The suicide rate in the United States has risen 35% in the last two decades. It’s a major public health issue.

In Colorado, 1287 individuals took their lives in 2022. That’s more than the number of deaths by motor vehicle and homicide combined. Men accounted for 997 deaths, compared with 290 deaths for women. El Paso County has the highest number of suicides with 189.

Every day in UCHealth’s 14 hospitals, providers are caring for patients who have attempted suicide. To help prevent suicide from happening, UCHealth offers a free, gatekeeper training called QPR. Question. Persuade. Refer.

The free training program is designed to teach people how to talk to a friend, family member or co-worker who may be considering suicide, and to ultimately reduce the number of suicides, which take a staggering 48,000 lives annually in the United States, according to the Centers for Disease Control and Prevention.

So, what should you do if your friend, family member or co-worker drops a few hints that they’re thinking about suicide? Or they’ve deeply withdrawn from activities that bring them joy? What should you do if you see a dramatic shift in a person’s behavior?

Start asking questions, says Robin Schawe, a licensed professional counselor at UCHealth, who offers QPR training.

In recent months, Schawe and UCHealth have been encouraging all employees to take the QPR training and it is offered for free to community members, businesses, churches, police officers, firefighters. Anyone. The trainings can be in-person or virtual.

It’s one of the many ways that UCHealth extends care outside the walls of hospitals and clinics and into communities.

“It’s been really beneficial,’’ Schawe says.

UCHealth has received grants through Zero Suicide to pay for booklets and materials to provide the trainings, which are aimed at saving lives and preventing the sheer despair that accompanies any suicide.

“Statistics say that every time a suicide happens, 150 people are affected by it – family, friends, teachers, health care providers, you name it, they’re affected,’’ Schawe said.

As part of follow-up care, UCHealth sends follow-up notes to hospitalized patients. A recent card from Schawe read: “It has been a few days since you were in the hospital and I hope you are doing better. This card is to remind you that you are not alone. Please let me know if you need extra support or resources.’’

UCHealth Today asked Schawe to walk us through QPR training. Just as millions of people have become familiar with lifesaving CPR, Schawe is intent on people learning QPR to reduce suicides.

What is QPR training?

It’s a way to learn how to talk openly and honestly to an individual contemplating suicide in three simple steps:

Question: If you notice a dramatic shift in another person’s behavior, or if the person has dropped hints about suicide, begin the conversation by saying: “I’ve noticed that your behavior has changed a lot from how you used to act. What’s going on?’’ Schawe says. “Start by just asking questions and not being afraid of the answers.’’

Persuade: If a person indicates they’re suicidal, persuade them to get help.

“What we know is that a lot of people who feel like they are suicidal don’t feel like they deserve the help. So, how can we get them to seek help? The best thing to do is to go with them to a medical or mental health provider.

“If they’re not willing to get the help, it’s a matter of calling 911,’’ Schawe said. “It’s not to get them in trouble but to check their welfare. Where available, you can ask for a co-responder unit (a law enforcement officer who is paired with a mental health counselor) because that is their job to go out and assess and figure out what is best for this individual.’’

Refer: Help the individual find a place where they can receive mental health treatment.

“It’s a matter of reaching out and asking for help,’’ Schawe said. “There is a perception in Colorado that there are limited services for mental health care. Colorado definitely doesn’t have as many resources as we need, but we’re getting better. It’s a matter of finding the right resource for that person. I am happy to help any person in the community who needs help with that.’’

Schawe said it is important for the individual considering suicide to reach out.

“Many times we have family members reaching out and asking for help for the individual but a lot times, until the individual reaches out, there’s not much we can do. A lot of it comes down to a person hitting rock bottom, and when they see where they’re at, they ask for help.’’

What are the warning signs that someone is suicidal?

During QPR training, Schawe and other behavioral health experts train people to recognize warning signs.

“When we think of warning signs we typically think of them as verbal, but what we really know is that there are behavioral signs, there are situational signs, but whether a person verbalizes ‘I’m going to kill myself,’ that is not always the case.

“A lot of times, verbal signs are indirect, so it is important to ask questions.’’

• Take notice and ask questions if you see a person withdrawing from friends, family or people they love, or if a person has stopped doing daily living activities, such as bathing, brushing their teeth, eating, etc.
• Be aware when someone decides to “get their affairs in order.’’ This is situational. If a person is middle-aged and preparing a will or a trust, that’s most appropriate. If a 23-year-old, out of the blue, starts giving away personal belongings, cleaning out their space, those are warning signs.
• If a person goes out to purchase a weapon, be aware. Again, this is situational. If an avid hunter came home with a new gun, that wouldn’t be alarming. But it would be concerning if someone who doesn’t like guns, doesn’t own a gun, and doesn’t hunt purchased a gun. If you have concerns, ask questions. Show the person that you care.

Though people may think of committing suicide for a long time, suicide is ultimately an impulsive act? Is that correct?

“What we are learning is that there is about a 10-minute window of increased impulsivity and increased risk taking,’’ Schawe said. “So we may see patients who live with suicidal ideation their whole life but there is a 10-minute window when they actually attempt.

For people with suicidal ideation, we talk to them about what means they’re thinking of. If there are firearms in the house, we tell the family to lock the firearms in one lock box and the ammunition in another lock box.

“The hope is that the individual will not be able to get into either and they won’t have what they need to complete it,’’ Schawe said.

What sort of precautions can you take to try to prevent suicide?

• Lock up firearms and ammunition in separate places
• Lock sharp instruments, including kitchen knives, in a secure place. Use them when needed but secure them in a safe place after use
• Lock up all medications

Does a person always exhibit a change in behavior before suicide?

Not always. And the behavior does not always manifest in symptoms of withdrawal, Schawe said. Sometimes, a very quiet person can be giddy or euphoric, taking a dramatic turn in behavior.

“A lot of times, we see some very aggressive behavior and erratic behavior, and instead of just assuming, ‘Oh, they had a bad day,’ we need to be asking questions about what’s going on,’’ Schawe said. “Ask them, ‘Hey, what’s going on?’ As a society, we don’t ask those questions. Everyone just seems to mind their own business and does not want to get involved with anybody else. We need to get involved.’’

Is there a crisis before a person makes plans to die by suicide? Is suicide typically triggered by a specific event?

Sadly, 45% of individuals who die by suicide see a health care provider one week prior to a suicide attempt.

“That’s why we at UCHealth try so hard with depression screenings when a patient comes to the hospital or visits an outpatient primary care clinic. We’re also in the process of adding depression screenings in other areas, including outpatient physical therapy and oncology,’’ Schawe said.

UCHealth has invested more than $150 million in behavioral health services to address a widening mental health crisis.

Four years after UCHealth announced the investment, concrete programs have been built across the state. Solutions include:

• Integrating primary and behavioral care in dozens of clinics
• Connecting patients by video to behavioral health services
• Expanding the number of inpatient psychiatric beds
• Developing a pipeline to bolster the behavioral health workforce
• Pairing behavioral health professionals with local law enforcement to assist people in crisis

What are some other things to consider regarding warning signs of suicide?

One reason people don’t talk about it is there remains a negative stigma about talking about it. One of the biggest myths is that if you talk to someone about suicide, you’ll put the idea in their head and they’ll do it. If they’re not already thinking about it, you’re not going to put that in their head.

“Also, one of the red flags we look for is whether a family or friend has had some one in their life end their life by suicide. If so, they are much more likely to do the same. The likelihood of someone else in the family doing it is very high.’’

Addiction to drugs and alcohol is also a factor.

“At least 90% of the time when we get someone in the hospital who has attempted, they are battling an addiction,’’ Schawe said.

UCHealth is building partnerships in communities to break the stigma about suicide and mental health problems.

Since UCHealth began offering QPR training in April 2021, more than 1,342 staff members at UCHealth’s southern region have received the training and another 610 community members have been taught QPR.

Trainings have been held for many community partners, including law enforcement, churches, schools and nonprofit organizations.  At least 8,783 notes of encouragement have been sent to patients.

“We want people to know that we are deeply committed to reducing the number of suicides in Colorado, and we encourage people to learn more about QPR, so they can be prepared to have conversations with people they know,’’ Schawe said.

If you would like to attend or host a free QPR training, please contact Robin Schawe and [email protected]