USA Suicides
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(age 15-24)commit suicide each year (2012)
at a rate ofone suicide every two hours
4,872 young people
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Rank & Cause Number of deaths1. Diseases of the heart 599,7112. Malignant neoplasms (cancer) 582,6233. Chronic obstructive pulmonary diseases 143,4894. Cerebrovascular diseases (stroke) 128,5465. Accidents 127,7926. Alzheimer’s Disease 83,637 7. Diabetes mellitus 63,9328. Pneumonia and influenza 50,6369. Nephritis, nephrosis 45,62210. Suicide 40,600
Ranking 10th in the USA
Suicide is a leading cause of death
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25 attempts for each documented death(Note: 40,000 suicides translates into 1,000,000 attempts annually)
Estimates of an attempted Suicide
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It is estimated that there are
6 survivorsfor each death by suicide
Number of Suicide survivors
Note: A “suicide survivor” is someone who has lost a loved one to death by suicide
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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
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0
1
2
3
4
51977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
4,395,480suicide survivors
732,580deaths by suicide
Survivors in the US population
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Question, Persuade, Refer
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What Can We Do?
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QPR is not intended to be a form of counseling or treatment.
QPR is intended to offer hope through positive action.
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QPR
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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
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Suicide Myths and Facts
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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...©
Suicide Myths and Facts
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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
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Risk Factors for Suicide
Previous suicide attemptsFamily history of suicidal behavior Recent losses: death of family
member, relative, or friendSocial isolation, withdrawal from
family and friendsHistory of Mental IllnessDrug or Alcohol AbuseExposure to violence in the home
or social environmentHistory of traumaLoss of social status
Engaging in violent or self-destructive behaviors
Chronic physical illnessConfusion about sexual
orientationHomelessnessLoss of social statusVictim of
humiliation/bullyingAccess to lethal means
such as firearms or medication
Diagnosis of depression or other mood disorder
* Not a QPR Slide
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“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.”
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Direct Verbal Clues
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Any previous suicide attemptAcquiring a gun or stockpiling pillsCo-occurring depression, moodiness, hopelessnessPutting personal affairs in orderGiving away prized possessionsSudden interest or disinterest in religionDrug or alcohol abuse, or relapse after a period of recoveryUnexplained anger, aggression and irritability
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Behavioral Clues:
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Being fired or being expelled from schoolA recent unwanted moveLoss of any major relationshipDeath of a spouse, child, or best friend, especially if by suicideDiagnosis of a serious or terminal illnessSudden unexpected loss of freedom/fear of punishmentAnticipated loss of financial securityLoss of social statusLoss of a cherished therapist, counselor or teacherFear of becoming a burden to others
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Situational Clues:
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Depression & Suicide
Depression often goes untreated or undiagnosed and sometimes results in suicide
25-50% of persons with manic-depression attempt suicide1 in 5 persons with this illness die by suicideOf all those who die by suicide, more than 2/3rds suffer from
depression or manic-depressive illnessDepression 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
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Time to ask
Tips for Asking the Suicide QuestionIf in doubt, don’t wait, ask the questionIf the person is reluctant, be persistentTalk to the person alone in a private settingAllow the person to talk freelyGive yourself plenty of timeHave your resources handy; QPR Card, phone numbers, counselor’s
name and any other information that might helpRemember:
How you ask the question is less important than that you ask it!
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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?”
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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.
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How not to ask the question
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“You’re not suicidal, are
you?”
“You wouldn’t do anything crazy would you?”
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P: PERSUADE
Listen to the problem and give them your full attentionRemember, suicide is not the problem, only the solution to
a perceived insoluble problemDo not rush to judgmentOffer hope in any form
HOW TO PERSUADE SOMEONE TO STAY ALIVE
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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.
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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
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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
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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.
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What else?
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Develop a resource list for your community
County Mental HygieneMobile Integration Team
School Support staffHospitals/In-patient Services
Local/County Suicide Prevention CoalitionLocal Suicide Prevention Support Groups
Youth SupportsLaw Enforcement
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Resources for anyone
Suicide Prevention Lifeline 1-800-273-TALK
Websites: www.suicideprevntionlifeline.org
www.afsp.orgwww.sprc.org
www.omh.ny.gov
To become certified in QPR visit:http://www.qprinstitute.com/about-qpr
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Safe
ty P
lan
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WHEN YOU APPLY QPR, YOU PLANT THE SEEDS OF HOPE.
HOPE HELPS PREVENT SUICIDE.
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Heather Morgan, MSEd., RHEdTioga County Public Health Educator
Tioga County Suicide CoalitionQPR Instructor * ASIST Certified
[email protected] * 607-687-8637
Contact
Questions?