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‘Paying attention saves lives’

CCHS holds QPR seminars on strategies to reduce death by suicide

Mick Collias gave presentations on suicide prevention and mental health Thursday at the Creston Community High School auditorium.
Mick Collias gave presentations on suicide prevention and mental health Thursday at the Creston Community High School auditorium.

“Suicide is preventable up until the last second,” Mick Collias of Crossroads Behavioral Health Services said during his QPR presentation Thursday at Creston Community High School.

QPR stands for “question, persuade, refer” and is a method for nonprofessionals to help dissuade those who are considering suicide. Collias said QPR is not counseling or treatment; it is intended to offer hope and a path to treatment. Those who look out for signs of suicidal ideation are often called “gatekeepers.”


Before QPR can be effective, the helper must be able to recognize the cues given by those who are considering suicide.

A direct statement of intent is rare — especially among teenagers. They are more likely to express their feelings in code: “I just want out;” or “I’m not going to be a problem any more.”

Behavioral clues such as stockpiling medication, acquiring a gun, giving away possessions, or unexplained anger or aggression can be signs that someone is in trouble. Collias also said that perfectionism can be a symptom of someone who is struggling to manage their emotions.

Situational cues include sustaining a recent loss — especially if it involved suicide, receiving a diagnosis of a serious illness, or being the victim of bullying.

Once a gatekeeper has identified that a person is considering hurting themselves, QPR is an effective way to prevent death by suicide.


Most important in the QPR method, Collias said, is asking the question in the first place — asking if the individual is thinking about harming themselves.

“How you ask the question is less important than that you ask it,” he said. “You don’t have to ask it perfectly.”

Collias did say there are some inappropriate or ineffective ways to ask a person if they are considering suicide. Sounding judgmental could turn the person away from help. Framing the question as a negative, i.e. “You’re not considering suicide, are you?” invites a quick no rather than requiring the person to answer.

He gave examples of both direct and indirect ways to ask the question.

• Are you thinking about killing yourself?

• Do you ever wish you could go to sleep and never wake up?

Collias stressed that any answer to these types of questions that isn’t a firm “no” is actually a “yes.” If the person says, “Not today,” or hesitates with “um’s” or “well...” they have definitely thought about suicide.

He also debunked the myth that talking to someone about suicide may put the idea in their head.

“You either are thinking about suicide, or you’re not,” Collias said.


The second part of QPR is to persuade the person to get help. Collias said the best way for a helper to do this is to ask if the person will go with them to a counselor. Second best is to offer to make an appointment for them.

Because there is often a gap between making an appointment and being seen by a mental health professional, Collias suggested creating a social contract with the person.

“Will you promise you won’t do anything to hurt yourself until you see the counselor?” is an example of an effective way to accomplish this.


Refer goes along with persuade in involving a professional. This can be a mental health center, an ER or a school counselor. It is important to get someone else involved, Collias said.

He also explained that most mental health centers and emergency rooms have a walk-in policy in effect where they will make sure an individual in crisis will be seen that day if it is an emergency situation — if the patient is in immediate danger of harming themselves.

Knowing the signs of suicide and how to react can prevent suicide, Collias said. Where QPR is taught, suicide deaths go down.

“Paying attention saves lives,” Collias said.

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