Since his retirement from the U.S. Army after 30 years of active commissioned service, Rich Curasi has been working with Veterans’ issues, and is focusing on Veterans’ suicide. In 2019, one of his professional colleagues told him about the formation of the Missouri Veterans Suicide Prevention Team (MOVSPT) and he has been an active proponent of the team ever since.
More than 25 Missouri veterans, family members and advocates from organizations that support the military community launched the Department of Mental Health program to create a statewide network of certified suicide prevention trainers.
Curasi became a certified trainer in Question, Persuade, Refer (QPR), a course that trains participants to learn the signs of suicide, provide hope for the individual in crisis and find immediate help for that person. The certified trainers go back to their communities and offer this suicide prevention course to others for free.
In 2018, suicide was the 10th leading cause of death in Missouri. For every death by suicide, 25 people survive an attempt. The Missouri Veterans Suicide Prevention Team’s mission is to know the warning signs and use that knowledge to save lives.
“The QPR Institute started from a three-year joint effort between Spokane Mental Health and Dr. Paul Quinnett, the founder, to launch a national suicide prevention training program,” Curasi said. “The QPR Institute became an independent organization in 1999. The MOVSPT started in late summer/fall 2019. It is a unique program of volunteer and certified suicide prevention trainers who are military service members, veterans, military-connected family and organization members.”
While there are a number of suicide prevention methodologies and approaches available, Curasi said the Missouri Department of Mental Health chose QPR, an evidence-based program recognized by SAMHSA (Substance Abuse and Mental Health Services Administration) as the basis for their program.
“QPR itself is not organized by chapters,” Curasi said. “Individuals, affiliated or not with groups or organizations may apply and train to become QPR trainers. The MOVSPT provides no cost QPR training at the request of organizations, groups, enterprises, or individuals across Missouri.”
Those trained in QPR learn how to recognize the warning signs of suicide, how to ask the question about suicide, and how to persuade individuals in crisis to get help and refer someone to care facilities.
According to the U.S. Department of Veterans Affairs 2022 National Veteran Suicide Data Report, the number of Veteran suicides increased on average by 47 deaths per year from 2001 to 2018. From 2019 to 2020, there were reportedly consecutive reductions of suicides, and in 2020, suicide was the 13th leading cause of death among Veterans overall, and the second leading cause of death among Veterans under age 45.
“White males are the most likely to contemplate suicide,” Curasi said. “In 2001, Veterans between the ages of 35 and 54 had the highest suicide rates, among both Veteran men and Veteran women. In 2020, suicide rates were highest among Veterans between the ages of 18 and 34. In 2020, the suicide rate among White Veterans was more than twice the rate among Black Veterans.”
Curasi emphasizes that depression is not the only path to a suicidal crisis, and focusing on depression alone tends to disregard other factors that can contribute to a suicide. Other factors include substance misuse, binge drinking, traumatic stress disorder and traumatic brain injury, mental health conditions such as anxiety disorder and manic-depressive disorder. Higher doses of opioid medications for pain control, insomnia, and even low cholesterol are included in factors that can lead to suicide.
QPR is designed to identify those factors, open a dialogue, provide hope, interrupt the crisis and direct that person to the proper care.
“People trained in QPR ‘Gatekeepers’ learn how to recognize the warning signs of a suicide crisis, learn how to actively question and listen to the individual, learn how to persuade the individual that suicide is not the answer, and then to refer the individual to get help,” Curasi said. “There is a myth that asking someone if they are considering suicide puts the idea in their head. This has been proven false: Asking someone directly about suicidal intent lowers anxiety, opens up communication, provides hope, and lowers the risk of a suicide attempt. Almost all efforts to persuade someone to live instead of attempting suicide will be met with agreement and relief. Taking the lead offers hope, and hope helps prevent suicide.”
QPR training sessions, as well as other mental health-related training, can occasionally activate strong emotions for people that have a close, personal connection to suicide,” Curasi said. “Our trainers are taught to engage with, and support someone who may be evidencing difficulty with the training content. MOVSPT trainers are the last ones to leave a training event and remain available to answer any personal questions and to assist them with connecting to care, if needed.”
For many reasons, Curasi said that military members are the most difficult for QPR trainers to reach, given military health programs, geographic locations and other access restrictions.
“A more responsive target population is the community that surrounds military members, veterans and their families,” Curasi said. “Military, Veterans, family members and associated personnel who have attended our Gatekeeper Training sessions have all responded positively to the training, with descriptions such as ‘instructive,’ and ‘eye opening.’”
For people in distress, QPR is an excellent way for them to know they no longer have to bear their pain alone. The course is built on that basis and emphasizes that aspect when engaging with individuals in crisis.
“Course follow-up materials and Dr. Quinnett’s book, ‘Suicide: The Forever Decision’ strongly reinforce this point,” Curasi said. “MVSPT provides these materials, to include the book, free of charge.”
When confronting someone who appears to need help, the content of the approach, as well as the attitude of the speaker contribute to the success of the engagement.
Curasi provided some examples of questions to ask:
“Have you been unhappy lately?”
“Have you been very unhappy lately?”
“Have you been so very unhappy lately that you’ve been thinking about ending your life?”
“Do you ever wish you could go to sleep and never wake up?”
“You look pretty miserable, I wonder if you’re thinking about suicide?”
“Are you thinking about killing yourself?”
He noted that the last two questions seem very direct, but given a serious crisis, they work.
“We also teach our trainers to instruct ‘Gatekeepers’ if they cannot ask the question, please find someone who can. We are the MOVSPT but our efforts are not restricted to Veterans. We reach out to, and train in the communities where Veterans live and work.”
MOVSPT has trained hundreds of people to recognize someone at risk of suicide and offer hope.
MOVSPT is not only providing QPR training, they are also looking to expand the team and certify more QPR trainers. They are also engaged in the Missouri Governor’s Challenge to Prevent Suicide Among Service Members, Veterans, and Their Families. To find out more, visit: https://mogovchallenge.com
Team members also recently contributed to the production of a brief training video intended to help individuals support someone who may be strugglingk, with the use of a safety plan: a brief intervention to help those experiencing thoughts of self-harm or suicidal thoughts. It is a set of coping strategies and resources an individual can use to decrease their risk of suicidal behavior. To view the video visit https://www.youtube.com/watch?v=RFtKlzwhkgY
Curasi has used QPR on two occasions, both of which involved immediate access to lethal means.
“Due to distance and time, one instance involved a detailed, personal telephone call, in which I was able to persuade the individual to secure the weapon and allow me to connect him with professional help,” Curasi said. “A second instance involved me running through the ‘question’ component while driving to the individual’s home where I was able to persuade him to stay alive, to separate himself from lethal means, and to promise to seek professional help at the earliest opportunity. I followed up the next morning. The value of QPR is that it’s fairly simple, straightforward, and immediate in its application. People trained in CPR are not counselors or therapists. They are people who care, and who are trained to offer hope.”
For Curasi, a great deal of what he would say to someone considering suicide would depend on the individuals involved and their relationship, but he has found the following statements to be effective:
“You’re not alone.”
“Others and I want you to live.”
“I’m on your side...we’ll get through this.”
“We can form a team. I know folks. Who else can help? Family? Friends? Brothers? Sisters? Pastor? Priest? Imam? Rabbi? Bishop? Physician?”
“The ways to address this are limited only by the ‘Gatekeeper’s’ care and resourcefulness,” Curasi said.
An MOVSPT suicide prevention trainer can be reached through the Missouri DMH Veterans Services website: www.dmh.mo.gov/veterans
MOVSPT is on Facebook: https://www.facebook.com/MOVSPT
The QPR Institute is at: https://qprinstitute.com/about-qpr