Question, Persuade, Refer: An Argument for Expansion of QPR Suicide Prevention Training

Note: This article is about suicide prevention. If you have been having thoughts about suicide,  please call the National Suicide Prevention Line at 1-800-273-8255 any time of day.

Progress and Tea reached out to me to speak about QPR as it’s a newer process in suicide prevention. In 2015, I observed a presentation about QPR and Veteran suicide, and I found the information highly information and necessary given the national and veteran suicide statistics. The Veteran suicide rate in 2014 was at twenty a day (VA Fact Sheet, 2016). Additionally, suicide was the 10th leading cause of death among all age groups in the United States, according to the CDC’s “2015 Facts at a Glance.”

QPR stands for Question, Persuade, and Refer, and it is meant as a gatekeeper training! What does that mean? Originally, this process was designed for people who are more likely to interact with individuals who are feeling suicidal; however, considering the statistics I mentioned in the opening paragraph, I believe everyone can benefit from this training. This article will be a quick and dirty overview because I am not a qualified QPR trainer. Nevertheless, I encourage you to look out for trainings near you, and if there are none scheduled, advocate for a training to come to your nearest school, library, work, or community center. Communities as a whole will benefit from it (Quinette, 2012). Let’s begin by breaking down the acronym.

Question: Ask the question and be direct about it. Unfortunately, I have heard from others and in many of my classes that some believe that if you talk about suicide, it will make people think about it. However, this isn’t a topic we should shy away from. The question I typically ask is: “Are you thinking about suicide?” It’s scary to ask because often we are scared of the answer.  However, if we don’t directly ask, we often get vague, suicidal statements that aren’t clear to both parties and do not clarify what someone is thinking (Quinette, 2012).

Persuade: This is the harder part as it’s a skill that you likely won’t gain just by reading an article. That’s why attending a training will vastly benefit you! If you suspect the person is suicidal, you have a moral duty to get that person help. Persuade is about convincing the individual having suicidal thoughts to seek the appropriate care and services. It may be impossible, no matter what you offer to persuade them to get help. At that point, I recommend you contact professional resources to get help if you feel their suicidal threat is serious. Ask for police or a social service crisis team to come assist you with getting the person who is feeling suicidal appropriate services. This is jumping to the R of QPR, but Quinette (2012) refers to it as the reluctant referral.

Refer: Refer is the final part, as there is likely a need for immediate intervention as well as ongoing care and services to continue suicide prevention. In this stage, you may offer to go with the individual to the hospital and sit with them while they wait, or you call the local crisis line with them to get them referred to appropriate county services.

While there are overall a multitude of places to refer them to, small towns have fewer resources and individuals may be more hesitant to seek and expect help in towns where everyone knows everyone. Also, places with fewer resources may have a waiting list to get help—the wait may be significantly longer than the individual can wait. This makes this the weakest part of QPR as we cannot control our community’s resources, although we can advocate for improved resource allocation from our community leaders and elected officials. This is why I really wanted to write this article and why I think it is important overall. Readers will be from varying parts of the state and maybe beyond. If you are reading this article and you know your community is weak in mental health services, I implore you to work on ensuring that QPR training is brought to your area. Organize to get as many individuals from the community to attend to increase community competency. Also prior to the training, coordinate with the resources that your community does offer to ensure your providers in the community are ready for immediate referrals (Quinette, 2012).

A month ago, calls to the National Suicide Hotline spiked after Logic’s VMA performance. It was a sign of what QPR has been emphasizing: increasing awareness can increase prevention (Tinker, 2017). Additionally, after the TV show 13 Reasons Why came out this year, there was a rise in suicide searches on the internet. This was concerning to health care professionals because the show did not publicize resources for viewers to reach out to if they were feeling suicidal, and some felt that this show glorified the act of suicide (Howard, 2017). Nevertheless, suicide is being talked about more, and as awareness is increased, we also need to increase people’s abilities to respond. Just as I had a CPR portion in health class while growing up, I think a QPR portion would be an appropriate addition to increase competence within the community.


Centers for Disease Control and Prevention. “Suicide: Facts at a Glance,” 2015.

Howard, Jacqueline. "'13 Reasons Why' Tied to Rise in Suicide Searches Online." CNN. July 31, 2017. Accessed September 16, 2017.

Quinnett, Paul. "QPR Gatekeeper Training for Suicide Prevention: The Model, Theory and Research." QPR Institute, (2012): 2-54. Accessed September 16, 2017.

Tinker, Ben. "Calls to Suicide Prevention Hotline Spike After VMA Performance." CNN. August 29, 2017. Accessed September 16, 2017.

Veteran Affairs. “VA Suicide Prevention Program Facts about Veteran Suicide,”  2016.


About the Author

Chantelle Robertson is a Licensed Professional Counselor in the state of Wisconsin. She obtained her Masters from Alverno College in 2015 and her undergraduate from the University of Wisconsin–Platteville in 2012. Chantelle has always been drawn to helping careers; in 2010 she obtained her EMT license and has kept that license active, working intermittently as an EMT. In 2013, Chantelle started her career path in Case Management, where she advocates for individuals who are diagnosed with mental illnesses.