Suicide Prevention Month is over, which means we will no longer see Instagram posts advising people on different ways to reach out to friends if they are in need or messages urging you to take time off for self-care or to seek out a therapist. Fortunately, NC State still offersQPR (Question, Persuade and Refer) trainingsto educate students, faculty and staff on recognizing the signs of suicide, which includes facilitated dialogue to help students become more comfortable with talking to friends who may be contemplating suicide.
A few months ago, I went to a virtual QPR training for the first time. While I found it especially useful for starting the conversation surrounding suicide, the problem with QPR trainings, and suicide prevention in general, is that it tends to stop at the “refer” part. According to data from the Centers for Disease Control and Prevention, about 0.9 % of college students attempt sucide each year. While this may seem like a small number, the lack of resources and education for students who do attempt suicide is shocking.
The problem with suicide prevention messages is that most are directed at the students who may be considering suicide or have suicidal thoughts but not the 1% who have already attempted. This is problematic because, oftentimes, students who attempt suicide do not just magically return to a state of mental well-being. While some students may transfer or drop out of school following an incomplete attempt, many continue going to school and participating in academic and campus life, but they may still be experiencing suicidal ideation.
There is an analogy which describes the problem with suicide prevention messages: Most target the “upstream” population, which refers to the majority of people who may struggle with mental illness but are unlikely to attempt suicide, while neglecting the “downstream” population, who are most at risk of suicide. Messages like “it gets better” and “you’re not alone” are all important for everyone to hear, but, as I’ve discovered from personal and secondhand experiences, these messages are not very helpful for someone who has already made a plan for ending their life.
Usually, when a student goes to the Counseling Center for a walk-in appointment, the counselor will help them make a safety plan. A safety plan consists of triggers, such as what kinds of things contribute to or increase their suicidal thoughts; coping skills, or things they can do in the moment to return to a calmer state; as well as steps to take if the crisis becomes too severe. For students who already have a safety plan, it makes sense to practice implementing their safety plan to prevent a future suicide attempt.
This is where QPR training and other forms of outreach can really be helpful. We need to support at-risk students in following and using their safety plans, as well as give information to friends, roommates, resident advisers and anyone who might come into contact with these students so that they can be of help the best they can. We need to do more to support students who have already attempted suicide or who have been hospitalized for psychiatric reasons.
In this virtual world, that could mean giving students support on creating an in-depth safety plan that involves friends and family members. It could also mean providing information sessions onmeans reduction, which has proven to be most effective in preventing suicide among those with acute ideation. It could be helpful to designate QPR training specifically for friends of students who have been hospitalized, as paper support is critical in preventing future attempts. We also need to do more as a community to remove the stigma around hospitalization. I found it a little strange that hospitalization was not mentioned at all during the QPR training.
The problem with suicide prevention on campus, and in general, is that targeting the general population takes away time and resources that could be spent addressing the unique needs of the students who are most at risk. Of course, self-care, destigmatizing mental illness and learning to talk to your friends about suicide is important for everyone to know about. However, addressing only the “upstream” population leaves out those who are the most vulnerable and actually furthers the stigma around severe mental illness and psychiatric hospitalization by pushing these issues aside.
While I think everyone should go to a QPR training, this is only the bare minimum. To effectively prevent suicide, we need to understandthe difference between passive and active suicidal ideation and how to recognize the signs of both. For those who do experience suicidal ideation or know someone who does, it is important to know about involuntary commitment versus voluntary commitment, and have a plan for what steps you will need to take if you choose to go to hospital. While suicide prevention messages and QPR training are great, they only address the surface of the problem; helping the most vulnerable requires all of us to do a little bit more.