What city would you want to have a heart attack in? The answer is Seattle, which has more CPR-trained people per capita than any other U.S. city.

Mental health professionals hope that one day QPR training will be just as prevalent in cities throughout the country. QPR stands for Question/Persuade/Refer, which provides a strategy to interrupt people with suicidal ideations and save lives.

Just asking “the question” about a person’s intent to attempt suicide is often enough to open a bridge of communication to stop what often is a short-term crisis and protect the lives of others.

QPR is not counseling or treatment; it is a strategy to offer hope through positive action. Those who learn QPR become “gatekeepers” who recognize the warning signs, clues and suicidal communications of those in crisis and use QPR skills to prevent a tragedy.

Professional caregivers, police officers, firefighters, religious leaders, school counselors, nurses, coaches, teacher, youth leaders, paramedics, case managers, and volunteers or paid staff in the many different human service organizations all likely are in contact people with suicidal thoughts at some point. As trained QPR gatekeepers, they can help reduce deaths by suicide.

Since QPR is based on a foundation of knowledge, compassion and understanding, the intervention strategy may also help detect a wide range of personal problems that need professional assessment and treatment before they reach suicidal thoughts and feelings.

QPR is simply “planting seeds of hope” in a person in suicidal crisis, said according to Partners Health Management QPR trainer Jeanne Patterson.

Patterson cited a study of folks prevented from jumping off the Golden Gate Bridge and who then received a mental health diagnosis and treatment. Researchers found that 95 percent of these people did not have another suicidal crisis in the next 12 months.

What that means, Patterson said, is that if we can stop them — even for a short time, the impulse to take their lives may pass with time and professional help.

Researchers also interviewed 34 Golden Gate Bridge suicide attempt survivors. All of them said that from the moment they left the railing, they regretted jumping and realized they did not want to die.

Of the more than 2,000 who have died by suicide at the bridge before they could be stopped, Patterson asked, “I wonder how many had the same thought?”


In 2020, the CDC said that 45,979 people died by suicide in the U.S, making it the 12th leading cause of death. Even more disturbing is that for every completed suicide, researchers estimate there are 25 attempts.

That means with nearly 46,000 thousand documented suicides in 2020, an estimated 1,150,000 survived an attempt to take their lives.

In 2020, suicide was the 13th leading cause of overall deaths in North Carolina, which ranked 37th nationally with 1,441 succumbing to suicide.

However, North Carolina’s young people are falling into suicidal ideation at a frightening level. Death by suicide was the second leading cause of death for 25- to 34-year-olds, the third leading cause of death for ages 10 to 24, and fourth leading cause of death for ages 35 to 44.

The populations most at risk for suicide are LBGTQIA+ youth, African-American youths, indigenous peoples and Alaskan natives, military members /veterans, and members of law enforcement.

Nationally, a total of 6,062 15- to 24-year-olds died by suicide in 2020.


One death by suicide creates huge ripples throughout families and communities. For each, 135 people are exposed to the suicide, with 53 experiencing a short-term life disruption, 25 a major life disruption, and 11 suffering devastating effects from the act. The impact is more severe in small, tight-knit communities, including schools.

The risk of a suicide attempt is also greater after a friend or relative dies by suicide. The children of a parent who died by suicide are four times more likely to attempt suicide.

With almost 46,000 suicides each year, over 1 million are by affected or experience significant life disruptions.


Several myths relating to suicide need dispelling, according to Patterson. A person in a suicidal crisis is not necessarily always going to be suicidal; in fact, most are not.

Asking someone if they are thinking about suicide will not increase the risk they will follow through. In fact, asking them lowers their anxiety and the risk of follow-through, opens communication, and shows you care and want to listen and help.

Just asking “the question” may actually stop the crisis thinking.

A person does not have to be a professional counselor to help a person in suicidal ideation; anyone can help by listening, caring, and getting the person to help.

Another myth is that suicidal people hide their intentions. Conversely, most give signs, behaviors, and indirect or direct communications signaling their plans.

Others mistakenly believe if a person talks about suicide, he or she will not follow through. Talking about ending their life is actually a clear sign they may attempt self-destruction.

A final myth is that nothing can stop a person who has made the decision to take his or her life.

Patterson emphatically declared that belief is wrong — that “suicide is the most preventable form of death. Almost any positive action you take can save a life.”


The first step in helping possibly suicidal people is to ask if they are thinking about taking their lives. Take all signs of suicidal crisis thinking seriously, understanding that the more signs there are, the more risk there is of an attempt.

These signs can be direct verbal statements of the desire to end their lives or indirect statements about being tired of life or that others would be better off without them.

Behavioral signs include previous attempts, depression, acquiring a weapon or other means, moodiness, hopelessness, putting affairs in order, giving away possessions, drug or alcohol use or relapse, or unexplained anger, aggression or irritability.

Sometimes situations may cause suicidal ideations to occur, according to Patterson, including being fired or expelled, an unwanted move, a loss of a relationship, the death of a spouse, child, or best friend (especially if by suicide), a terminal illness diagnosis; an unexpected loss of freedom or fear of punishment; an anticipated loss of financial security; the loss of a cherished counselor, teacher or therapist; or a fear of becoming a burden on others.


Patterson said to remember that asking the question is the most important thing. “There is no perfect way to ask,” but avoid the term “commit suicide” in the question.

Tips include:

♦ If the person seems in imminent crisis, ask the question directly.
♦ If the person is reluctant to talk, be persistent. Continue asking.
♦ Talk to the person in a private setting.
♦ Let the person know you care and let them talk freely without expressing judgment or opinions.
♦ Allow plenty of time to talk and listen — time gives the person the opportunity to get out of the crisis thinking spiral.
♦ Have resources handy before you talk to the person, if possible — a suicide hotline number in your phone (1-800- 273-TALK (8255) or the new 988 number), phone numbers of supportive friends or relatives, counselor name, etc.)

If the direct question is too difficult, the questioner can use a more indirect approach. Ask if they have been unhappy lately, if they ever wished to go to sleep and not wake up, or if they are thinking about hurting themselves.

Avoid adding judgment words to the question, such as: “You’re not thinking about suicide, are you?” or “You wouldn’t do anything stupid, would you?” These kinds of questions close rather than open communication or sharing and also indicate a reluctance to hear the real answer.

If you cannot ask the question because you feel too close to the situation or cannot find adequate words, get someone else who can immediately.


After asking the question, most people want to talk, so being a good listener is crucial. Listening is a great gift because it takes time, patience, and courage. Give your full attention, don’t interrupt, and speak only when the other person is finished. Avoid judgment or condemnation.

The goal is simple — to get the person to agree to get help in some form. This means a visit with a counselor, priest, minister, school nurse, psychologist, or whatever professional person he or she is willing to see. Help make the appointment or take them to see someone immediately if in full-blown crisis.

Give the person hope by emphasizing that suicide is not a solution to a problem or pain and collaborate on finding alternative solutions. Focus on healthy solutions while acknowledging the person’s pain and showing respect. Continually offer hope for finding positive solutions and emphasize future possibilities.

Moving to the referral step, ask them to go with you to get help now or ask how you can help them stay safe until help is available.

Efforts to persuade them to some form of help will most likely be met with relief, said Patterson, because they really do not want to die — they just want the emotional pain to stop.

Most feel relief when they can talk about bottled-up feelings and welcome someone else taking the lead in getting professional assistance.

Offering continual encouragement, demonstrating that you want them to live and you’re on their side, and showing that they are not alone is important in their treatment and recovery journey.

To broaden the person’s safety net, ask the person who else he or she would like to know about their feelings. Get others that the person trusts involved to support them.

Creating a support team to go with them to appointments and visit, call, text, and send cards can help them through their time of crisis and treatment and save their lives.

Those in daily contact with the suicidal person can also help with day-to-day problems while they observe and monitor how the person is doing.


Sleep disturbances or excessive sleep, anger, depression, recklessness, drug or alcohol use, and out-of-character behavior can all be signs a teen is in emotional crisis. If they are acting differently, say something. You know your child or friend best, added Patterson.

The most important thing is to trust your gut. If something feels off, open lines of communication, especially by listening to the teen.

Ask what’s wrong and offer help. Ask if they are having thoughts about harming themselves. Most teens just need someone to listen and care to lessen their thoughts of suicide.

Give them a list of contacts and phone numbers of trusted people such as a doctor, minister or counselor or hotlines to call if they start to feel overwhelmed or need to talk.

Express nonjudgmental concern without dismissing their fears or feelings, get them professional help, and get them to a safe environment without means of self-harm. If the situation becomes a crisis, call 911 or take the teen to the ER to get immediate help.


When Abraham Lincoln was a depressed and suicidal young man, his friends asked for his guns and knives. Lincoln himself realized he was not safe with a weapon in his home during his misery. He wrote, “To remain as I am is impossible; I must die or be better, it appears to me.”

After his depression lifted, Lincoln later wrote to a depressed friend, “Remember in the depth and even the agony of despondency, that very shortly you are to feel well again.”

Like Lincoln’s friends, QPR gatekeepers can buy those in crisis the time to rest, get professional help, and heal from the depths of their pain.


For more information about signing up for future QPR training sessions, visit

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