When in doubt, ask.

That’s the message those attending the QPR suicide prevention training Thursday learned.

About 85 people attended one of five sessions at Good Shepherd Medical Center, where they learned how to identify signs of someone who may be at risk for suicide, and learned methods for de-escalating the situation and referring them to someone who can help.

The training, called QPR, stands for “Question, Persuade, Refer” — the three steps that people can take to help a person they think may be suicidal.

Trainings were led by Umatilla County Health Prevention Education Coordinator Amanda Walsborn. It included information about how to recognize warning signs as well as a role-playing session.

Walsborn led the class through an exercise where they were asked to recognize myths and facts about suicide. A common myth, she said, is that talking openly with someone about suicide will put the idea in their mind.

“It’s a really common fear,” Walsborn said. “But the majority of folks feel relieved that someone has recognized they’re suffering, and cares enough to reach out.”

She added that someone is either thinking about suicide or not — another person cannot put the idea in their mind.

QPR, she said, is comparable to CPR in that it allows laypersons, rather than health professionals, to help someone in crisis.

“It’s a brief intervention, and most people will refer those at risk to a provider for ongoing treatment,” she said.

Walsborn noted that Umatilla County over the past decade has averaged about 12 suicides per year. In 2016, she said, that number jumped to 16. Oregon has one of the higher suicide rates in the U.S., coming in at 12th. States with the highest rates were Alaska, Wyoming and Montana, and the lowest rates were in New Jersey, New York and Washington, D.C.

Walsborn said the rates likely are related to population density, as well as the availability of providers.

“They may be in major metropolitan areas where they can walk to a doctor’s office,” she said. “We don’t have that here, and certainly not in Alaska.”

She said that while availability of providers does heavily impact people’s ability to receive mental health treatment, it’s an obstacle that can be overcome by training civilians knowledgeable about the QPR process.

“It’s important to have individuals trained as suicide prevention gatekeepers,” she said.

Walsborn reviewed some clues people can look for to determine whether someone may be considering suicide. She said those clues can be verbal, situational or behavioral, and direct or indirect.

Many behavioral clues, she said, will include previous suicide attempts, stockpiling guns or pills, moodiness or depression, putting personal affairs in order, or drug and alcohol abuse or relapse.

Situational clues often include experiencing some type of loss, whether a financial setback, death of a loved one or an unexpected loss of freedom or fear of punishment.

Walsborn noted that it’s important to watch people for signs of abnormal behavior — which may be different for different people.

She recalled a student in Pendleton who was typically unruly and didn’t do homework or participate in class. The student came back one weekend, and was subdued, doing her work and not making a scene in class.

“Thank goodness her teacher noticed and took action,” Walsborn said. “She was able to communicate to the student some resources — she was experiencing some behavioral health issues, and was likely at risk for suicide.”

Walsborn had the students role play some scenarios where a person might be at risk for suicide. She encouraged the person asking to be direct with their questions.

“You want to be very clear and intentional with your questioning,” she said. “If you’re in doubt, don’t wait to ask. Talk to the person alone in a private setting, and give your full, undivided attention.”

She added that the person asking questions should be careful not to ridicule, or imply that thinking about suicide is stupid.

“You’re setting them up for a ‘no’ answer,” she said.

Then, she said, listeners should offer their help, and refer the person to a provider who can assist them further. Ideally, she said, take the person directly to someone who can help them. If that’s not possible, call and make an appointment for them.

Juli Gregory, the hospital education coordinator, said this was the first QPR training that Good Shepherd has hosted.

She said it was a good introduction, and that many in the health field don’t even know the correct way to respond to those who may be suicidal.

“I think (Amanda) kind of nailed it. Suicide has affected most of our lives — it has in mine,” she said.

She was happy to see a mix of community members and hospital employees at the training.

Erin Stocker, the Human Resources director for the Morrow County School District, was at the training with her 14-year-old son Tyson, and her mother Barb Gibbs, a licensed practical nurse at Good Shepherd. She said she was glad to receive the training to be able to support staff and students.

“I think it’s good to be able to identify classmates or help anyone in that situation,” Tyson said.

Gibbs said she was at the training not as a nurse, but as a community member.

“I’m at a loss to help,” she said.

Stocker said the subject of suicide is uncomfortable to discuss, but she hoped talking about it through trainings like this one would provide some resources, and some relief.

“If we do talk about it, there’s only one outcome — the improvement of the crisis we’re facing in our society with this type of thing.”

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