Spring 2003
This Issue Contains Several New Developments And Important Opportunities For Certified QPR Instructors.

Thanks to all of you, more than 59,000 U.S. citizens where trained in QPR in 2002! Evaluations coming in from around the country indicate a high level of acceptance of the QPR message and great satisfaction with the training you are doing. Formal evaluations are underway or planned in several states. If you have conducted an evaluation and would like it posted on the QPR Institute web site, please forward it to us and we will take care of the details (PowerPoint slides and text preferred). Also, we have developed a series of follow-on evaluation questions and measures to determine QPR effectiveness over time and are available on our website.

NEWS & OPPORTUNITY! Thanks to Janet Schnell, a new QPR Mentoring program has been tested with great results. Janet took her QPR training via the self-study program and began training gatekeepers in her community. Soon, she had a school interested. She then recruited 10 trainers from the school who also took the self-study program. Janet mentored them while they studied and helped them make their 1st presentations. Everyone Janet has mentored has become a successful QPR Instructor. She will be expanding the program in 2003. And you can, too.

If you are interested in becoming a QPR Mentor for your community, please contact us for a program description and how to get involved in mentoring other instructors. As this program saves thousands of dollars in travel expenses that are better spent in suicide prevention, we wish to thank Janet for her contribution and to encourage you consider the program for your community (compensation for mentors is built into the program). Janet will consult with anyone interested in becoming a QPR Mentor (she does have to charge a fee for her time).

As announced in the last newsletter, QPR has gone to China. Dr. Quinnett presented one lecture on the challenge and opportunity of suicide prevention training, followed by a full day workshop on educational models, suicide prevention content, distance learning, web-based technologies and the new QPR mentoring program (developed by Janet Schnell of Indiana). More than 90 suicide prevention professionals attended from all over China. We are now training a QPR Master Trainer in Beijing who will, in turn, train other trainers throughout China.
The QPR Institute and The National Hopeline Network recently joined forces to raise funds for 1-800-SUICIDE by producing a dual punk rock music CD for the Plea for Peace Take Action tour. Via CD, the QPR gatekeeper training program is delivered in a multimedia format, backed up by crisis line staff and volunteers for instant access by young people concerned for others or for themselves. We are carefully evaluating this mode of delivering gatekeeper training. We wish to publicly thank all the rock groups that donated their music to this suicide prevention effort.

The QPR Institute wishes to acknowledge the U.S. Armed Forces and their families for their efforts in the Middle East.
NEWS! The Institute of Medicine (IOM) has published Reducing Suicide: A National Imperative. Dr. Quinnett has written a book review for Suicide Information and Edu-cation Center in Calgary, Alberta, Canada. A copy of this review is available on our web site via the public newsletter.
The generic QPR booklet and card have been redesigned and edited to enhance their appearance. The edition includes slight changes in language to reflect current usage as well as recent research findings. There is no price increase. Remember, your community can custom design and print your own booklets and cards and save money.
OPPORTUNITY! The QPR Institute has initiated an affiliate program to enable suicide prevention agencies and organizations to benefit financially from sales of training programs, books and materials from our web site. Help raise funds for your organization’s mission. Please check the website Affiliate Program navigation button for details and how to enroll.
The QPR web site now includes a new “Institutions” navigation button that explains our Institutional Suicide Risk Reduction Program and includes slides of Dr. Quinnett’s presentation to the American Psychiatric Association’s Task Force on Patient Safety. Dr. Quinnett will be presenting a workshop on the Institute’s Suicide Risk Reduction Program at the APA’s May meeting in San Francisco. The Institute’s Suicide Risk Reduction Program is now available to all healthcare organizations.

NEWS! Despite all your hard work teaching QPR, we are only scratching the surface on training needs. To train more people in this life-saving program we have spent the last two-years testing and refining a QPR gatekeeper training that can be delivered via a multi-media, interactive, web-enabled CD-ROM. Please visit our website (www.qprinstitute.com) for a full description of this new training approach. Our target audiences for this training program include individuals, businesses and corporations, rural America and states where there are no QPR Instructors currently available. If your organization would like a sample of the QPR on CD-ROM to review, please let us know.

NEWS and OPPORTUNITY! Based on the new QPR Gatekeeper program on CD we have adapted portions of the new QPR on CD ROM as a possible option for use in your presentations. The new CD plugs into any computer and includes navigation buttons to a short, attention-grabbing introductory presentation on the problem of the suicide in America, a digital version of the QPR introductory video, a set of the QPR curriculum slides in PowerPoint so you can deliver an integrated computer assisted presentation and, in case you have a cold or lost your voice, the CD includes a digital voice-over presentation of the QPR PowerPoint slides by Dr. Quinnett. The CD will play on a full sized monitor or screen. These CDs are only available to Certified QPR Instructors and cannot be shown by others or as a stand alone presentation without your presence. The cost is $29.95 plus $3.95 shipping and handling and can be ordered through the Instructor’s section of our website.

For those who may have missed the announcement, the electronic version of Suicide: The Forever Decision is now available free to anyone in the world who needs it. Book reviews by suicidal sufferers can be found on the Barnes and Noble and Amazon.com web sites.

We wish to thank Reese Butler and the staff of the Kristin Brooks Hope Center, National Hopeline Network (1-800-SUICIDE) for helping us bring out this new, e-version, third edition of the book. Instructions for the download are on our web site, including links to free download software for those who need it. This e-version of The Forever Decision carries a general public license and can be copied in digital format to anyone, anywhere. To help suicidal people and those who love them, please consider the following applications:

  • Can be emailed to crisis line callers
  • Can be given to suicidal patients and clients
  • Can be forwarded to list-serves for distribution
  • Can be placed on high school and university servers for students
  • Can be placed on web sites as a free download
  • Can be burned to CDs and copied for distribution
  • Can be sent to suicide chat rooms throughout the World Wide Web
  • Can be hosted on institutional, corporate and public health web sites
  • Can excerpted for newsletters (please reference how people can get the book)

We are pleased to announce a new partnership and a new online course called QPR Suicide Triage Training for Correctional Workers. A number of experts have reviewed the content and we have teamed up with the Corrections Learning Network (http://www.cln.esd101.net) to deliver suicide prevention training to more than 800 jails and prisons throughout the United States. With the QPR Gatekeeper course as the foundation and using CLNs TV production, broadcast capacity and satellite bandwidth, suicide prevention awareness and educational programs can now be delivered directly to both staff and offenders from Puerto Rico to Hawaii. We may need onsite Certified QPR Instructors as well, so please let us know if you're interested in participating.
QPR Instructor Toolkit Update

According a recent article in the Los Angeles Times 1 in 142 U.S. residents is behind bars, or more than 2 million people. Why does this matter to QPR Instructors? Because a) it is estimated that the suicide rate in American jails is 9 to 14 times higher than the general population and b), correctional workers are targeted for suicide prevention training in the Surgeon General’s new national strategy.

In addition to this toolkit fact sheet update, here are a couple of helpful resources:

1. The Corrections Learning Network, or CLN, is a basically free staff development and offender education program funded by federal grants. Working with the QPR Institute, CLN will be broadcasting free suicide prevention informational programs over their television network in the near future. If your local jail or prison is not on the network, you might suggest to them that they look into this program. For details they can call Anne Charles at 509-323-2767 or check them out at their website at http://cln.esd101.net/directory.htm.

2. The Jail Suicide/Mental Heath Update, a joint publication of the National Center on Institutions and Alternatives and the National Institute of Corrections, U.S. Department of Justice is also free and a terrific source of information on jail suicide. For subscription information and the online edition of the Update, please visit ww.nicic.org/inst/jail-mental.htm

Corrections and Suicide: Special Issues, Risk Factors and Circumstances

The following summaries are not intended to be comprehensive reviews of the available literature on suicide in correctional settings. Our intention is to provide QPR Instructors with brief, bulleted, downloadable files which can be used to enhance their QPR presentations and their suicide prevention knowledge.

Youth at special risk
While all correctional workers are familiar with the high number of mentally ill persons in their care and custody, a recent major study of mental disorders among detained youth needs to be highlighted. Research by Linda A. Teplin, Ph.D., of Northwestern University and her colleagues, and as published in the Archives of General Psychiatry (Vol. 59, No. 12), found the following:

  • More than 109,000 youth are in U.S. juvenile facilities on an average day, and more than 60% are racial or ethic minorities and come from low income families (U.S. Department of Justice).
  • The rate of psychiatric disorders in their sample of 1,829 ethically diverse teenagers between ages 10 to 18 in Chicago’s Cook County Juvenile Temporary Detention Center was more than 50% of the males and almost 50% of the females had a substance abuse disorder.
  • More than 40% of both sexes met criteria for disruptive behavior disorders, and 20% of the females met the criteria for major depressive disorders.
  • 17% of the males and 26% of the females were either depressed or dysthymic (a low-grade but persistent type of depression that often goes undiagnosed and untreated).

Clearly, without identification and assessment of suicide risk, and treatment for the psychiatric disorders to lead to suicidal behavior, these more than 50,000 at-risk young people represent a significant challenge to the correctional system.
Observable Warning Signs and Symptoms of Potential Pending Suicidal Behavior in Correctional Settings.

(NOTE: you may wish to add some of these warning signs to any QPR program presented to correctional staff.)

The following signs and symptoms are adapted from Lindsay M. Hayes’ article, Suicide Risk Despite Denial, in Jail Suicide/Mental Health. Fall 2000, Vol. 10, No. 1

Depression: the single best indicator of potential suicide because approximately 70 to 80 percent of all suicides are committed by persons who are severely depressed. The following are common signs and symptoms of depression:

  • Inability to go on (expressing hopelessness/helplessness)
  • Extreme sadness and crying
  • Withdrawal or silence
  • Loss or increase of appetite and/or weight
  • Insomnia or awakening early; excessive sleeping
  • Mood variations
  • Tenseness
  • Lethargy (slowing of motor movements or reactions)
  • Loss of self-esteem
  • Loss of interest in people, appearance or activities
  • Excessive self-blaming
  • Strong guilt feelings
  • Difficulty concentrating or thinking
  • Agitation (including high level of tension, extreme anxiety, rage or wish for revenge)
  • Expressions and/or evidence of strong guilt/shame over offense
  • Talking about or threatening suicide
  • Intoxication/withdrawal
  • Previous suicide attempts
  • Severe agitation or aggressiveness
  • Striking mood changes
  • Does not deal effectively with present and preoccupied with the past
  • Begins to pack belongingness, giving away prized possessions
  • Psychotic symptoms
  • Engaging in non-lethal self-injury (regardless of lethality)

Situational Risk Factors Which May Affect Jail Suicides

  • Arrestee with little or insignificant criminal activity.
  • Juvenile (anyone under 18, whether or not waived to adult court).
  • Persons with high status in community (fear of humiliation).
  • Prior suicide by close family member or loved one.
  • Previously imprisoned and facing new serious charges and long prison term.
  • Recent suicide attempt by another inmate (“copycat”).
  • Harsh, condemning, rejecting attitudes of officers, e.g., We’ll give you the rope whenever you’re ready.”

All of the above files were adapted from Lindsay M. Hayes, Suicide Risk Despite Denial (or When Actions Speak Louder Than Words), in Jail Suicide/Mental Health, Fall, 2000, Vol. 10, No. 1.
Keep up the wonderful and life-saving work!
The QPR Institute
P.O. Box 2867
Spokane, WA 99220
e-mail: qinstitute@uswest.net
www.qprinstitute.com
Phone: 888-726-7926