QPR stands for Ques­tion, Per­suade, and Refer — the 3 sim­ple steps any­one can learn to help save a life from suicide.

Just as peo­ple trained in CPR and the Heim­lich Maneu­ver help save thou­sands of lives each year, peo­ple trained in QPR learn how to rec­og­nize the warn­ing signs of a sui­cide cri­sis and how to ques­tion, per­suade, and refer some­one to help. Each year thou­sands of Amer­i­cans, like you, are say­ing “Yes” to sav­ing the life of a friend, col­league, sib­ling, or neighbor.

QPR can be learned in our Gate­keep­er course in as lit­tle as one hour.

*This class is not intend­ed for cer­ti­fi­ca­tion purposes.*

What is a Gatekeeper?

Accord­ing to the Sur­geon General’s Nation­al Strat­e­gy for Sui­cide Pre­ven­tion (2001), a gate­keep­er is some­one in a posi­tion to rec­og­nize a cri­sis and the warn­ing signs that some­one may be con­tem­plat­ing suicide.

Gate­keep­ers can be any­one, but include par­ents, friends, neigh­bors, teach­ers, min­is­ters, doc­tors, nurs­es, office super­vi­sors, squad lead­ers, fore­men, police offi­cers, advi­sors, case­work­ers, fire­fight­ers, and many oth­ers who are strate­gi­cal­ly posi­tioned to rec­og­nize and refer some­one at risk of suicide.

As a QPR-trained Gatekeeper you will learn to:

• Rec­og­nize the warn­ing signs of suicide
• Know how to offer hope
• Know how to get help and save a life

How is QPR like CPR?

Both are interventions

Much of the world is famil­iar with CPR — short for car­diopul­monary resus­ci­ta­tion — an emer­gency med­ical inter­ven­tion cre­at­ed in 1957 by Peter Safar. The process is designed to sta­bi­lize peo­ple who aren’t breath­ing or breath­ing inter­mit­tent­ly and who may be in car­diac arrest until the per­son can reach a hos­pi­tal or oth­er care.

Sim­i­lar­ly, QPR is an an emer­gency men­tal health inter­ven­tion for sui­ci­dal per­sons cre­at­ed in 1995 by Paul Quin­nett. An abbre­vi­a­tion for Ques­tion, Per­suade and Refer, the intent is also to iden­ti­fy and inter­rupt the cri­sis and direct that per­son to the prop­er care.

Both are part of a “Chain of Survival”

Both CPR and QPR are part of sys­tems designed to increase the chance of sur­vival in the event of a crisis.

In the Chain of Sur­vival mod­el of emer­gency car­diac care, the like­li­hood that a vic­tim will sur­vive a car­diac arrest increas­es when each of the fol­low­ing four links is connected:

• Ear­ly Recog­ni­tion and Ear­ly access | The soon­er 9–1‑1 or your local emer­gency num­ber is called the soon­er ear­ly advanced life sup­port arrives.
• Ear­ly CPR | This helps main­tain blood flow to the vital organs.
• Exter­nal Defib­ril­la­tor | A device ready for use when advanced med­ical per­son­nel arrive.
• Ear­ly Advanced Life Sup­port | Admin­is­tered by trained med­ical per­son­nel who pro­vide fur­ther care and trans­port to hos­pi­tal facilities.

Sim­i­lar­ly, with QPR, the fol­low­ing Chain of Sur­vival ele­ments must also be in place:

• Ear­ly Recog­ni­tion of sui­cide | The soon­er warn­ing signs are detect­ed and help sought, the bet­ter the out­come of a sui­ci­dal cri­sis will be.
• Ear­ly QPR | Ask­ing some­one about the pres­ence of sui­ci­dal thoughts and feel­ings opens up a con­ver­sa­tion that may lead to a refer­ral for help.
• Ear­ly inter­ven­tion and refer­ral | Refer­ral to local resources or call­ing 1–800-Suicide for eval­u­a­tion and pos­si­ble refer­ral is critical.
• Ear­ly Advanced Life Sup­port | As with any ill­ness, ear­ly detec­tion and treat­ment results in bet­ter outcomes.

Early Recognition

We can­not overem­pha­size the need for ear­ly recog­ni­tion of sui­cide warn­ing signs.

A well-exe­cut­ed, strong and pos­i­tive response to the ear­ly warn­ing signs of a pend­ing sui­cide event may ren­der sub­se­quent links in the Chain of Sur­vival unnec­es­sary. Most peo­ple think­ing about sui­cide are suf­fer­ing from an undi­ag­nosed and/or untreat­ed men­tal ill­ness or sub­stance abuse dis­or­der for which excel­lent treat­ments exist.

The prompt recog­ni­tion of the scream of a smoke detec­tor can elim­i­nate the need to sup­press a rag­ing fire. In just that way, by rec­og­niz­ing ear­ly the warn­ing signs of sui­cide, open­ing a sup­port­ing dia­logue with a sui­ci­dal per­son and secur­ing con­sul­ta­tion a pro­fes­sion­al may pre­vent the need for an emer­gency room vis­it or psy­chi­atric hospitalization.

Different Crises, Different Warning Signs

In CPR the gen­er­al pub­lic is edu­cat­ed about the clas­sic signs of a heart attack: pres­sure, full­ness, squeez­ing and pain in the cen­ter of the chest, sweat­ing, and oth­er symp­toms, and then taught how to respond.

In QPR the gen­er­al pub­lic is edu­cat­ed about the known warn­ing signs of a sui­cide cri­sis: expres­sions of hope­less­ness, depres­sion, giv­ing away prized pos­ses­sions, talk­ing of sui­cide, secur­ing lethal means, and then taught how to respond.

Who needs Training?

The city of Seat­tle, Wash­ing­ton and sur­round­ing King Coun­ty has trained more cit­i­zens in CPR per capi­ta than any oth­er region in the coun­try. As result, CPR-trained cit­i­zens are more like­ly to resond to per­ceived med­ical emer­gen­cies in Seat­tle than in any oth­er city in the Unit­ed States, which leads to more favor­able sur­vival rates.

Accord­ing to Sand­dal and his col­leagues (Sand­dal, 2003), “In the Seat­tle car­diac care sys­tem it is esti­mat­ed that one in four per­sons has been exposed to CPR train­ing. One can con­jec­ture that the recog­ni­tion of, and sur­vival from, an acute sui­cide event would be more like­ly if one in four per­sons were trained as a sui­cide lay gatekeeper.”

At the end of 2009, an esti­mat­ed one mil­lion Amer­i­can cit­i­zens have been trained in QPR by Cer­ti­fied QPR Instruc­tors. Because of the nature of sui­ci­dal warn­ing signs, and who is most like­ly to rec­og­nize and respond to them, we at the QPR Insti­tute strong­ly con­cur with the goal of one in four per­sons trained a basic gate­keep­er role for sui­cide pre­ven­tion in the Unit­ed States and in oth­er coun­tries. Because sui­cides hap­pen in fam­i­lies – where emer­gency inter­ven­tions are more like­ly to take place — we believe that at least one per­son per fam­i­ly unit should be trained in QPR.