Sunday, March 26, 2023

Prevention of suicides during Covid-19 crisis with QPR technique


By Dr Pooja Mohanty

The deadly second wave is making people vulnerable to fear panic and anxiety leading to attempt to suicide as a way to escape the mental pressures. During this lockdown India has seen numerous suicides. We are seeing a surge of suicides during the second wave.

These disturbing numbers reinforce the need for suicide prevention programmes to be pursued more persistently. The mental health practitioners emphasize on dissemination of suicide prevention programmes for all sections of people in the society. One such successful evidence based programmes are QPR gatekeeper training programmes.

Both CPR and QPR are interventions. CPR (Cardiopulmonary Resuscitation) is an emergency medical intervention for people who face cardiac arrest and constricted breathing. This procedure helps families and friends as gatekeepers to stabilize patient before they can report to the hospital emergency department. Similarly QPR (Question, Persuade, Refer) is an emergency mental health intervention for suicidal persons created in 1995 by Paul Quinnett. QPR programmes follows 3 steps.

(1) Question the individual’s desire or intent regarding suicide,

(2) Persuade the person to seek and accept help, and

(3) Refer the person to appropriate resources.

Both interventions are a part of “Chain of Survival” designed to increase chance of survival in the event of crisis.

QPR ‘Gatekeeper Training’ for suicide prevention is a preventive educational program designed to teach “gatekeepers” the warning signs of a suicide crisis and how to respond.  Gatekeepers can include anyone who is strategically positioned to recognize and refer someone at risk of suicide (e.g., parents, friends, neighbors, teachers, coaches, caseworkers, police officers). Logical locations like schools, colleges, educational campuses, and offices should inculcate these training programmes as a part of learning programme to make their zones friendly places for mental health wellbeing and assure teamwork in the same.

QPR gatekeeper training programmes are flagship suicide prevention training progammes which help in increasing awareness on misconceptions in society about suicide and alarming oneself with facts to dispel such myths. The programmes are inclusive of psychological assessments, knowledge, risk factors, warning signs, basic interviewing skills and the questions need to be asked for detailed assessment.

Most people thinking about suicide are suffering from not being able to reach out or ask for help. Impulsivity, hopelessness, negative thought patterns and attribution styles are variables connected with high suicide completion rates. Suicide ends with the continuum that generally begins with suicidal ideation, threatening, suicidal planning, attempt, preparation of the final act and finally completion. As gatekeepers we need to intervene into this continuum and recognize the warning signs. The sooner warning signs are detected and help sought, the better the outcome of a suicidal crisis will be. Early QPR helps in asking someone about the presence of suicidal thoughts and feelings opens up a conversation that may lead to a referral for help. Seriousness of suicide depends on the specificity of suicide plan and the degree of intent. It’s important to break this continuum, increase the chain of survival, identify sadness leading to sorrow, and be finally able to save a life.

(Dr Pooja Mohanty, (PhD NIMHANS) Fellow (Oxford University, UK)`Psychotherapist, XLRI, Jamshedpur. She is a certified practitioner of Suicide Prevention and mindfulness-based stress reduction programmes for depression. The views expressed are personal opinion of the author.)

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