The concept of QPR for Suicide Prevention, a community gatekeeper training program, grew out of Dr. Quinnett’s own personal experience with the challenge of delivering clinical services to at-risk elders living in their homes in the Spokane, Washington community. Together with Ray Raschko, MSW, Director of Elder Services, and Mary Higgins, CEO of Spokane Mental, the Gatekeeper’s Program began in the 1980’s and continues to today. The program was designed to locate, identify, and refer frail elders living in their homes and at risk for premature disability, nursing home placement, hospitalization or death.

In a very brief training format, community gatekeepers (meter readers, telephone personnel, pharmacists, and others) were trained to identify and refer older persons showing signs and symptoms of significant distress and/or difficulties while still living in their homes and communities. The program was very successful and won the Ford Foundation’s Innovations in Psychiatry award. The Gatekeeper program has gone on to became a national and international model for service delivery to at-risk elders.

While not an implicit goal of the program, independent studies of suicide rates among older Americans living in Washington State showed a steady, ten-year decline in Spokane County where the Gatekeepers were operational. As rates for similar older persons living in other counties climbed, deaths of persons over 65 by suicide dropped significantly.

Building on these findings, and based on Dr. Quinnett’s experience as a suicidologist, QPR was a natural extension of the concept that those most at risk for self-destruction tend not to self-refer. These groups include elders, youth, ethnic and cultural minorities, law enforcement personnel, people in uniform, and gay and lesbian youth, among others. Based on this compelling and early research, it is the belief of the QPR Institute that if lives are to be saved in suicide prevention, we must first locate, identify and then Question, Persuade and Refer those most at risk to providers of care.

Given the fact that the symptoms for depressive illness have become increasingly well known, and that the majority of suicidal persons communicate their distress and intentions to suicide to others – often in plain language, the QPR concept moved to the next level.

Working with the Spokane County Health District and broad range of community representatives from schools, youth groups, law enforcement, churches, mental health and others, a community task force was presented with the QPR concept and how it might work. With the support of county health officials and the Medical Director of SCHD, Dr. Quinnett developed a core curriculum, wrote the first QPR booklet and, with community input and help, refined the text and content to meet the needs of a wide range of people and age groups. The first QPR Gatekeeper Instructors were trained in 1995.

Once community training began, the following highlights summarize subsequent developments:

• 1995. Evaluation of training is established, assisted by Dr. Dennis Dyck, Director, Washington Institute for Mental Illness Research and Training.
• 1995. Deanna Cooper, a health educator for Spokane County Public Health, conducts a community based effectiveness evaluation of QPR training to: change attitudes toward suicide; improve basic knowledge about suicide; and to assess the degree to which people trained in QPR report themselves more or less likely to act when intercepting a suicidal communication. The research showed positive and statistically significant results on all measures. This research project becomes the basis for Ms. Cooper’s masters thesis at the University of Washington School of Public Health (available in public record).
• 1996. A formal core curriculum of eight hours of material, plus the reading of two books on suicide and suicide intervention and treatment is established for the training and certification of QPR Gatekeeper Instructors. A course evaluation format is established and training instructors begins.
• 1996. Eli Lilly and Company funds a nine-minute QPR video for training the community gatekeepers. The $50,000 video is hosted by actress and author, Carrie Fisher. The video becomes a portion of the QPR Gatekeeper public health training format.
• 1996-1999. Spokane Mental Health helps underwrite research and development of the QPR concept and later, the QPRT Suicide Risk Assessment Inventory and its second and third editions.
• 1998. Albuquerque Public Schools enters into a joint research project with Spokane Mental Health (and what will later become the QPR Institute) to assess the effectiveness of QPR training in adult employees, and whether or not the training effect persists over time (out to 18 months). Again, the results are consistently positive and statistically significant.
• 1998. The QPR concept is expanded and integrated into a systems approach to suicide risk reduction, which includes enhanced training in suicide risk assessment for professionals and gatekeeper training. The program wins the 1998 J.J. Negley Presidents Award for Avoiding Suicide Malpractice.
• 1999. Due to funding cuts at Spokane Mental Health, Dr. Quinnett and staff form the QPR Institute, Inc., a suicide prevention training organization working to educate communities, professionals and institutions.
• 1999-2001. The QPR Institute contracts the Department of Health and the Washington State Youth Suicide Prevention Program, to train QPR Gatekeeper Instructors for Washington State, and to provide enhanced suicide risk assessment training to all 35 hotlines in the State of Washington. The contract includes evaluation of training effects for QPR Gatekeeper training, as well as assessment of the new QPR Suicide Triage Training Program. Again, the results for gatekeeper training are consistent and highly significant for those trained.
• 2002 through 2003: QPR becomes the most widely taught suicide prevention gatekeeper training program in the US, with more than 1,400 Certified Instructors in more than 35 states training more than 250,000 citizens since the program’s inception. Also, more than 10,000 clinical providers have been trained in suicide risk assessment and management.
• Beginning in the fall of 2003, the QPR community-based program will undergo a rigorous random clinical trials evaluation funded by the National Institute of Mental Health and lead by investigators from the University of Rochester and the University of South Florida. More than 30 major mental health facilities have installed the QPR Institute’s Institutional Suicide Risk Reduction Program