www.qprinstitute.com/joomla
Sign up for an account using
the special code given to you
to access the materials.
To access the course
materials click “learning paths”
You get to this page by
clicking “Learning Paths”
www.qprinstitute.com
“QPR Instructor
Resources”,
password:
“listen”
www.qprinstitute.com
“QPR Instructor
Resources”, password:
“listen”
EMS Instructor
Materials next slide
EMS Instructor
Materials
WELCOME
COLORADO EMS
SUICIDE PREVENTION
SPECIALIST TRAINING
Before we get started I want you
to check out the 3 people sitting
nearest to you.
Introduction

Depending on your relationship with those
being trained, I would recommend a brief
introduction of yourself. I like to answer the
questions; “Who is the person standing up there
training me?” “Why should I believe him/her?”
“What does he/she have to teach me and where
did they acquire this information?”
Take Out Your Packets
Just Like It’s Your Birthday!
Taking Care of Yourself.





Suicide is personal
Many of you may be survivors
Some may be attempt survivors
This training can be difficult
Take care of yourself during this training.
Raise your hand if…
Wait until all questions asked





Have you ever thought about suicide?
Do you know someone who has?
Do you know anyone who has made a suicide
attempt?
or even died by suicide?
Are you worried, right now, that someone you
know is thinking about suicide?
Prerequisite online learning





QPR Gatekeeper for Suicide Prevention
Certificate
Understand suicide as a major public health
problem
Name major suicide prevention organizations
and access their web sites
Recognize someone at risk of suicide
Recognize at least three suicide warning signs





Demonstrate increased knowledge, skill and selfefficacy in the application of QPR
Know how to engage and assist a suicidal
colleague or co-worker
Understand the common myths and facts
surrounding suicidal behavior
Describe and name multiple local or state
referral resources
Understand means restriction and how to
immediately reduce risk





Recognize and identify at least three risk factors
for suicide
Recognize and identify at least three protective
factors against suicide
Understand the nature of suicide
Engage in an interactive and helpful
conversation with someone who has attempted
suicide
Engage in an interactive and helpful
conversation with the loved ones or family
members of someone who has died by suicide
Classroom learning goals




Understand risk factors and warning signs
associated with suicide
Understand the nature of suicide
Recognize risk factors associated with exposure
to trauma
Understand the need for and identify various
strategies for self-care




Respond to suicide attempt survivors
Help suicide survivors (family members left
behind)
Help fellow EMS providers who may be having
suicidal thoughts
Identifying local and national suicide prevention
resources
Clump Up




Why you are here
What has your experience taught you
Share what you learned from the online material
What do you still want to know
About suicide
 About teaching this material

Training others to be EMS Suicide
Prevention Specialists (EMS SPS)


The minimum training required to be awarded
an EMS SPS certificate is five (5) hours
The course can be taught entirely by the
Instructor using the materials and audio visual
aids, provided the EMS SPI is also a QPR
Certified Gatekeeper Instructor.
If not a QPR Certified Instructor, those
earning a certificate as an EMS Suicide
Prevention Specialist must complete




Minimum of two (2) hours of online training
Minimum of three (3) hours of classroom
training
Pass all online and classroom quizzes and exams
as determined by the EMS SPI
Participate in role-plays and exercises

See sample training schedule in packet
QPR Institute Training for Everyone

To create safer communities means training at
all levels:
- QPR Citizen Gatekeeper Training and Instructor
Certification Course
- QPR Suicide Triage Training and Instructor Training
Course for 1st responders (e.g., QPR for EMS)
- QPRT Suicide Risk Assessment training for health
care professionals
- QPRT for physicians and nurses
QPR
Colorado EMS SPS
Classroom Training
Classroom Material Schedule







Introduction and overview
Brief review of QPR and online materials
Suicide in Colorado
Understanding Suicide
Local Resources
Role-plays
Self care
Suicide in Colorado






34,598 suicide in United States in 2007
Or 94.8 a day for a rate of 11.5
940 suicides in Colorado in 2009
Or 2.6 a day for a rate of 18.4
Colorado ranked 6th in 2007
Up from a ranking of 9th in 2006
In Colorado in 2009





940 people died by suicide
190 people died by homicide; 8 by legal intervention
15 children age 4 or younger were a victim of
homicide
7 people died of unintentional firearm injuries
Suicide is the second leading cause of death and
homicide is the third leading cause of death for
young Coloradans ages 15-34.
Health Statistics Section, Colorado Department of Public Health and Environment
Colorado Suicide 2005 - 2009
Health Statistics Section, Colorado Department of Public Health and Environment
UNDERSTANDING SUICIDE



Provide a leading theory to better understand
suicide
Teach the three necessary conditions for a
suicide event to occur
Demystify and de-stigmatize suicide by bringing
the behavior into the range of understandable
human behavior
Underlying Principles




Suicide is not the great mystery that it has been
made out to be.
The basic components of suicide are knowable.
When we understand these components we can
act with more confidence.
Informed interventions save lives.
Suicidal Behavior





Means someone is in extreme pain and
suffering
Means complex feelings and behavior
Involves many reasons and factors
Means coming at it from many directions
This training is just one those directions
Nature 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
Understanding Suicide
Based on the work of Thomas Joiner, PhD
and his book Why People Die by Suicide
Underlying Principles
Suicide is not the great mystery that it has been
made out to be
 The basic components of suicide are knowable
 When we understand these components we can
act with more confidence
 Informed interventions save lives
It’s what we don’t know that we don’t do, and what we
don’t do costs us lives unnecessarily lost.

Basics of Suicide and Serious
Attempts

Two major components associated with suicide
and serious attempts
The desire to die and
 the capacity for self harm


Two elements within the desire to die
Perceived burdensomeness
 A sense of thwarted or low belongingness

Sketch of the Theory
Those Who
Desire Suicide
Those Who Are
Capable of Suicide
Serious Attempt or Death by Suicide
Acquired Capacity for Suicide
 Suicidal
behavior is not just about the
desire to die
 It
requires the capacity to inflict self
injury
The Acquired Capability to Enact
Lethal Self-Injury

This capacity is acquired over time

Accrues with repeated and escalating experiences
involving pain and provocation, such as
Past suicidal behavior, but not only that…
 Repeated injuries
 Repeated witnessing of pain, violence, or injury (i.e..
physicians, EMS, ED nurses, and law enforcement
personnel)
 Any repeated exposure to pain and provocation.

The Acquired Capability to Enact
Lethal Self-Injury

According to Joiner, with repeated exposure,
one habituates – the “taboo” and prohibited
quality of suicidal behavior diminishes, and so
may the fear and pain associated with selfharm
What do tattoos mean?
Tattoos and Suicide

In a case-controlled study comparing accidental
deaths to suicides, people who died by suicide were
more likely to have tattoos (Dhossche, Snell, &
Larder, 2000).

Could it be that the eventual suicide victims
obtained increased capacity for suicide partly via
painful and provocative experiences, such as
tattooing, piercing, etc.?
Deliberate self-harm and suicide
Evidence:
- People who have experienced or witnessed
violence or injury have higher rates of suicide –
prostitutes, self-injecting drug abusers, people
living in high-crime areas, physicians

- Those with a history of suicide attempt have
higher pain tolerance than others
Components of the Desire for
Death
 Perceived
Burdensomeness
 Thwarted
Belongingness
Perceived Burdensomeness
 Feeling
ineffective to the degree that
others are burdened is among the
strongest sources of all for the desire
for suicide
Suicide lightens the load the rest of
us carry….
Research:
Brown, Comtois, & Linehan (2000) reported
that genuine suicide attempts were often
characterized by a desire to make others
better off, whereas non-suicidal self-injury
was often characterized by desires to express
anger or punish oneself …
Thwarted or Low Belongingness
 The
need to belong to valued groups or
relationships is a powerful, fundamental,
and extremely pervasive human
motivation
 When
this need is thwarted, numerous
negative effects on health, adjustment,
and well-being have been documented
Thwarted Belongingness

The need to belong is so powerful that,
when satisfied, it can prevent suicide -even when perceived burdensomeness
and the acquired ability to enact lethal
self-injury are present…

By the same token, when the need is
thwarted, risk for suicide is increased
Thwarted Belongingness:
Empirical Evidence

Hoyer and Lund (1993) studied nearly a
million women in Norway; over the course
of a 15-year follow-up, over 1,000 died by
suicide

They reported that women with six or more
children had one-fifth the risk of death by
suicide as compared to other women
Those Who Desire Suicide
Perceived
Burdensomeness
Those Who Are
Capable of Suicide
Thwarted
Belongingness
Serious Attempt or Death by Suicide
Prevention/Treatment Implications

The model’s logic is that prevention of “acquired
ability” OR of “burdensomeness” OR of “thwarted
belongingness” will prevent serious suicidality

Increasing belongingness may be the protective
factor one can influence the most and quickest

Example PSA: “Keep your old friends and make
new ones – it’s powerful medicine”
Questions and discussion?
RESPONDING TO SUICIDAL
PEOPLE AND THEIR LOVED ONES

The following structured interactive discussion
session is intended to assist you by reviewing the
training received online in this area.

Through role-plays you can practice and share
strategies for dealing with those who have
attempted suicide and the families and loved
ones of both attempt survivors and those who
complete suicide

Finally this section is to minimize your
experience of secondary trauma in responding to
suicide events.
Review









Being emotionally present
Accurate empathy
Genuineness
Unconditional positive regard (NO Judgment!)
Active listening
Reflecting
Open ended questions
Problem solving
Plan of Action
The definition of few terms
Survivors of suicide:
Committed suicide
 He took his own life
 She ended her own life


She died by suicide
First responders may face any of
the three following scenarios:



A person who may be suicidal and have
recognized warning signs
A person who has just attempted suicide or
attempted in recent past
Family, friends of someone who has attempted
suicide or dies by suicide
On the way to the ED



Distressed person after a suicide attempt: “I just
can’t take it anymore. My father is cold and
distant and never listens to me when I’m
upset. It’s like he can’t stand to be around me
when I express my feelings.”
You: “It sounds like your dad doesn’t listen to
you when you say what you feel.”
Distressed person: “Right. You got that
right!”


Distressed person: “Now that you how hard it
is for me to ever talk to my dad, maybe you can
see why we can’t spend any time together. If I
get the least bit upset, he’s going to blow up.”
You: “So anytime you get upset, or show your
feelings, your dad seems to withdraw or shut
you down. Does he sometimes just leave the
scene?”
What do you say to the family?





Discuss
Boot camp “In your experience”
Scenarios students have experienced?
Thoughts what would you add to what others
have said?
Building consensus - we’re learning how to do
this together
Suicidal Language
Putting it in context
Without understanding the context, it is
difficult to understand the message…
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?
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 10story building
Now… which person needed immediate and aggressive
intervention?
Help reduce confusion…







Risk Factor?
Protective Factor?
Warning sign?
Clue?
Threat?
Suicidal Communication?
Clear statement, coded or hidden?
What are these?








“I’m going to kill myself!”
Buying a gun.
Pointing a loaded gun at your head.
Giving away prized possessions.
Heavy drinking when you are clinically depressed.
Telling your friends what kind of music you want at
your funeral when are apparently healthy.
Saying goodbye, a kiss and hug from a teenaged boy.
“If a person kills himself, does he go to hell?”
Steven Pinker – The Stuff of Thought



The need for indirect speech – the speaker says
something he/she doesn’t mean literally
knowing the hearer will interpret what was
intended and correctly interpret what was meant.
All humans know how to “read between the
lines” See, Politeness Theory (Politeness: Some
Universals in Language Use – Brown & Levinson,
1987)
Context is everything….
We are all very nice…



When lost and we need to ask a stranger for
directions, “Excuse me…”
“Would you like to come and see my etchings?
“Would you like to come up for coffee?”
“Polite indirect speech can use any hint that
cannot be pinned down as a request by its literal
content, but that can lead an intelligent hearer to
infer its intended meaning…” SP, 2006.
Our job?
To make hearers of suicidal communications,
polite requests for rescue, or for help from one’s
community or significant others understood so
that positive actions can follow.
 Plausible deniability:
“Can you pass the salt?” vs.
“The chowder is pretty bland.” Or, “They never
have enough salt in this restaurant.”

Forms of communications: Off
record requests in context…




Hints “Lions could hide in the lawn.”
Understatements “You got a real nice store here.
It would be too bad if something happened to
it.”
Idle generalizations “It’s too dark to read in
here.”
Rhetorical questions “It looks like someone has
had too much to drink?”
Examples from real cases…




Parishioner 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.”
Last words from real cases




Depressed 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.”
Suicidal Communications
- If 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?
QPR ROLE PLAY PRACTICE
SESSION AND Q&A
QUESTIONS FOR THOSE WHO
WERE “SUICIDAL”

“What did you become aware of during the course of this
exercise?
QUESTIONS FOR THOSE WHO
PRACTICED QPR

“What did it feel like for you ask about suicide risk?”

“How comfortable were you?”
FIRST RESPONDER SELF CARE

Provide a structured interactive discussion
session in which students can recognize and
discuss the stressful nature of their jobs

In small group discussion, review their personal
coping skills and stress management strategies
and brainstorm additional ones

Help students identify where they can go to gain
additional skills
What your peers said
It works if you work it

Having someone to talk too about the stress and
the feelings that build up inside so they don’t
just one day explode

Being around friends and family and just
hanging out

Sitting by the fire with a few friends, telling
stories, watching for the first star of the night
and poking the fire with a stick

Taking walks, playing ball or other forms of
exercise to clear out the tension

Going fishing, panning for gold, or other
activities in order to spend some valuable time
with yourself and clear your head

Meditation, prayer, yoga, and other spiritual or
religious practices that can help provide a sense
of peace and perhaps some perspective
Positive Coping Methods

Number 1 at 35%


Number 2 at 30%


Peer and family support talking it out
Physical activities, hunting, fishing, outdoors,
exercise
Other methods included

Faith/prayer/reflection
Some not so positive coping



7% just walk away/move on to next call
5% drugs and alcohol
Other comments included
Detach emotionally
 Inadequate
 Internalization
 Irrelevant

Getting help for yourself questions
How do I know if help is warranted?
 How bad do I have to feel before I ask for
help?
 Isn't it better to "tough it out" with
emotional problems?
 How do I pick a professional? Which
kind?

More questions
What's the difference between a social
worker, psychologist, psychiatrist, and
counselor? Whets a CD counselor?
 If I did make an appointment, what
questions should I ask?
 Will my insurance pay for the help I may
need?

Once in the office questions:
What will happen on my first visit?
 Are things I should ask to get off to a good
start?
 Is it OK to get a second opinion if I don't
like what I hear?
 How will I know what I need?

More questions
Do I have to like the professional, and
what if I don't?
 What should I do if I'm disappointed?
 Should I ask about the risks and benefits of
the treatment proposed?

Last to recognize it



How far do you push a friend, family
Who can you go to, to protect confidentiality
Particularly in small towns
THANKS!
Descargar

Welcome to QPR!