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Research Results

The QPR training module is designed to enhance general awareness about suicide, teach the average non-professional the warning signs of suicidal thinking and behavior, and to teach three basic intervention skills that can help avert this tragedy. Compared to pre-training baselines, our research shows increased knowledge in all of these areas, including the trainees' rated liklihood to intervene when suicidal warning signs are observed and interpreted. Preliminary data from certified QPR trainers in the field show the training sessions themselves result in immediate identification and referral (by audience members) of persons they know who are, on the date of the training, currently communicating suicidal thoughts, feelings and plans, or who are sufficiently depressed or despairing that asking the suicide question was indicated.

The training module also includes a QPR booklet and three-part folding card, similar to a CPR card. Contained in these materials is additional information about the nature of depression and suicide, the role of alcohol in suicidal crises and, if necessary, the reliance on the involuntary treatment laws currently enforced in all 50 states.

Presently, a QPR Instructor Certification courses are being offered and taught throughout the United States. Ongoing research and evaluation is several states is attempting to establish the potential impact of this program, not only on levels of awareness about suicide as a national problem, but on the positive impact of the application QPR can have in the lives of suicidal individuals.

The author of this article has trained over 5,000 QPR gatekeepers, and more than 15,000 persons have been trained nationwide in the past year alone.

Case Examples:

At a QPR training of executives in a health maintenance organization, the QPR presentation ended (as is required of all instructors) with the Q & A, at which time two women asked to speak with the instructor.

The first asked, "My son's friend told me that he had a pistol to his head at the Christmas party last week. Should I be concerned?" This question led to an affirmative answer, and an immediate referral for evaluation of this teenaged boy.

The second woman in attendance asked the instructor, "My husband has kept a revolver near our bed all of our married lives. He recently took it to a pawn shop and hocked it. When I asked him why he'd done it, he said `Don't ask stupid questions!' What should I do?" In this case, a plan was made to bring her husband to the instructor's office, whereupon a suicide evaluation was conducted. Interestingly, the gentleman said, "I wasn't going to use the pistol, I was going to leave that for the kids, but I was going to go to the lake and gas myself."

In both of these cases, the suicidal communication were clear in retrospect, and in light of enhanced awareness about the nature of suicidal communications. Once the question was asked by a second party, the individual at risk was persuaded to accept help, and referrals were completed. Our data base includes a growning number of such interventions.

QPR: Potential Law Enforcement Applications

The ultimate goal of QPR, CPR for Suicide Prevention, is to increase the relative safety of Americans in every walk of life. Among high-risk populations, including law enforcment personell, QPR has the potential to make a positive impact. Because of the relatively closed and close-knit communities in which law enforcement professionals work, the opportunity for suicide risk recognition, detection and referral is higher than it might be in a more open society. The law enforcement professional's life may be an open book to colleages but, in terms of applying QPR, therein lies opportunity.

Make no mistake, suicide is always multi-determined, multi-factorial and will always be impossible to predict. That does not mean it is preventable. From a statistical point of view, and given that suicide is always a rare event, preventing a suicide will never be knowable. The best we can say is that if your department has not had a suicide in recent years, your base rate is below the national average for other law enforcment agencies, and below the base rate for similar age cohorts compared to national data, then you must be doing something right.

QPR has particular application to law enforcement environments because, in the author's view -- and as an outsider looking in -- law enforcment people believe in looking after each other, taking special care to see to the safety of partners, support staff, and their families. Since suicidal communications are selective (suicidal people don't tell everyone of their plans), we can never know who needs to know QPR, thus the need for everyone to spend an hour to potentially save a life. The more people who know what to do and when, the greater the odds someone will have to the opportunity to act. As one officer told me when he was acutely suicidal, "I only told one person at the department what I was planning to do. And he said, 'Don't talk crazy!' I never said another word to anyone."

A Community Policing Initiative?

QPR might also be adapted as a community service under community policing efforts. Police officers have been involved in first responder systems, and QPR can also be a first responder effort.

QPR, CPR for Suicide Prevention is a program designed to meet one of the top priorities in suicide prevention: gatekeeper training. QPR gatekeepers are persons in the community who have an increased knowledge about suicide and its prevention, are aware of potential suicidal crises in persons caught in dynamic and rapidly changing, potentially personally-threatening circumstances, and who are aware that untreated depression, especially combined with alcohol and other potential substance abuse, create a very high risk potential for at least some of the population. This training module requires only an hour on the part of the small audiences, and is reinforced by enhanced and acknowledged referral systems for professional assessment and/or treatment.

Since law enforcement personnel are at elevated risk for suicidal behaviors, especially fatal suicidal behaviors, it is important that departments of all sizes address this training need in all personnel. Support staff, dispatchers, officers, administrators, everyone needs to know something about suicide prevention and what can be done to avert these tragedies.

As an ex-military person, it is tempting to suggest a proposition that perhaps the prevention of suicide in a fellow officer is not a matter of choice, but one of duty. Certainly we would not expect a CPR-trained officer to stand by while another gagged on a piece of meat in a restaurant. QPR, like CPR, appeals to the Good Samaritan in everyone, but also limits that samaritanism to intervention and referral, not ongoing counseling or treatment.

Among the problems yet to be resolved is the stigma of mental health intervention and treatment, and officer reluctance to accept services when they are clearly needed. It has been the author's experience, however, that once a distressed and suicidal officer is given either a direct order or a strong recommendation to seek the help needed, they are quick to take this lifeline of support and benefit from the care they receive.

But there is good news. A recent unpublished study by the U.S. Navy (3/4 Anjeski) Despite the fact that approximately 95% of all completed suicides are by people suffering from acute or chronic psychological disturbances, the elevated risk for law enforcement personnel is not likely to disappear in the near term. .

*Final notes, we'll need a sidebar on some suicide statistics, sidebars for warning signs, myths.. The tragedy is doubled by the fact that the vast majory of depressions, once recognized and treated aggressivly, respond favorably in a matter of a few weeks. Many suicide completions take place on the part of the person's effort to simply stop their psychological suffering, avoid embarrassment, and in an attempt to save family from any additional shame and consequence. Fortunately, the suicide seldom solves anyone's problems except that of the person who ended his or her own life.

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