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Kara Millier from the Taney County Health Department during QPR training with the JATC.

May is Mental Health Awareness Month. It is a time to raise awareness of those living with mental health issues with the goal of  reducing the stigma of these issues in our society. 

One of the most important lessons I have learned, not only dealing with my own mental health, but having family with mental health issues as well is the importance of communication. Being able to talk to someone about the issues you recognize in others but also having someone you can talk to if you are experiencing troubling times.

Recently the Junior Auxiliary of Taney County hosted a class presented by the Taney County Health Department for QPR suicide prevention training, which I was invited to take part in. . 

So what is QPR? QPR is a form of training to help prevent suicide. It stands for Question, Persuade and Refer. The basis of the training is to help members of public learn how to become someone who may be in the best possible position to prevent a suicide, according to the QPR training booklet, which was passed out to everyone in attendance at the training. 

Question - learn how to ask a person about suicide. 

Persuade - help persuade someone to get help from a professional.

Refer - Be able to give someone the appropriate resources for help.

The name QPR is similar to CPR, which was done by design. CPR training enables citizens to take action to save lives from a cardiac incident. QPR is designed to train citizens to take action of saving lives from suicide.

Taney County Health Department Community Health Educator Kara Miller said the QPR program is important to help bring down the suicide numbers in the county, state and nation.

“I’m happy to be here to present the QPR suicide prevention training that we have found is pretty effective,” Miller said to the class. “We have been offering QPR classes for around a year now. We at the Health Department looked at some of the suicide numbers here in the state of Missouri and we were alarmed. One of the most alarming is the number of children who are dying by suicide in the state of Missouri. Suicide in Missouri is the second leading cause of death among youth and young adults aged 10 to 17. That’s alarming! So, we thought we needed to do something. We began QPR training. I know of two examples where someone was in a class that we have trained and they’ve used QPR within a week to save somebody’s life. So it really does work. I’ve been with the Health Department for 21 years, and this program is probably the best program that we have ever had as far as preventing things in our community.”

Suicide is the 12th leading cause of death in the USA, according to the American Foundation for Suicide Prevention. 

According to the World Health Organization, over 800,000 people die each year by suicide. That is more people that are killed in all the wars and homicides combined. Of these deaths each year, more than 40,000 are Americans, which means there is one death by suicide every 13 minutes in America alone. Suicide is the third highest cause of death for people aged 15 to 44. For every life lost to suicide, another 25 people will attempt suicide, often causing serious medical injury or lifelong disability.

So how can we help?

One of the first things is to learn how to communicate when we have feelings of sadness or learning how to ask someone we feel may be struggling. 

QPR training teaches people how to be a gatekeeper. So what is a gatekeeper? According to QPR training, a gatekeeper is anyone in a position to recognize a crisis and warning signs that someone may be contemplating suicide. In other words, anyone can be a gatekeeper, if you are willing to see the signs of your fellow human who may be struggling. Being aware of the signs someone may need you to reach out. From someone not being their typical self, to someone withdrawing from activities and things they enjoy, to someone who is giving their prize possessions away can all be signs. 

There is a stigma to not only being able to talk about your own mental health issues but an uneasiness when asking someone else about their mental state.

So how do we get over this stigma to be able to reach out to others? 

According to the QPR training we must break through our emotional reactions to suicide to be able to talk about suicide and potentially save a life. One of the biggest things I took away from the training is how we word things has truly the biggest impact on those who struggle.  

“Depression, anxiety, substance abuse, bipolar and thought disorders like schizophrenia all contribute great risk or suicidality. Yet most people suffering from a mental illness do not kill themselves. They get help. They find a way and they recover to live full and productive lives. If recovery is possible, that means suicide is preventable,” Miller said. “Thankfully, the world is changing. We understand mental illness. We understand suicide, and we know the treatment saves lives. Right now our teachers don’t teach us about depression and suicide. Our faith leaders often struggle to talk openly about these topics. To often doctors can’t talk to their patients about suicide. Even patients who are sitting in their offices planning how to end their lives, perhaps by overdosing on the medication being prescribed to them. The world remains dangerously ignorant about suicide. So to save lives, we must bring the subject out of the shadows. Effective treatment would save thousands of lives around the world. But we must learn to talk comfortably about suicide. And we need your help to start the conversation. Join us in this fight, a fight to save lives, preventing suicide. It’s what people do.”

I know from personal experience with my own mental health and dealing with close family members who struggle with depression, anxiety and suicidal thoughts, wording when brooching the subject of suicide is key to being able to help.

Speak with empathy and not judgment. Ask questions without making someone feel disregarded and shamed. One of the worst things someone can do if someone is expressing suicidal thoughts is silence. Ignoring someone who has reached out usually comes from fear, according to the QPR training. 

There are several myths about talking about suicide which were addressed during training. 

“We need to figure out a way to talk about suicide and mental health,” Miller said. “If people in crisis get the help they need, they may never be suicidal again. So they just need someone to listen to them. They may need treatment for depression. Depression is the number one disability in the United States today. One of the myths we need to dismantle is asking a person about suicide will only make them angry and increase the risk of suicide. This is a myth that has gone forever, in truth never asking someone if they’re considering suicide is not going to plant the seed. They they’ve done studies on this and they know that people who are having mental health crises are probably already thinking about suicide. So bringing it asking them can prevent suicide. The fact is suicide prevention is everybody’s business and we can all help prevent it. 

“Another myth is people considering suicide keep their plans for themselves. This isn’t true. Most people considering suicide will communicate their intent in the week prior to their attempt, but they may not tell one person. They may tell one person one thing, may tell another person another thing and unless those people are communicating they may not know the extent of the issue. Then the last myth is once a person decides to complete suicide, there’s nothing anyone can do to stop that. And just from what I’ve said we all know that’s not true. Suicide is in fact, the most preventable kind of death and almost any positive action may save a lot. Any sort of positive action may save a life.”

Once we get comfortable talking about mental health and suicide or even uncomfortable but still willing to talk, what then?

We then focused on the P in QPR, Persuade. This was more about talking…again communication is key. Talking to someone who is struggling. Giving them hope and an ear to listen. The goal is to persuade them to seek help. Most of us are not trained mental health professionals, so the next step to prevent suicide is to help persuade someone to get help from a profession. 

The last step is to Refer… whether that means giving them a phone number of a therapist or hospital or physically helping them find someone or somewhere to go to get help. When you not only give them hope but you help them find a plan for recovery, suicide is preventable. 

As someone who has struggled with depression and lived in a home with a child who suffered from depression, I can tell you the things I learned in QPR training are things I know work. I have spent years recognizing signs, years talking about mental health so as to remove the stigma. I know just asking the simple questions to the harder questions can make all the difference.

“How are you feeling?”

“How is your mental health doing?”

“Can we talk about what you are feeling and how it is affecting you?” 

“Are you thinking about self harm?” 

“Do you ever think about suicide?”

These questions were and still are common in my family. It is more important to me to allow the ones I love to feel they can honestly express themselves and the mental health issues they face than it is to be comfortable. So please learn to be uncomfortable and if you see someone in crisis or you think someone is in crisis, ask them.

For more information on QPR training visit

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