QPR (Question, Persuade and Refer) is a suicide prevention program developed by Dr. Paul Quinnett, which offers tools to help someone in pain who is contemplating suicide. The premise of QPR is to first know the warning signs of suicide. Secondly, once one notices the warning signs, one must ask directly, "Are you thinking of killing yourself?" Next, we persuade the person to seek help and lastly, we refer the person for help. This research based model relays a simple message; if one notices the warning signs of suicide; one might save a life by following the steps of QPR.

As a QPR Gatekeeper trainer, I offer the following information so you can save a life. Last week in this column, I offered the reality of suicide through statistical and research analysis. This week I relay what one can do to support a person who is questioning or deciding to end his or her life.

Save this column, put it in your purse, wallet or stick it on your refrigerator for quick reference. Just as one might be prepared for CPR by carrying a CPR card, carrying information about QPR prepares one to save the life of a suicidal person.

Warning Signs

Suicide warning signs include a previous suicide attempt, current talk of suicide, making a plan to end one's life, strong wish to die or preoccupation with death (thoughts, music, reading), depression, hopelessness, being withdrawn, substance abuse or a recent attempt by a friend or family member to commit suicide.

Suicide behavioral clues include any previous suicide attempt, acquiring a gun or stockpiling pills, co-occurring depression, moodiness, hopelessness, impulsivity, increased risk taking, self-destructive acts, giving away prized possessions to friends, sudden interest or disinterest in religion, drug or alcohol abuse or relapse, unexplained anger, aggression and irritability, skipping school and running away.

Situations that precipitate a suicide attempt might include being expelled from school, fired from job, a sudden move, family problems or 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, sudden loss of freedom or fear of punishment, feeling embarrassed or humiliated in front of peers or being the victim of assault or bullying.

QPR - Question, Persuade, Refer

QUESTION

Asking someone, "Are you thinking of killing yourself," is difficult or impossible for some people. Many feel intrusive, and are fearful for the answer they might receive. Asking the question, although difficult, is the most important words one can say to stop a possible suicide attempt. Remember, if you cannot ask the question, find someone who can.

Tips for asking the suicide question

• If in doubt, don't wait, ask the question.

• If the person is reluctant, be persistent.

• Talk to the person alone and in a private setting.

• Allow the person to talk freely - don't interrupt.

• Give yourself plenty of time.

• Have resources handy; the information at the end of this article.

How to ask the suicide 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?"

• 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?"

How NOT to ask the suicide question:

"You're not thinking about doing anything crazy like killing yourself, are you?" When you ask the question this way, what you are really saying is, "Please don't tell me you are suicidal even though I think you are."

PERSUADE

Once the person discloses to you that they are contemplating suicide, your job is to persuade that person to stay alive. To do this, listen to the problem and give him or her your full attention. Remember, suicide is not the problem, only the solution to a perceived insolvable problem so does not rush to judgment. Passing judgment stops conversation. Offer hope in any form; hope keeps people alive.

How to persuade the person to seek help

• Ask, "Will you go with me to get help?"

• Ask, "Will you let me help you get help?"

• Ask, "Will you promise me not to kill yourself until we've found some help?"

• Convince the person that you want them to be alive, that you care about them and that they are important to you.

Your willingness to listen and help can rekindle hope which the person contemplating suicide has lost. Hope makes all the difference.

Someone contemplating suicide often believes there is no hope to the trouble or depression they are facing. Your goal is to become that hope.

• 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 and then making the arrangements to get that help.

• Being a friend and offering hope is important but getting professional help is paramount to the lifelong success of one in emotional pain.

• 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.

• 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.

• Follow up with a visit, text, call or email. Let the person know you care about what happens to them.

As Dr. Paul Quinnett states, "We are only responsible for what we know at the time we know it, not for things we will learn later on!" If you know someone who is suicidal today, ask the Question. If you can't ask the question, find someone who can.

When you apply QPR, you plant a seed of hope and hope helps prevent suicide. For QPR training for your organization, visit http://www.qprinstitute.com/ or email me.

• Emergency: 911

• Kootenai County Crisis Line: (208) 664-1443

• Kootenai Behavioral Health Center: (208) 765-4800

• Project Safe Place Coeur d'Alene: (208) 676-0772

• SPAN Idaho (Suicide Prevention Action Network) website: http://www.spanidaho.org/

Bill Rutherford is a psychotherapist, public speaker, elementary school counselor, adjunct college psychology instructor and executive chef, and owner of Rutherford Education Group. Please email him at bprutherford@hotmail.com.