Effective suicide prevention requires a collective commitment to keep those around us safe and supported. The QPR (Question, Persuade, Refer) approach provides a way for everyone to contribute to a healthier community—whether you’re a mental health or medical professional, employer, parent, friend, or simply someone who wants to do their part.
In this conversation, Joshua Stein, MD, a Child and Adolescent Psychiatrist at Newport Healthcare’s PrairieCare division, shares practical insights on suicide prevention and explains how QPR can be used.
What Is QPR and how does it work?
When people we know are not acting like themselves or are experiencing suicidal thoughts, many of us don’t know what to do. We’re concerned, but we don’t know how to engage them. We’re worried we may make things worse or stress them out further. It can also be uncomfortable to talk about mental health and suicidal thoughts, even for some professionals.
QPR was created as a way to address that mix of emotions. Suppose someone is displaying signs, symptoms, or concerning trends. With QPR, the people around them have the tools to question what’s going on and persuade them to get help—whether the support person is a high school student, coach, physician, bartender, or hairdresser.
Trying to prevent suicide can sound overwhelming, but QPR is a straightforward approach and a valuable tool that saves lives and is effective in preparing people to intervene. It helps us feel like we can do something when faced with someone in crisis.
Can anyone use QPR?
One of the best things about QPR is that it can be specified for any audience to use. Some of my favorite moments while giving this training have been with audiences who are not in the healthcare field. I’ve presented QPR to construction workers, youth groups, and even coaches and athletic directors at a large school district.
To practice QPR, you don’t need to have any previous training or medical background. As long as someone embraces the approach and is willing to help, they’ll come away with a great skill set for supporting people when they’re struggling. We can teach it to teenagers and young adults as well, as long as they can understand it, reference it appropriately, and feel strong enough to follow through with it.
What are the signs or phrases you should watch for that indicate someone is struggling?
QPR teaches us to recognize both direct and indirect signs of crisis. Someone might say something very direct, like “I’m having suicidal thoughts.” Other times, it’s more subtle, such as “I wish I could go to sleep and not wake up” or “I just can’t do this anymore.”
When we hear comments like this, the goal is to feel ready to step in and respond. You might say, “That sounds really serious. I’m worried about you—what’s going on?” or even ask directly, “Are you thinking about taking your life?” Having the courage to ask can open the door to persuading them to life-saving help.
With each step we take to learn how to recognize when someone is struggling and offer support, we strengthen our overall well-being and connection as humans.
Joshua Stein, MD
How do you initiate a conversation with someone who is struggling?
Suppose you notice concerning signs in someone close to you, such as giving away meaningful belongings, withdrawing from hobbies or activities they once loved, appearing persistently blue or down, or making references to suicide. In that case, it’s essential to check in.
The first step is deciding if you can safely and comfortably start the conversation. If not, it’s okay to reach out to someone else who can, such as a coach, teacher, parent, or youth leader who may have a better skill set or connection with the person. If you feel comfortable, you might say, “I’ve noticed you’ve seemed down, and I’m worried about you. Can we talk?” or simply, “I care about you and want to make sure you’re okay.”
What resources and options can you provide to hep people access the proper care?
If you’re concerned about someone and they’re ready to be referred to help, the 988 crisis hotline is available anytime by phone, text, or online chat. It’s a quick way to get immediate support, and if necessary, 988 operators can escalate the call to 911. If someone is in imminent danger, such as attempting to overdose on medications or otherwise end their life, call 911 right away.
For care recommendations for children ages 7–17 and young adults ages 18–35, connect with the Newport Healthcare Clinical Outreach Team or contact our Admissions experts anytime, 24 hours a day, seven days a week.
Can you explain the ripple effect of suicide and how QPR is a key component to prevention?
A vital part of a suicide prevention training like QPR is that it can help so many people, not just the person who is struggling. Suicide impacts far more than the individual—it affects the people who love them, their classmates and coworkers, and their entire community.
By learning QPR or other forms of suicide prevention, we’re helping to create a healthier community. With each step we take to learn how to recognize when someone is struggling and offer support, we strengthen our overall well-being and connection as humans.
What are other ways we can keep people safe?
One critical approach is “means restriction.” This involves limiting access to potentially lethal or dangerous items in the home when somebody is having suicidal thoughts or urges.
Research shows that thinking about suicide to an attempt can transition quickly, often occurring within minutes to an hour of the decision. If lethal means aren’t available, that window can pass—they get past five minutes, and then they get past an hour. They’re able to get back to wisdom, to decision-making, and to getting the help they need.
This means locking up medications, removing firearms from the home, and reducing access to other potentially harmful items. The goal is to create as many barriers as possible, giving the person more time to reconnect with support and safety.
What encouraging actions or words can we offer someone who’s struggling?
We all know how to care for somebody who’s broken a leg or is physically ill, but when it’s a mental health concern, at times we feel uncomfortable or don’t know what to say. I would encourage people to trust that just being present helps.
We can show support by telling the person “We’ll get through this together,” by checking in frequently, by dropping off food like you would for someone who’s physically ill, by writing cards or bringing gifts. These are significant gestures of care that show the person that they matter to you and you’re not going anywhere.
Leaning in and offering hopefulness, rather than stepping away or avoiding them, is incredibly important. When someone’s having a difficult time, receiving small, consistent acts of kindness and presence can provide crucial hope and connection at a time when they need it most.
About Joshua Stein, MD
Dr. Stein is a Child and Adolescent Psychologist and Clinical Director at Newport Healthcare’s PrairieCare division, where he provides patient-centered mental healthcare that supports children, adolescents, and families in long-term recovery. With deep expertise treating anxiety, depression, emerging personality disorders, family dynamics, and more, Dr. Stein also supports our inpatient hospital and clinic services. He provides trainings for multiple populations working with youth, ranging from special education teachers experiencing burnout to athletic directors seeking suicide prevention strategies.
To learn more about QPR training, visit the website here.