QPR

1. QPR In School Settings Ask A Question, Save A Life

2. QPR In School Settings Question, Persuade, Refer

3. QPR In School • QPR isnotintended to be a formof counseling or treatment. • QPRisintended to offer hopethrough positive action.

4. QPRSuicide Myths and Facts In School • MythNo one can stop a suicide, it is inevitable. • FactIf a young person in a crisis gets the help they need, they will probably never be suicidal again. • MythConfronting 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. • MythOnly experts can prevent suicide. • Fact Suicide prevention is everybody’s business, and anyone can help prevent the tragedy of suicide.

5. In School QPRMyths And Facts About Suicide • MythSuicidal young people keep their plans to themselves. • FactMost suicidal people communicate their intent sometime during the week preceding their attempt. • MythThose who talk about suicide don’t do it. • FactPeople who talk about suicide may try, or even complete, an act of self-destruction. • MythOnce 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...

6. QPRMyths And Facts About Suicide In School • MythIf a suicidal youth tells a friend, the friend will access help. • FactMost young people do not tell an adult. Good Friends Don’t Keep Deadly Secrets!

7. QPR In School Suicide Clues And Warning Signs The more clues and signs observed, the greater the risk. Take all signs seriously.

8. QPR In School Strongest Predictors • Previous suicide attempt • Current talk of suicide/making a plan • Strong wish to die/preoccupied with death(i.e., thoughts, music, reading) • Depression (hopelessness, withdrawal) • Substance use • Recent attempt by friend or family member

9. QPR In School 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.”

10. QPR In School Indirect or “Coded” 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.”

11. QPR In School Behavioral Clues: • Past suicide attempt • Getting a gun or stockpiling pills • Giving away prized possessions • Impulsivity/increased risk taking • Unexplained anger, aggression, irritability • Self-destructive acts (i.e., cutting) • Chronic truancy, running away • Perfectionism

12. QPR In School Situational Clues: • Being expelled from school /fired from job • Family problems/alienation • Loss of any major relationship • Death of a friend or family member, especially if by suicide • Diagnosis of a serious or terminal illness • Financial problems (either their own or within the family) • Sudden loss of freedom/fear of punishment • Feeling embarrassed or humiliated in front of peers • Victim of assault or bullying

13. QPR In School Other Youth Related Clues: • Change in interaction with family and friends • Recent disappointment or rejection • Sudden decline or improvement in academic performance • Physical symptoms: eating disturbances, changes in sleep patterns, chronic headaches, stomach problems, menstrual irregularities • Increased apathy

14. QPRTips for Asking the Suicide Question In School • If the young 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 • If in doubt, don’t wait, ask the question • Have your resources handy: QPR Card, community resources phone numbers and know your school protocol for handling suicide risk • Remember:Howyou ask the question isless important than that youaskit

15. QQUESTIONHOW TO ASK THE SUICIDE QUESTION Less Direct Approach: • “Have you been unhappy lately?” “Have you been very unhappy lately?” “Have you been so unhappy lately that you’ve been thinking about ending your life?” • Do you ever wish you could go to sleep and never wakeup?”

16. QQUESTION 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 can not ask the question, find someone who can.

17. WAYS NOT TO ASK THE QUESTION “You’re not thinking about suicide are you?” OR “You’re just kidding about killing yourself, right?” Asking in this way encourages a negative response from the young person you are talking with. It may also imply that your are frightened by the intensity of their feelings. Similarly, be aware of your own non-verbal clues.

18. PPERSUADE FOR QPR IN SCHOOL SETTINGS • Listen to the problem and give them your full attention • Remember, suicide is the solution to a perceived insoluble problem. Suicide is not the problem. • Do not rush to judgment • Offer hope in any form

19. PPERSUADE CONT.THEN ASK: • “Will you go with me to talk with your school counselor?” • Would you like me to tell your school counselor that you would like to talk to him or her?”

20. PPERSUADE CONT. • “Are you willing to talk to your counselor within the next 10-15 minutes?” • If they say “yes” ask them, “Will you promise me not to kill yourself in between now and the time you talk to your school counselor?” • Continue to monitor them closely until the are with the counselor.

21. PPERSUADE CONT. • “If you are unable or unwilling to talk to your counselor, I want you to know that I care enough about you that I will let them know.” NOTE: The school counselor and/or administrator must be informed if you believe you are seeing suicidal clues or warning signs from a student.

22. RREFER FOR QPR IN SCHOOL SETTINGS • Suicidal young people often believe they cannot be helped, so you may have to do more. • The best “referral” involves taking the person directly to see the school counselor. • The next best “referral” is when the student wants you to talk to the counselor first, or when they agree to talk to the counselor on their own within the immediate future. (The young person should be monitored closely in the interim.) • The third best option is to make sure the student is safe, is under observation by an adult, and then you tell the school counselor the warning signs you have observed.

23. NOTE: You are not being disloyal or violating a trust when you share of a young person’s suicidality with a school counselor or administrative staff. You are being disloyal if you do not!

24. For Effective QPR In School Settings • Say: “I want you to live,” or “I’m on your side and we’ll get through this.” • Communicate with the school counselor and administration. • Get Others Involved.Ask the person who else might help. Family? Friends? Teachers? Brothers? Sisters? Pastors? Priest? Rabbi? Bishop? Physician?

25. For Effective QPR Cont. • Join the Team.Offer to work with other school personnel and concerned members of the community members to help reduce youth suicide. • Follow upwith a visit, a phone call, a card, or in whatever way feels comfortable to you, to let the young person know you care about what happens to them. Caring may save a life.

26. REMEMBER Since almost all efforts to persuade a young person to live instead of attempt suicide will be met with agreement and relief, don’t hesitate to get involved.

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

29. Reducing a Suicidal Person’s Access to Firearms – Bonus Module Recommendations for Gatekeepers on Reducing Gun Violence The QPR Institute wishes to thank Elaine Frank and Cathy Barber of Dartmouth and Harvard Universities for their contributions to this QPR gatekeeper training program! What you are about learn is an approved derivative program from Counseling Access to Lethal Means (CALM) - an AFSP/SPRC Registered Best Practice training program.

32. Sri Lanka & Pesticides • Pesticides are the leading suicide method in Sri Lanka. • Restrictions were placed on sales of the most highly human-toxic pesticides in the mid to late 1990s. • Suicide rates dropped 50% from 1996 to 2005. • Nonfatal poisonings and suicide by other methods did not drop. Gunnell 2007. Int’l J of Epidemiology.

33. United Kingdom & Domestic Gas • Before 1960, domestic gas was the leading method of suicide in the United Kingdom. • By 1970, almost all domestic gas in the UK was non-toxic. • Suicide rates dropped by nearly a third. • The drop was driven by a drop in gas suicides; non-gas suicides increased slightly. Source: Kreitman 1976, Brit J Prev Soc Med.

34. Why Does Reducing Access to Firearms Work to Prevent Suicide?

35. Why Means Matter • Suicidal crises are often relatively brief. • Suicide attempts are often undertaken quickly with little planning. • Some suicide methods are far more deadly than others (“case fatality” ranges from 1% for some methods to 85-90% for the most deadly). • 90% of those who survive even nearly-lethal attempts do not go on to later die by suicide. See: www.meansmatter.org for studies examining each of these concepts.

36. Focus on Firearms • Firearms are the leading suicide method in the U.S. • Gun owners and their families are at about 3 times higher risk of suicide than non-gun owners. • This isn’t because they’re more suicidal. Gun owners are NO more likely to be mentally ill, to think about suicide, or to attempt suicide. • Rather, they’re simply more likely to die in a suicide attempt. Sources: • Miller M, Injury Prevention 2009 Findings also in ICARIS-2 survey • Betz M, Suicide Life Threat Behavior, 2011. Miller M, Injury Prevention, 2009. Ilgen M, PsychiatrServ, 2008. Sorenson & Vittes, Eval Rev, 2008.

37. Reducing a Suicidal Person’s Access A simple step to increase a suicidal person’s safety is to reduce access to firearms at home. Many counselors and providers and family members of at-risk people don’t think to do this. This temporary safety intervention is not anti-gun.

38. Making a Difference • Family and friends can protect a suicidal person by temporarily storing all firearms away from home. • Have a trusted person outside the home hold onto them until the situation improves. • Some storage facilities, police departments, gun clubs, and gun shops will store guns. • If off-site storage isn’t an option: • Lock the guns at home with new locks or combinations. • Keep ammunition out of the home or locked separately. • Or, remove a key component of the guns, e.g., the bolt.

39. To keep him safe… … when, as a young man, Abraham Lincoln was depressed and suicidal, a friend said of him, “Lincoln told me that he felt like committing suicide often.” Seeing suicide warning signs, Lincoln’s neighbors mobilized to keep him safe, watching over him, and removing his knives and pistol. They pulled together the same kind of safety net QPR gatekeepers can build today – and which included making sure our President did not have access to the means of suicide. It was said that when he again became depressed later in life he “dared not carry even a pocket knife… “ Source: Lincoln’s Melancholy, A.W. Shenk, Houghton, Mifflin, Co. 2005

40. For more information Know the Signs website: www.suicideispreventable.org Means Matter website: www.meansmatter.org Take CALM-Online—free, online course on Counseling on Access to Lethal Means http://training.sprc.org/ Request technical assistance from Means Matter cbarber@hsph.harvard.edu Request an in-person CALM training elaine.m.frank@dartmouth.edu

41. Contact Information • Meghan Boaz Alvarez, M.S., MFT • KCMH Hotline & Access Center Supervisor • Suicide Prevention/Intervention Educator • (661) 868-8007 • Kern County Mental Health Crisis Hotline-1-800 991-5272 • With help comes HOPE