Ben Camp, M.S.Ed . QPR Master Trainer - PowerPoint Presentation

Slide1

Ben Camp, M.S.Ed.QPR Master Trainer

Question, Persuade, and Refer (QPR): Introduction to Suicide Prevention Gatekeeper TrainingSlide2

Before We Get Started I want you to check out the three people sitting nearest to you. How are they doing?

Do they look OK?

How do they appear?

2Slide3

Ben Camp, M.S. Ed.Faculty—Washington Institute for Mental Illness Research and TrainingOver 30 years experience in COD,

Inpt

, OP, Adult/

Adol, CD/MH at all levelsFormer Mental Health Commitment SpecialistFormer Director of Training: Suicide HelplineCommunity Intervention Specialist: Native Aspirations

Principal author

To Live To See The Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults

Faculty Eastern Washington UniversityNational Steering Committee SPRC

3Slide4

Learning ObjectivesBy the end of this training and small group discussions, you will be able to:Discuss and articulate suicide as a national and Job Corps public health problem

List at least three reasons why people complete suicide

Describe

the theory and rational behind effective gatekeeper trainingIdentify the gatekeeper’s role in the chain of survivalPractice at least two QPR skills

4Slide5

5 Suicide is PersonalSlide6

Raise Your Hand If…(Wait until all questions asked)You have ever thought about suicide? You know someone who has? You know anyone who has made a suicide attempt…

…or died by suicide?

You’re worried, right now, that someone you know is thinking about suicide?

6Slide7

Big PictureThink, plan, attempt, die10 million adults think about suicide each year 1.2 million plan a method (gun, MVA, etc.)

840,000 attempt (minimum count

)

Approximately 33,000 dieSuicide is 11th cause of death overall3rd for young people (rate has almost tripled since 1950s)unexpected upturn 2003-2004

1

st

for young people in some states/communitiesSource: National Comorbidity study, CDC and NIMH7Slide8

Scope of the Problem14% of American youths 12-17 (3.5 million youth) experienced at least one episode of major depressive disorder (SAMSHA, 2004)

Over 7% (est. 1.8 million youths) thought about killing themselves at the time of their worst or most recent episode of MDD

Est. 712,000 youths tried to kill themselves during their worst or most recent major depressive episode (2.9% of all youth)

8Slide9

9Scope of the Problem15-24 year olds 1st

, 2

nd

, 3rd cause of death (Utah, ID, College, the nation) 20% of teens seriously considers suicide each year (Grunbaum, 2002); 10% of college population (CHS) Slide10

A Few More NumbersBoys die 4X as often as girlsGirls attempt more than boys (3X)Youth: 100-200 attempts per 1 completionBoys use firearms more, girls OD moreLethality of method contributes to outcomes

90% of youth who die by suicide are suffering from an Axis I mental disorder (mood disorder, substance abuse and often both)

10Slide11

Youth Especially at Risk?Highest suicide rate in US?

Native American males

Greatest increasing rate?

African American males (up 200%)

Highest rate of suicide attempts?

Hispanic youth (males & females)Highest rate of suicide attempts of any group?

Hispanic females

11Slide12

All the Numbers…(CDC)Think, plan, attempt, die (last 12 months)19% of all high school students (1 in 5) thought seriously about suicide14% made suicide plan8.3% made an attempt

2,000 +/- die each year

12Slide13

For Your Job Corps CenterOf 1,000 students this year –200 will think seriously about suicide140 will plan how to kill themselves80 will make a suicide attempt

Let’s work to make sure none die!

13Slide14

14Introduction to QPR Gatekeeper Training

QPR stands for

Q

uestion, 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. Slide15

15Why QPR?Each letter in QPR

represents an

idea

and an action stepQPR intentionally rhymes with CPR – another universal emergency interventionQPR is easy to remember Asking Questions, P

ersuading people to act and making a

R

eferral are established adult skills “Out of clutter, find simplicity” -Albert EinsteinSlide16

QPR Ask a Question, Save a Life

16

©Slide17

QPR Question, Persuade,

R

efer

17©Slide18

QPRQPR is not about learning to be a counselorQPR is

about offering hope by getting involved and doing

something

18

©Slide19

Suicide Myths and

Facts

Myth

No one can stop a suicide, it is inevitable.Fact If people in a crisis get the help they need, they will probably never be suicidal again.Myth

Confronting a person about suicide will only make them angry and increase the risk of suicide.

Fact

Asking someone directly about suicidal intent lowers anxiety, opens up communication and lowers the risk of an impulsive act.Myth Only experts can prevent suicide.Fact Suicide prevention is everybody’s business, and anyone can help prevent the tragedy of suicide.

19

©Slide20

Suicide Myths and Facts

Myth

Suicidal people keep their plans to themselves.

Fact Most suicidal people communicate their intent sometime during the week preceding their attempt.Myth

Those who talk about suicide don’t do it.

Fact

People who talk about suicide may try, or even complete, an act of self-destruction.Myth Once 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.

20

©Slide21

Suicide and HomicideMore homicides or suicides per year?Is there any overlap between homicide and suicide? Discussion

21Slide22

Suicidal BehaviorMeans someone is in extreme pain and sufferingMeans complex feelings and behaviorInvolves many reasons and factorsMeans approaching from many directions

22Slide23

23Nature of Suicide and Joiner’s New Theory

Psychic suffering (Psyche-ache)

Hopelessness

Unbearable mental anguish

Cognitive constriction

Grossly impaired problem solving ability

Feeling a burden to others

Thwarted belongingness

Acquired capacity for self-injury and habituation to pain

(T. Joiner, Why People Die by Suicide, 2006)Slide24

Serious Attempt or Death by Suicide

Those Who

Desire Suicide

Those Who Are Capable of SuicideSlide25

Journey to SuicideAcquired Capacity for Self-InjuryLethality of method and seriousness of intent increase with attemptsPeople who have experienced or witnessed violence or injury have higher rates of suicide – prostitutes, self-injecting drug abusers, people living in high-crime areas, veterans, physicians

Those with a history of suicide attempt have higher pain tolerance than others

25Slide26

Serious Attempt or Death by Suicide

Those Who

Desire Suicide

Those Who Are Capable of Suicide

Perceived

Burdensomeness

Thwarted

BelongingnessSlide27

27Perceived BurdensomenessFeeling ineffective to the degree that others are burdened is among the strongest sources of all for the desire for suicide.

Slide28

28Why do some people want to die?

Feel that I am a burden to my family

Feel that everyone will be better off without me

Darkness Calls: The Healthy Aboriginal NetworkSlide29

29Thwarted BelongingnessOur need to belong to valued groups and relationships is so powerful that, if frustrated or thwarted, serious negative health consequences follow – including suicide. Slide30

Why do some people want to die?30

Feel like I don’t belong

Feel like no one cares if I live or die

Darkness Calls:

The Healthy Aboriginal Network Slide31

Serious Attempt or Death by Suicide

Those Who

Desire Suicide

Those Who Are Capable of Suicide

Perceived

Burdensomeness

Thwarted

BelongingnessSlide32

DiscussionTake a few minutes to discuss this theoryDoes it have face validity?Does it seem to be inclusive?What are some ramifications?If this theory is valid, what impact would this have to self referrals?

32Slide33

Our ChallengeMost youth don’t get treatment because they don’t self-refer or don’t even know they’re depressedSo, how do we find and help them before they make a suicide attempt?

33Slide34

Suicide Clues And Warning SignsThe more clues and signs you notice, the greater the risk. Take all signs seriously.34

©

QPRSlide35

Direct 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.”

35

©

QPRSlide36

Indirect 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.”

“I’m going to stay with my Grandfather” Who is dead.

36

©

QPRSlide37

Indirect Verbal Clues

37

Darkness Calls: The Healthy Aboriginal Network

Slide38

QPRBehavioral clues:Has made a suicide attempt in the past

Acquiring a gun or stockpiling pills

Is also depressed, moody, feels hopeless

Putting personal affairs in orderGiving away prized possessionsSudden interest or disinterest in religion or spiritualityDrug or alcohol abuse, or relapse after a period of recoveryUnexplained anger, aggression and irritability

38

©Slide39

Non-Verbal Clues39

Darkness Calls: The Healthy Aboriginal NetworkSlide40

QPRSituational clues:Being fired or being expelled from schoolLoss of girl/boyfriend or other important relationship

Death of a best friend, aunt/uncle, especially if by suicide

Being told you have a serious or terminal illness

Sudden unexpected loss of freedom/fear of punishmentLoss of a favorite counselor, teacher, coach, or supportive personFear of becoming a burden to others40

©Slide41

Suicide ThreatsSuicide threats are warning signs, but not all suicide warning signs are threatsA suicide threat means (at the least) that the person has considered violence but has, for now, decided not to act

Only the living make threats

41Slide42

Which of the Following is a Suicide Warning Sign?“I’m going to blow my brains out.”

“I just can’t stand it anymore.”

If either is a suicide warning sign, which statement requires immediate and urgent intervention?

42Slide43

Content vs. Context“I’m going to blow my brains out!”

Is sitting in your office in a psychiatric hospital

“I just can’t stand it anymore.”

Is standing well out of arm’s reach on the edge of 10-story building

Now… which person needed immediate and aggressive intervention?

43Slide44

44Slide45

45

Asking the suicide questionSlide46

46Scenario #118 Y.O. male showing signs of being disengaged, angry with low to no motivation. When questioned, states that he is just home sick and will be better soon. He stated to his roommate that he “just wanted everybody to leave him alone to do what he needs to do.” When questioned, he denies suicide. His mother has been calling for the past few days leaving messages with staff that she is greatly concerned.

DiscussionSlide47

47Why was mother concerned?This 18 Y.O. told his sister a few days ago that wanted to end it all and kill himself. Slide48

48Scenario #217 Y.O. female came in late to class and has been missing several of her assignments. The teacher asked her to stay after class where she found out that she has been depressed lately and lacks motivation for school. She is having trouble with some other girls on center and feels like she doesn’t belong. She ends the meeting by stating “I have learned my lesson.” She wants to do better in class and is asking how she can make up her assignments.

DiscussionSlide49

49Why was she late for class?This student took an overdose of 20 aspirin tablets and 4 sleeping pills she brought from home. After waking up she decided to come to class without telling anyone what she had done. Slide50

Last Words from Real CasesDepressed farmer to inpatient nurse on discharge, “Don’t worry about me, I’ll be six feet under by Friday.” Depressed boy to mother, “Do you think God has a place in heaven for a boy like me?”Father to son, “I’m going home soon.”

WWII vet to social worker, “Don’t worry, when the going gets tough the tough know what to do.”

50Slide51

51Examples from Real CasesParishioner to Pastor, “Do people who kill themselves go to hell?”Catholic woman to best friend, “It’ll be fine, I’ve seen the virgin.”

Patient to pharmacist, “Are you sure this is enough medicine to cause death?”

Patient to doctor, “You’ve been a wonderful doctor. Thanks for everything.”Slide52

The 7 D’s of Suicide Risk AssessmentDid you?Develop an empathetic and respectful relationship?D

efine the problem(s) suicide would solve?

D

etect suicide ideation?Determine desire, capability, intent, and means availability?Detail risk and protective factors?Decide on level of acute risk present?Develop a collaborative crisis mitigation, means restriction and follow up plan?

52Slide53

53

SRMI quiz (1,100+ practicing professionals)Slide54

Suicidal Communications Clump UpIf you were suicidal, who would you tell?How would you tell them?How many times would you tell them?What would you do if people did not respond?

How would you change your message if ignored?

54Slide55

55QPR TheoryAssumption: passive systems don’t work

Those most at risk for suicide:

tend not to self-refer for treatment

tend to be treatment resistantoften abuse drugs and/or alcoholdissimulate their level of despair go undetectedgo untreated (and remain at risk for suicide)Slide56

QPR TheoryMost suicidal people send warning signsWarning signs can be taughtGatekeepers 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

56Slide57

Goals for QPR Gatekeeper TrainingEffective Gatekeepers:Are alert to the possibility of suicide Know suicide risk factors

Recognize symptoms of distress

and depression

Recognize suicide warning signsKnow what to say, when to say it, and what to do57Slide58

The QPR Chain of Survival4 links…Early recognition of warning signs Early application of QPR

Early referral to professional care

Early assessment and treatment

Knowledge + Practice = Action 58Slide59

59Seven Life-Saving GoalsDetection of suicidal persons

Active intervention

Alleviation of immediate risk factors

Accompanied referralAccess to treatmentAccurate diagnosisAggressive treatment“Ask the question, save a life.”Slide60

60QPR Prevention Strategy

AWARENESS SURVEILLANCE DETECTION

Suicidal Thoughts

Suicidal Warning Signs

Suicide Attempt

Suicide injury or death

Perceived Insoluble Problem

INTERVENTION

OPPORTUNITIES

Question

Persuade

Refer

TreatSlide61

61A Simple TruthThe person most likely to prevent you from taking your own life is someone you already know Slide62

62Clear Verbal Threats

& Uncoded Clues

Untrained Detection Network

Teacher

Job Corps Site counselor

Student in crisis

Job Corps Site nurse

Girlfriend

Pastor

Parents

Best friend

No Clues

Coded Clues

Self-referral unlikely

Hotline call unlikely

Intervention unlikely

Coded Clues

Coded Clues

Coded Clues

Consultation

No Clues

Source: Paul Quinnett, Ph.D., QPR for Suicide Prevention

Diagram 1Slide63

63QPR Gatekeeper Network

Teacher applies QPR

Student gets support

Parents

Depression/alcohol

screening

Nurse

Counselor

Food service staff

Teachers

Best

friend

Network Trained to detect suicidal students

Q

uestion

Asked

P

ersuaded

R

eferral

Completed

Suicide

attempt averted

Referral

Referral

QPR Intervention

Source: Paul Quinnett, Ph.D., QPR for Suicide Prevention

Diagram 2

GirlfriendSlide64

64Research QuestionsDoes QPR Training Produce….

Changes in knowledge, attitude, perceived self-efficacy among adults?

Yes.

Changes in detection rates? Yes.Increases in referrals? Yes.Changes in service utilization (crisis response and outside providers)?

Yes.

Slide65

65If Overwhelmed by Life….Georgia high school students with suicide attempts were 2 to 3 times less likely to endorse help-seeking when in crisis

Conclusion: those students at highest risk, and the most hopeless, are the least likely to ask for help!

Solution? WE MUST GO TO THEM!

Slide66

66Complete ResearchGo to http://www.qprinstitute.com/

Click Evidence of QPR on left hand side of pageSlide67

We Feel that Suicide Prevention Training Should… Match level of training with level of duty Be delivered in a standardized fashion Provide measurable outcomesEmbrace technology

Be culture-sensitive and acceptable to learners

Be low-cost, compared to other options

67Slide68

68Advanced Online Training

Training

from EWU for

Job Corps Center Counselors, Psychologists, Nurses and Social Workers Suicide risk detection, assessment and management training

University

based - CEU or college credit

APA approved (6 hours)Blended DVD, study guide, + online

CertificateSlide69

69Take Out Your BookletsOn the back side is a website, user ID, and password

http://www.qprtraining.comSlide70

Change Organization for Alternative

70Slide71

71ResourcesFree book for downloadSuicide: The Forever Decision

qprinstitute.comSlide72

Resources72Slide73

Contact InformationPaul Quinnett: 509-235-8823www.qprinstitute.com

Ben Camp: 509-939-7001

Bcampsight@aol.com

Please visit our web site and download the free e-book:

Suicide: the Forever Decision

and share it widely…..

73