How to Prevent Suicide


The following is paraphrased from QPR, Ask a Question, Save a Life by Paul Quinnett, Ph.D. To have this workshop presented to your organization, call (509) 458-7171 or 1 800 256-6996

It is a myth that suicide can't be prevented. It can. QPR is one technique that can help. QPR stands for "Question", "Persuade", and "Refer". Much like CPR or the Heimlich maneuver, the fundamentals of QPR are easily learned. And like CPR and the Heimlich maneuver, the application of QPR may save a life. The more people who are trained in this technique, the more lives that will be saved.

Research shows that the great majority of those who attempt suicide give some signal first. Yet those in a position to do something about it are often reluctant to get involved. Sometimes, because the thought of death is frightening, we deny the person may be suicidal. Overcoming the denial is an important step.

People who are thinking about suicide, are not necessarily being irrational. They look at it as a solution to their problems. What we have to do is make them realize there are other solutions.

Before applying QPR, you have to recognize the warning signs of suicide:


Direct Verbal Clues

"I've decided to kill myself"
"I wish I were dead"
"I'm going to commit suicide"
"If such and such doesn't happen, I'll kill myself"

Indirect or coded verbal cues

"I'm tired of life"
"What's the point of going on"
"My family would be better off without me"
"Who cares if I'm dead"
"I can't go on anymore"
"I just want out"
"You would be better off without me"
"Nobody needs me anymore"

Behavioral Clues

Donating body to medical school
Buying a gun
Stockpiling pills
Putting business affairs in order
Changing a will

Situational Clues

Sudden rejection or undexpected separation
Death of someone close (esp. by suicide)
Diagnosis of terminal illness
Anticipated loss of financial security of personal freedom.

Sudden happiness in a depressed person may be signal of suicide.

Wishing to be dead is a frequent symptom of untreated depression. Since depression saps energy and purpose, sometimes the depressed person is 'too tired' to carry out a suicide plan. However, as the depression finally begins to lift, the person may suddenly feel 'well enough' to act. As strange as it sounds, once someone decides to end his or her suffering by suicide, the hours before death are often filled with a blissful calm. This sudden change in appearance is a good time to apply QPR.

If someone is contemplating suicide, keep them sober

People who take their lives have to pass a psychological barrier before they act. This final wall of resistance is what keeps many seriously suicidal people alive. Alcohol dissolves this wall and is found in the blood of most completed suicides. If someone is contemplating suicide, keep them sober.

The first step to preventing suicide is to Question.

Get the person alone or in a private setting and ask the person is they are contemplating suicide. A crowded restaurant is a bad place to do this. Your own home may be a good one. Ask questions that acknowledge the individuals distress. Questions like, "Have you been unhappy lately?" "Do you ever wish you could go to sleep and not wake up?" Or you can ask directly, "Do you want to stop living".

Asking the suicide question does not increase risk.

Giving a 'yes' answer to these questions is often a release for the individual. It makes them feel better, not worse. The suicide question is now on the table for discussion. But that also means you have obligations you did not have a minute ago.

After asking the Question, you have to listen

Listen for the problems death by suicide would solve.

Listening is the greatest gift one human can give to another. Advice tends to easy, quick, cheap and wrong. Listening takes time, patience, courage, but is always right. Give your full attention and don't interrupt. Do not judge or condemn. Listen for the problems death by suicide would solve.

The second step is to Persuade the individual to get help.

The goal of persuasion is to get the person to say 'yes', they will get help. Ask the following quesitons: "Will you go with me to see a counselor (priest, minister, nurse, etc.)?", "Will you let me help you make an appointment with....", "Will you promise me...."

Sometimes poeple will agree to get help and not get it or resist the idea of getting help. So you may want to make a "no-suicide" contract: a promise not to hurt oneself until help is gotten." Because making a promise appeals to our honor, and agreeing to stay safe relieves our suffering, the answer is almost always, yes.

If the answer is 'no', the individual is probably a "danger to self or others' and can (should) be involuntarily committed so they can access professional help. Call 911.
Remind the person that there are better alternatives than suicide.
Focus on other solutions to problems, not the suicide solution.
Accept the reality of the person's pain and offer alternatives.
Offer hope in any form and in any way.

Remove firearms, car keys, medications, knives, and other instruments which may be used to commit suicde. By restricting access to the means of suicide you buy time for another solution to be found. Removing the means to suicide is, in itself, an act of hope.

The final step is QPR is to make a Referral

Get the person to get help. Call AMI/FAMI for sources of referrals. Go with them. The best referrals are when you personally take the person you are worried about to provider or appropriate professionals. If you are making a referral, don't worry about being disloyal, you are trying to save a life. Don't worry about breaking a trust or not having enough info to call for help. This gets in the way of helping.

This is just a brief digest of the materials in the pamphlet: QPR by Paul Quinnett at Greentree Behavioral Health. I strongly suggest you have him present to your organization. Call 1 800 256-6996. (edited by DJ Jaffe)


(This was taken down from America On-line. It was written by Sharon who has two children have had episodes of suicidal ideation. )

I know myself (I have a bio-chemical depression), suicide ideation is a normal part of life. What I tell myself is that I won't kill myself until tommorrow. No matter how bad I feel I won't do anything until tommorrow. Of course, by tommorrow I feel better and the ideation is gone or less. If it's not I have a contract with my lover that I will tell her of the ideation and abide by whatever she says I have to do (call someone, get to my doctor, or whatever). For the woman who has lost one son and almost lost another, a contract would be a good idea. I am also a mental health professional who has worked with severly mentally ill clients. Suicide assessment was an almost daily issue.

The questions to ask were:

1. Do you feel like killing yourself? (scary to ask but research shows bringing it out in the open won't cause suicide)
2. Do you know how your going to do it? (Or, in other words, is there a plan?)
3. Do you have what you need to do it? (Pills, gun, etc. In other words, do they have the means to do it?)

If all the criterion is met we would insist on a no suicide contract. It sounds simplistic but it's amazing how well it works. When a staff member asked me to assess a client once I asked the client if she was planning to kill herself that night (YES, be that blunt, you are dealing with death here). She replied that she couldn't kill herself, she had a contract that said she couldn't. If a client refused to sign a contract we attempted to have them hospitalized because they were in danger of harming themselves.

I firmly believe that these 3 steps should be taught to all teens so that they know what to look for in there friends. Research shows that a succussfull suicide sparks others but confronting a person with very direct questions does not cause them to kill themselves. If friends follow the three steps and find that their friend is in danger they should be given step 4.

Step 4: Get help immediatly. NOW. Go to a school counselor, their parents, their friend's parents, the police, someone. Keep looking until someone listens. Their friends lives are in danger. We must bring suicide out of the closet of shame. We must not be afraid to talk about it in a very blunt way. When a family has had to deal with a successful suicide all family members are in danger. Talking can keep feelings and fears out in the open.

I had a client who's mother and 2 brothers had committed suicide. He was a schizophrenic who had been hospitalized frequently because he tried to harm himself. He told me once, with tears in his eyes, "I've got to stay alive, I'm the only one left' He worked hard to stay safe and, as of this writing, it has been three years since he has made an attempt. He was helped most by having to check in with staff every night and telling them whether he had felt like harming himself that day and, if so, he would make a fresh contract. It was a daily battle for him, as it is for many of us on this board, but, by learning skills to combat ideation we can come out on top.



Suicide and NBD

WESTPORT, Aug 02 (Reuters) - Three separate studies published in the August issue of the American Journal of Psychiatry provide confirmatory data that suicide is more common among those with psychiatric illnesses than it is among the general population.

In one study, conducted at the Christchurch School of Medicine, New Zealand, researchers examined 302 individuals who made serious suicide attempts and 1,028 comparison subjects.

Annette L. Beautrais and associates identified "...mood disorders, substance use disorders, antisocial behaviors, and anxiety disorders," as strongly associated with suicide attempts. The overall risk for those diagnosed with two or more psychiatric disorders was almost 90 times the risk of suicide for those with no metal disorders.

Elsewhere in the journal, two studies identified a relationship between successful suicide and suicidal feelings in the elderly and the presence of psychiatric illness.

At the University of Rochester, NY, Dr. Yeates Conwell and colleagues analyzed the DSM-III-R diagnoses of 141 persons who had completed suicide between the ages of 21 and 92 years.

"We found that over 90% of the victims had a diagnosable axis I disorder...substance use disorders were most prevalent, followed by mood syndromes and primary psychotic disorders," the New York researchers wrote. "The diagnoses of alcoholism, drug abuse, and primary psychoses were significantly predicted by younger age at death, " Dr. Conwell included. "Mood disorder diagnoses were more common in older victims." The group reported that depressed elderly men were at highest risk for suicide.

Meanwhile, Dr. Igmar Skoog and others of Gothenburg, Sweden, reported a trial in which "...of 44 subjects with the feeling that life was not worth living, 35 (79.5%) had mental disorders, and of 13 with thoughts of suicide, 11 had mental disorders." In comparison, "...only 4.0% of the mentally healthy in this study felt that life was not worth living or wished they were dead."

According to Dr. Skoog, complaints of depression and suicidal feelings are often dismissed in the elderly as "...reasonable for their age."

The take-home message, according to the Swedish group is: "The substantially higher mortality rate of subjects with the feeling that life was not worth living emphasizes that all levels of suicidal feelings must be taken seriously."

Am J Psychiatry 1996;153:1001-1020.



Finding method in madness Researchers link suicide to brain chemicals
November 15, 1996 From Correspondent Eugenia Halsey

Every year, 30,000 people in the United States commit suicide. Now, predicting who will do so may not be the mystery previously thought. Certain chemicals in the brain seem to play a role, scientists are saying. New studies indicate that people who commit suicide have something in common: not enough serotonin, a brain chemical that controls mood.

Serotonin normally helps people restrain their impulses. Without enough of the chemical, they may act on their suicidal thoughts.

This shows psychiatric illnesses and suicide are brain- related disorders, researchers say.

"They're not just a function of the vagaries of everyday life," said John Mann of Columbia University. "People don't go out and kill themselves just because they've lost their job." In Washington, at a workshop on suicide research, scientists said they have pinpointed an area near the front of the brain where the biochemical activity seems To go awry in people who commit suicide. "It's as if people who commit suicide are no longer able to inhibit their suicidal tendencies and actually are able to go on and complete the suicide," said Columbia's Victoria Arango. The faulty chemical activity may stem from genetic factors, or upbringing, and when coupled with a psychiatric disorder or stressful event, may be what pushes the person toward suicide. Now, through techniques like this, scientists are trying to see if they can detect the same abnormality in the brains of people who are alive. "We have new imaging technologies that are getting more precise. They're helping us to localize better areas of the brain that may be altered in the psychiatric disorders," said Dr. Mary Blehar, of the National Institute of Mental Health. -

In turn, patients' doctors and families could be alerted to try to prevent suicides.

"We already know from studies of people who've killed themselves that of the 50 percent who went to the doctor with major depression, fewer than a quarter received adequate doses of antidepressants. So we could do a better job of treating the depression," said Columbia's Mann.

With suicide the third leading cause of death among young people, mental health experts say identifying those at risk could finally put a dent in the numbers of those killing themselves.



Remember Suicide IS NOT an option


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