1. QPR: A Brief Orientation
Paul Quinnett, PhD
President and CEO
The QPR Institute

2. Perspective
So long as suicide remains a mystery, we have no responsibility to prevent it. But once we begin to understand suicide, we must act boldly in good faith to save lives. The QPR Institute Staff and Faculty

3. Suicide is Not a Mystery
Suicidal behaviors are not rare… Suicide is understandable… Suicide makes sense to the suicidal person…. If suicide is to be prevented, how will it be done? AWARENESS TRAINING EDUCATION ACTION

4. If Suicide is Preventable, What Must We Do?
Increase our sense of shared responsibility for the prevention of suicide
Improve our collective competence to prevent suicide attempts and completions
Leadership must agree that suicide is a serious problem and that it is preventable

5. Orientation to QPR Gatekeeper Training and the QPR Institute
Orientation goals:
What is QPR?
Why is it important?
How does it work?
What is the evidence base?
Who is using it?
How long does it take to learn?
What are the end goals?
What training is available?

6. QPR stands for Question, Persuade and Refer,
an emergency mental health intervention that
teaches lay and professional Gatekeepers
to recognize and respond positively to someone exhibiting suicide warning signs and behaviors.
QPR Gatekeeper Training for Suicide Prevention © 1996

7. Official 5 QPR Training Outcomes
As measured by independent university researchers… QPR training increases:
Knowledge about suicide
Gatekeeper self-efficacy
Knowledge of suicide prevention resources
Gatekeeper skills
Diffusion of gatekeeper training information
These are minimum measureable outcomes…

8. Why QPR? Each letter in QPR represents an idea and an action step
QPR intentionally rhymes with CPR – another universal emergency intervention
QPR is easy to remember
Asking Questions, Persuading people to act and making a Referral are established adult skills
“Out of clutter, find simplicity” Albert Einstein

9. QPR
Is a simple, direct, behavioral intervention designed to produce a predetermined outcome: a referral for professional help
Is designed to produce a helpful dialogue between someone at risk for suicide and a trained Gatekeeper
Teaches Gatekeepers to take bold, positive action to access professional care

10. Theory QPR is theory-based
Recognizes that even socially isolated suicidal individuals have contact with potential rescuers
QPR reaches out to at-risk people within their own environments and does not require suicidal people to ask for help.

11. People in crisis often do not ask for help
Assumption: passive systems don’t work
-Those most at risk for suicide:
- tend not to self-refer for help
- tend to be treatment resistant
- often abuse drugs and/or alcohol
- dissimulate their level of despair
- go undetected
- go untreated (and remain at risk for suicide)

12. Research to Practice Most suicidal people send warning signs
Warning signs can be taught
Gatekeepers can be trained to a) recognize suicide warning signs and, b) intervene with someone they know
Gatekeepers must be fully supported by policy, procedure, and professionals in their community
The person most likely to prevent you from taking your own life is someone you already know

13. The QPR Chain of Survival (think CPR)
4 necessary links…
Early recognition of warning signs
Early application of QPR
Early referral to professional care
Early assessment and treatment
Knowledge + Practice = Action

14. QPR PREVENTION STRATEGY
AWARENESS SURVEILLANCE DETECTION
Suicidal Thoughts
Suicidal Warning Signs
Suicide Attempt
Suicide injury or death
INTERVENTION
OPPORTUNITIES
Perceived Insoluble Problem
Question
Persuade
Refer
Treat

15. Gatekeeper roles
Strangers don’t prevent suicide, people you already know do…
Friends, family members, co-workers, and professionals with a duty to public safety have the greatest opportunity to recognize, detect, and refer….
The more people trained the better the odds an at-risk person will be detected before a suicide attempt is made

16. QPR
Effective QPR depends on the recognition of suicidal communications and warning signs, risk factors and quick, compassionate, positive action. Just as tightness in the chest, radial left arm pain and sweating are warning signs of a pending heart attack, so are clinical depression, statements of hopelessness and giving away prized possessions warning signs of a pending suicide attempt.

17. QPR is like CPR… The more people trained the more lives are saved.
Experiencing an out-of-hospital cardiac arrest?
To survive, where do you want to be?
In one American county your odds of survival are 56%; in most others it is less than 5%.
Learn why one county in America leads the world in preventing death by cardiac arrest:
Google “Cardiac Arrest Seattle.”

18. For QPR to be successful….
Train as many people as possible to recognize symptoms of distress and direct and indirect suicide warning signs and to take quick action to intervene
QPR training gives people the knowledge, skills, and – most importantly – the permission and courage to reach out to those in distress….
Just one story…

19. A life saved? From a QPR gatekeeper…
A few months after participating in a QPR Gatekeeper Training, a gentleman who participates on our pastoral support team received a call from a woman indicating she was suicidal, had a plan and means, and was ready to 'do it now'. 
He remembered QPR, and supported this woman, talking to her about her value and purpose. She indicated she was willing to have someone come to help her, so while they were talking, he asked a colleague to dial  
The police arrived at the woman's home while he was still on the line with her.  They took her in for assessment and care.  The woman is now on her way to recovery.  She is so thankful to the man who helped her through her crisis, and is doing very well.

20. From a QPR instructor…
One of the training participants approached me immediately after the training and said that she needed to go home immediately to talk to her brother, who lives with her.  She said that he has been exhibiting multiple warning signs for suicide that were just taught in the QPR class, but she never recognized them as such. 
She and I talked about this and prayed together, and then she went home to her brother.  After she walked in the door, he just happened to tell her that he  was feeling suicidal.  Because of the QPR training she had just participated in, she knew exactly what to do.  She talked to her brother, and they called the Access & Crisis Line together. 
The folks at the crisis line referred them to help.  He subsequently went to a psychiatrist for assessment, and began therapy.  Had this woman not participated in the QPR Gatekeeper Training, she wouldn't have known what to do.   But, I'm happy to report now that the turn-around has been drastic!  He is now involved in supportive groups, and the church.

21. Skills taught to QPR Gatekeepers
QPR Gatekeepers are: - Are alert to the possibility of suicide - Recognize suicide risk and protective factors - Recognize symptoms of distress and depression - Recognize suicide warning signs - Know what to say, when to say it, and what to do

22. Evidence for QPR: Does it work?
QPR Training is safe and effective
15 university published studies
Only gatekeeper training program listed in SAMHSA’s National Registry of Evidence Based Practices and Policies
AFSP/SPRC Best Practice Registry
Used by 500+ colleges and universities
More than one million gatekeepers trained
20,000 gatekeepers/month trained in 2012
No adverse outcomes reported since 1996

23. How long does it take to learn QPR?
Classroom training: minutes, or longer
Online training takes minutes, or longer if downloadable guided practice session is used
Post training discussions with others typically follow, as each person trained shares what they learned with average of five people
Sharing QPR training and materials with co- workers, friends, and family members is a key outcome of the training experience.

24. What QPR is Not
QPR training is not designed to produce therapists, but to provide ordinary people with enough of those skills that have been shown to produce significant behavior changes via brief interventions, including the value of imparting hope, empathic and active listening, and behavioral steps to immediately reduce risk factors and enhance protective factors.

25. SEVEN LIFE-SAVING EVENTS
Detection of suicidal persons
Active intervention
Alleviation of immediate risk factors
Enhancement of protective factors
Accompanied referral
Access to treatment
Accurate diagnosis
Aggressive treatment
“Ask the question, save a life.”

26. Features of QPR Classroom training
Only taught by well-trained Certified QPR Instructors licensed by the QPR Institute
Multi-media, lecture, and interactive
Practice session included
Video hosted by actress and author, Carrie Fisher
Includes official printed QPR booklet/card
Customized referral/crisis response by QPR instructor or hosting organization
Annual 30-minute review recommended

27. Features of QPR Online Interactive, self-paced, multimedia training
Hosted by actress and author, Carrie Fisher
Unlimited user access (3 years), exam and certificate
Free mental health screening for learner or family member
Printable materials (QPR booklet/card)
On demand review and/or annual review
Immediate crisis service access
Customized referral/crisis response by hosting organization

28. Advanced training for professional gatekeepers….
It is not known to what degree intervention on this “last professional contact” might prevent suicide
Older adults have the highest rates of “last contact” and, therefore, provide the greatest opportunity for intervention
Alternative approaches are needed for identifying those who make no contact
Primary Care Providers have most frequent “last contacts” with those who die by suicide
Luoma, Martin and Pearson, Am. J. Psychiatry, 2002

29. IOM: Reducing Suicide, 2002
“Most people who complete suicide had contact with a health professional within a year of death, and 40 percent of these contacts were within one month of their death. Many people die by overdose on the prescription medications provided them at these visits.”
Since most suicides are premeditated, are these missed opportunities? Professionals need advanced training in suicide risk detection, assessment, treatment, and management.

30. Advanced Best Practice Training for all Professional Stakeholders
Options: Classroom, online, or blended online + classroom training
T4T training for Advanced Trainers
Basic QPR enhanced, enriched, and practice- specific online and blended courses for: mental health and chemical dependency professionals, nurses, physicians, PAs, NPs, EMT/firefighters, law enforcement and correctional professionals.
Training creates a “culture of safety”

31. Creating a “culture of community safety”
Leadership
Policy
Procedures
Culture
Training matches level of duty
Where possible training is mandatory
Professional competency
must be demonstrated
Mental Health/Chemical Dependency Professionals
QPRT Training – 8-10 hrs
Primary Care Providers, First responders & School Counselors, Corrections, Clergy
Triage training 6-10 hrs
Every willing citizen/student completes
basic QPR gatekeeper training

32. Let it begin with you…
We must train hundreds to save one, thousands to save hundreds, and millions to save thousands… and only faith, hope, and technology can get us there….

33. Wrap up
QPR Gatekeeper Training for Suicide Prevention is the most widely taught basic suicide prevention program in the United States. Advanced training for professionals is the next order of business in the suicide prevention movement Independent researchers have shown online QPR training is equally effective to classroom training and the same results are achieved.

34. QPR Institute taglines…
Saving lives through excellence in education Ask a question, save a life Preventing suicide… It’s what people do

35. Learn more…
Visit your local or state suicide prevention leadership websites
Join in the cause
Visit the QPR Institute at
Free e-book, Suicide: the Forever Decision is also free as a download.
Search your smart phone apps under QPR for free crisis support downloads or our book