Question Persuade Refer

Written By GR LGBTQ HCC AmeriCorps

READ FIRST: Suicide is a difficult topic for many to talk about. If you have lost someone to suicide or have been suicidal, you are welcome to skip to the QPR section for prevention training. If at any point reading you experience any extreme emotions, thoughts, or behaviors, please call or text 988 and talk with a trained professional. 

The more awareness we bring to suicide, the less darkness it has. And the less darkness it has, the less power it holds. Talking about it is difficult. But not talking about it is dangerous and deadly. Learn to respond when your friend is in trouble. Learn to react when no one else can. Learn to be the light shining in someone else's darkness so that we can help people have power over their mental health. 

Why are people suicidal?

Most individuals who have made a serious suicide attempt and survived don’t truly want to end their life. If they don’t want to end their life, this suggests that there must be underlying reasons. There are two main reasons that have been studied that influence suicidal behaviors: Pain and isolation. Pain can take form in multiple ways including guilt, shame, remorse, unworthiness, addictions, substance use, etc. Isolation, especially within the LGBTQ+ community can look like rejection, disowning from family members, or lack of community. 

Three feelings have also been studied that when blended together, the likelihood of suicidal thoughts are very high. 

  1. When the person feels unlovable

  2. When the problem feels unsolvable

  3. When the pain has grown unbearable

Warning Signs

80-90% of people who have died by suicide indicated warning signs before taking their life. I often hear people who have lost someone to suicide say “I didn’t think it was that bad” or “I didn’t think they were really going to do it.” Pay attention. Some of these signs may be easy to dismiss as attention seeking. If someone is seeking attention in this way, they need help. Other signs can easily be missed. Suicide is preventable and it may only take one positive action to save a life. Please pay attention. 

Direct Verbal Cues:

  • I wish I were dead

  • I’m going to end it all

  • If___ doesn’t happen, I’ll kill myself

Indirect Verbal Cues:

  • I just want out

  • I won't be around much longer

  • I’m tired of my life, I just can’t go on

  • People would be better off without me

  • Pretty soon, you won't have to worry about me

ASK if you are uncertain about the intentions behind these phrases such as “Tell me more about  that” or “What makes you think that?”

Behavioral Cues:

  • Any previous suicide attempt

  • Acquiring a gun or stockpiling pills

  • Putting personal affairs in order. For example; Receiving a random phone call from a friend thanking you for being there for you in high school

  • Giving away prized possessions. For example; Your friend gave you his favorite watch

  • Sudden interest or disinterest in religion

  • Unexplained anger, aggression, or irritability

What is QPR?

QPR stands for Question, Persuade, and Refer. It is a tool used to reduce suicidal behaviors through practical and proven suicidal prevention training.

Question the person directly about suicide

The fact that you ask is more important than how you ask it. If you cannot ask for whatever reason, find someone who can. Ask with respect. Remember that their life is the most important issue at hand.  This is not about you and your feelings. This is about them and their safety. Do not bring up politics or beliefs. Don’t criticize or belittle them for being suicidal. Your job is to ask the question, listen, and let them talk freely. If they do not want to talk in depth about their experience, leave this up to a trained professional. 

  • Indirect: Have you been unhappy lately?

  • Direct: You seem really sad lately and you matter to me. When other people go through these things its not unusual to have thoughts of suicide. Are you having these thoughts?

Persuade the person to seek and accept help

  1. Listen for protective factors. Examples of protector factors include family, friends, responsibilities, hobbies, important people, religion

  2. Affirm protective factors. What are sources of hope for them? Get them to talk about anything that they care about and affirm it. This will bring them back to the present and give them control. 

Script: “You have a dog? I didn't know you had a dog. What kind is he?” or “I didn’t know you played guitar. What kind of music do you like to play?’ 

  1. Point them towards hope when you sense those emotions deescalating

Script: “I know you are going through a lot right now but it seems like you still have some things that you care about and people who matter to you. Maybe it’s worth staying alive for now.”

  1. Listen and Affirm if the emotions are not deescalating

Refer the person to appropriate resources

  1. Best option: Take the person directly to someone who can help and stay with them 

  2. Second option: getting a commitment from them to accept help, then making arrangements

  3. Third option: getting a commitment to not attempt or complete suicide and give the person referral information

If this is a situation where there is a firearm or the person is agitated, call 911. Always put your safety first.

Myths:

Myth #1: No one can stop suicide, it is inevitable

Fact #1: If the person gets help, they may never be suicidal again. Almost any positive action may save a life

Myth #2: Confronting a person about suicide will increase their risk of suicide

Fact #2: Asking someone directly lowers anxiety, opens communication, and decreases risk

Myth #3: Only experts can prevent suicide

Fact #3: Anyone can help stop suicide. Almost any positive action may save a life

Myth #4: People who talk about suicide will not do it - they are looking for attention

Fact #4: If someone is so badly needing attention that they are talking about suicide, give them attention. Ignoring them increases their risk of pain and isolation

Resources for LGBTQ+ 

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GR LGBTQ HCC AmeriCorps
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