After a suicide, there are often those who blame themselves.
They saw something wrong. They didn’t know what to say. They didn’t know how or where to get help.
These survivors are left with unspoken guilt and pangs of regret.
Thousands of Missourians are breaking this cycle of regret by becoming gatekeepers.
Gatekeepers is a suicide prevention program that goes into schools, offices and community centers to teach suicide prevention. The program teaches participants to question someone they suspect of having suicidal thoughts, to persuade the friend or loved one that there are professionals who can help and to refer the at-risk person to such services.
It’s called the question, persuade and refer technique, or QPR.
“It’s kind of like a CPR course for suicide,” said Joseph Parks, director of the state Department of Mental Health. “We are teaching people how to intervene in very critical situations.”
The QPR technique was developed in 1999 by Paul Quinnett, a Washington state psychiatrist. The technique has been taught in 40 states to more than 250,000 participants.
In Missouri, there are an estimated 25 suicide attempts for every completed suicide and there are an estimated 7,000 attempts each year, according to the Missouri School Web Project, an online teaching resource for teachers.
In 20 years of practicing psychiatry, Parks said he has never seen a person attempt suicide because someone expressed concern.
“It’s better to err on the side of letting someone know you’re concerned,” he said.
Suicide prevention programs began in Missouri in 1844 after Gov. Thomas Reynolds committed suicide while in office. His death led to the creation of the state’s first mental hospital.
Missouri’s Gatekeepers program began last year after the approval of a bill sponsored by Rep. Todd Smith, R-Sedalia, and Rep. Connie Johnson, D-St. Louis, calling for improvements to the state’s suicide prevention plan.
Smith lost his brother to suicide in 2002.
The state Department of Mental Health and the Department of Health and Senior Services worked with a panel of 10 Missourians to redraft the plan. At 14 Town Hall meetings across the state, citizens were asked their opinion of the new prevention plan. The responses surprised government officials.
“People wanted training and instruction on what they could do to help prevent suicides,” Parks said.
Debbie Meller was one of those people. Working as Parks’ secretary, she couldn’t leave her work at the office.
“I wanted to do more and was extremely interested in helping people learn how to deal with suicide,” she said.
So, Meller began teaching Gatekeeper classes.
Meller works to dispel myths that she says many hold about suicide.
“People have heard that once a person decides to commit suicide nothing can be done to stop them,” she said. “That’s not true.”
Suicide is the most preventable kind of death, Meller said.
The Gatekeeper handbook says if a person gets the right help during a crisis situation, they are less likely to attempt suicide again. But to prevent a suicide, those who suspect a problem must ask the right questions, and for many this is the most difficult step.
Elizabeth Makulec of St. Louis works in Missouri schools to help students feel comfortable confronting their peers.
“Kids are the best gatekeepers because they spend the most time together in different activity levels,” said Makulec, executive director of the program Kids Under 21.
Nationally, suicide is the third leading cause of death for people ages 15 to 24. “Kids don’t have the coping mechanisms to realize that what happens today can be very different from what happens tomorrow,” Makulec said.
School officials are realizing that they need to give more consideration to coping skills and mental health, she said. If they don’t, students won’t develop the social skills and emotional capabilities to handle the pressures of adult situations.
At Hickman High School, a team of 44 student Gatekeepers, called the Kewpie Care Team, instructs teachers and students in the QPR techniques.
“We still live in a society where mental health issues are not looked on in a positive light and many students don’t seek treatment because of the stereotype of depression,” said Maria McMahan, who runs the program at Hickman.
“The peer educators are working to break down the barriers of the stereotypes and get people educated and talking about depression,” she said.
Missouri’s suicide rate decreased in 2003, said Parks, who partially attributes the decline to the QPR program.
“We are making people aware of the scope of the problem and letting people know that you can make a difference in someone else’s life,” he said.
For more information about Missouri’s QPR program call 573-751-2794.
Call 800-SUICIDE for the national suicide hotline.