QPR: CPR for Police Suicide Prevention

A five-year veteran uniformed police officer, in acute distress about his wife divorcing him, hints to his shift supervisor that he changed his mind about a new duty assignment he had requested. He says, "Forget that transfer I asked for, I've decided to work things out permanently."

The shift commander asks him into an office. "What's the matter?" he asks. "Is something going on in your personal life?"

At frist resistant, the officer slowly begins to talk about his wife leaving him, his sense of devastation, and his inability to convince her to reverse her decision. The supervisor says, "I'm worried about you, and I'm concerned for your safety. Have you had any thoughts about killing yourself?"

The officer nods.

"Then I want you to see a professional immediately. I'll make the arrangements. Chaplin or psychologist?"

"Psychologist," the officer replies, accepting help. Then he asks, "Do I have to give up my gun?"

"Only for a couple of days," replies the supervisor. "And not if you promise me you won't kill yourself until we gotten you some help. Are you willing to do that?"

"Okay," the officer sighs. "Okay. Okay. How soon can I see the psychologist?"

"Today."

Background

As a clinical psychologist who consults with and provides treatment services for law enforcement personnel in the Pacific Northwest, this partly ficitionalized officer was referred to me for evaluation and possible treatment. Had his supervisor not done all the right things at the right time, he might have ended up in a morgue instead of my office.

As is typical of most suicidal crises, the nature of this man's troubles were long in development but brief, transient and quite remedial during the crisis itself. An immediate but caring confrontation about his hinted plan to suicide ("I've decided to work things out permantely"), led to a caring attitude, a few minutes of active listening, and an immediate referal -- which referal also included an agreement not to commit suicide. Coupled with rapid access to a supportive, cop-friendly, counseling environment, this officer was able to not only weather his emotionmal storm, but return to duty in a matter of a few days. Since a divorce could not be averted and there were children involved, follow up counseling and support continued for several months.

Three things happened to help avert what could have been a tragedy, not only for the officer and his family, but for the department as well.

First, his supervisor was trained in QPR, CPR for Suicide Prevention. This acronym stands for Question, Persuade, and Refer, and is a simple, behavioral intervention that can be taught in one hour. QPR training teaches supervisors and fellow officers the three critical steps to take when a fellow officer communicates that he or she may be contemplating suicide.

Second, as with other life-threatening crises, the supervisor acted immediately and boldy. The most common response from significant others to a sucidal communication is denial, fear, avoidance and passivity -- none of which are helpful responses to someone in a suicidal crisis and all which may increase the person's sense of isolation, helplessness and hopelessness. Doing nothing for an officer in acute distress does not lower the risk for a suicide attempt, but raises it.

Third, a mental health resourse was immediately available to both the supervisor and the officer. Consultation for the supervisor, together with ready access to a safe, secure, tolerant and helpful professional, can greatly reduce the customary resistance many officers feel about seeking help when they are in trouble.

The Numbers and the Culture

While the data are limited, law enforcement personnel appear overrepresented in the completed suicide data. Suicide takes more officers lives than homicide (1), and one study found the rate of suicide among officers to be three times the national average (2-3). From a family and departmental point of view, and given the emtonal wreckage such deaths cause, a single officer suicide is always one too many.

From the available research on completed suicides in America, law enforcement personnel represent an elevated risk to themselves based on three probable factors: 1) because many fear career-ending exposure should they seek treatment, police officers tend not to self-refer when in a crisis; 2) the law enforcement culture discourages the admission of psychological distress or psychiatric illness, and 3), depression -- the most common diagnosis found in completed suicides -- is more easily masked than other psychiatric disorders, and thus goes undetected, undiagnoses, and untreated. Add to this the well documented risk factors of being male, white, black or Hispanic and working in a high-stress enviornment that requires access to a firearm, and you have a potentially toxic psychosocial formula for a greater-than-expected suicide rate among police officers.

One last risk consideration. People contemplating suicide must make a decision about the method they intend to use to bring about death. This decision is almost always made in keeping with one's values, personal identity, familiarity and availability of the selected method. Thus, anthesiologists tend to use drugs, pilots may use single seater aircraft and, in the case of law enforcement personnel, the preferred choice is almost always a firearm. Unlike overdoses, cutting and hanging attempts, firearms lead to high mortality rates among attemptors. With a handgun or shotgun, there are seldom second chances.

Some good news about what can be done.

If suicides among police officers are going to be prevented, it will be necessary for those who know and work with them to not only raise their awareness about the depth and breath of this problem, but to learn what prevention and intervention steps to take and when to take them.

The good news is that the research literature on suicide and its prevetion is growing, not rapidly due to lack of funding, but growing all the same. Steady progress is being made.

Among the things we have learned recently:
* Most suicides are completed by people suffering from untreated clinical depression, often complicated by acute or chronic alcohol intoxication.
* Depression is a stress-spectrum disorder with strong biological components. It is a medical illness, not a weakness of character.
* If treated aggressively, 70% of the depressed and suicidal people will repond favorably to treatment in a matter of few weeks.
* The newer antidepressant medications have few side effects which might impair job or family functioning and, as a result, compliance with medication regimes is good and treatment responses can be excellent. An antidepressant medication regime need not remove an officer from active duty.

We also know important things about preventing suicidal deaths. Recent unpublished research from the Department of the Navy (4) found that among a series of 41 completed suicides, 90% of those who took their lives communicated their intentions to do so to someone who, had they been trained, might have intervened and prevented the death. In only 34% of these cases were the communications directed to a professional with any responsiblity to take positive action, while in 66% of the cases the suicidal communication was directed to a shipmate, spouse, family member or significant other. Similar studies across other age groups confirm that most people who contemplate suicide communicate their intentions to others, increasing the rate of those communications as the crisis worsens, and especially in the last week before an attempt is made. These warning signs and signals can be interpreted and acted upon.

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