According to a study by the Centers for Disease Control published in the Journal of Consulting and Clinical Psychology 1995, 10% of college students admitted to having suicidal thoughts during the 12 months preceding the survey. These students came from both two- and four-year public and private colleges and universities. Seven percent said they had made a suicide plan, 2% had attempted suicide at least once, and 0.4% had made a suicide attempt that required medical attention. While statistics vary, suicide is either the second or third leading cause of death among the U.S. college-aged population. The question before American colleges and universities is not if they should deal with suicidal students, but how.

Among the goals and objectives of the Surgeon General’s National Strategy for Suicide Prevention 2001 is the following: “By 2005, increase the proportion of colleges and universities with evidence-based programs designed to address serious young adult distress and prevent suicide.” According to the Surgeon General’s strategy:

• Young adults aged 18-24 have the highest incidence of reported suicide ideation
• One fourth of all persons aged 18-24 years in the U.S. are either full- or part-time college students
• A large proportion of this at-risk population could be reached through campus-based suicide prevention efforts

Throughout the Surgeon General’s report is the stated need for “gatekeeper” training. Gatekeepers are persons trained to recognize the warnings signs of suicide and to take decisive action to help avert a suicide attempt.

The QPR Institute Suicide Risk Reduction Program
The QPR Institute offers an evidence-based general systems approach to gatekeeper education and training and suicide risk reduction practices in defined communities. Targets for gatekeeper training are outlined here, together with a graphic logic model to describe the program. In the QPR Suicide Risk Reduction Program for colleges and universities, all links in the Chain of Survival (borrowed from CPR/cardiac survival literature) are recommended to be in place, or to be included in a planned-for campus and system-wide intervention implementation model.

These four links include the following:

• Awareness and recognition of suicide warning signs.
• The application of QPR.
• Intervention, initial evaluation and referral by school counselors or equivalents
• Ready access to professional assessment and treatment.

Background
We know that as an emergency health crisis intervention, CPR training is often required of student health services personnel, residential advisors and all campus security personnel. However, due to undetected, untreated or under treated disorders of thought and mood, college students are more likely to die from suicide than from problems that might be remedied by CPR. Yet, at present, there is no standard of training provided or expected of persons who may be in a position to save a student from suicide.

In fact, according to the American College Health Association whose accrediting bodies include the Joint Commission of the Accreditation of Healthcare Organizations and the Accreditation Association for Ambulatory Health Care, Inc., there are currently no requirements that suicide prevention training or related risk assessment skills are necessary to meet current accreditation standards. Given the morbidity and mortality rates of university and college students at this time - and in the context of developing social policy advancing suicide prevention efforts - we believe now is the time to implement suicide prevention training using the university campus as the educational venue.

Also, there is little doubt that colleges and universities carry some burden to protect students from self-destruction (click here for an executive summary of the current legal climate regarding student suicide). Despite good intentions, cost-effective, specific suicide risk reduction skills training is frequently unavailable for students, staff and faculty. Working with Washington State University and Eastern Washington University, the QPR Institute is able to offer a variety of distance learning and classroom training programs, for both staff and students. These CEU or for-credit programs are well-tested, evaluated, modularized, exportable, multimedia and have web-enabled options. They are designed for broad distribution at modest cost and include options for mass customization and branding. These educational programs have been adopted by many large organizations, portions of the U.S. armed forces and many state departments of public health or education. More than ten major universities currently use some QPR Institute programs.

In terms of experience, the QPR Institute and its multidisciplinary faculty have trained more than 10,000 professionals and more than 1,200 Certified QPR Gatekeeper Instructors in 34 states. These Certified QPR Instructors have trained more than 250,000 Americans as suicide prevention gatekeepers. More than 10,000 healthcare professionals have used our training and “best practices” protocols to assess and manage more than 100,000 healthcare consumers.

A community-based approach
Colleges and Universities are communities. Therefore, a community-based approach is necessary for the successful introduction and ongoing support of suicide prevention programming on college campuses. The QPR Institute staff and faculty believe that for suicide attempts and completions among college students to be minimized, broad public health education and the diffusion of innovative suicide risk reduction practices are required. Basically, universities must come to accept that not only is suicide preventable, but that universities share in the responsibility to educate, inform, identify, refer and provide potentially life-saving information and interventions to its students, staff and faculty. Just as the U.S. Air Force has successfully undertaken steps to significantly reduce suicidal deaths among a similar aged population through a strengths-based community competence model, so too can universities create a safer more secure place for potentially at-risk students.

It is our belief that once campus leaders and other key gatekeepers are equipped with the knowledge and training necessary to help reduce suicidal behaviors, good will, personal energy, funding and implementation of suicide prevention awareness-raising and training efforts can and will be successful. As faculty, graduate students and professionals-in-training acquire suicide prevention knowledge and skills through campus gatekeeper training and for-credit course options, the national agenda for suicide prevention will move forward across a broad front.

University Readiness Questionnaire
To help university communities achieve success in their suicide prevention efforts, we have developed the following list of questions, both to inspire leadership and to ensure broad community support for program implementation.

1. Does your college or university have a designed point-person who will be available full time to organize and monitor a campus-wide suicide risk reduction program? If not full time, then how much time can be devoted by this person to this task? What skills and leadership does this person bring to the table?
2. Does your college or university have a suicide prevention task force or workgroup that meets regularly to discuss, plan and execute “next step” efforts to reduce suicide risk among students? What is the regular attendance at such meetings? How often does your group meet? What is the commitment level of the participants? Do they represent all the major stakeholders (student health services, administration, counseling department, campus security, etc.)?
3. Has your college or university targeted who should be trained? Is there a priority list? How many people – students, gatekeepers, care providers, etc. – does your group imagine impacting? Where would you train people, and who should train them?
4. Has a contact person been designated from each major stakeholder group? What is the “buy-in” from groups who cannot or are unable to send someone to the workgroup?
5. Is mental health or campus counseling services at the table? Are they supportive? Are they already doing some of the activities you might plan for? Do they believe there is both the will and the capacity to assess and treat suicidal students detected through broad public health awareness, detection and referral efforts? If they need help to handle additional suicidal persons, how can your group assist them? How can administration help them?
6. How will you fund your efforts?
7. What should be the nature, form and extent of semi or annual evaluation reports to leadership?

Thank you for time in reviewing this draft proposal and for your interest in helping to prevent suicide.

The Staff and Faculty of the QPR Institute