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Articles > The ‘Question, Persuade, Refer’ of suicide prevention
The ‘Question, Persuade, Refer’ of suicide prevention
QPR 1 Sept 2025
August 28, 2025

By Alicia Levitt

In the last 20 years, the rates of death by suicide in the United States have risen more than 30 percent. That shocking and steady statistical rise led the State of Indiana to enact a law several years ago requiring that all teachers receive training in evidence-based suicide prevention.

As the director for academic excellence at The Lutheran Schools Partnership in Fort Wayne, Ind., I initially became a suicide prevention trainer in order to help teachers in the northeast Indiana Lutheran schools meet that requirement. However, I now see that sharing this information with others as a part of my ministry can impact anyone, anywhere, of any age.

Suicide is one of the most preventable kinds of death. We can all provide care and hope to others who may be struggling.

I am trained to teach QPR, which stands for Question, Persuade, Refer. During QPR training, we first learn about some of the clues we may notice that tell us someone is considering suicide.

We might notice behavioral signs, such as changes in mood, actions, or demeanor. We may notice situational clues, such as loss of a loved one, an unwanted move, a difficult medical diagnosis, or a loss of financial security. Someone who is thinking of suicide may also share direct or indirect verbal clues, such as “I just can’t go on any longer,” or “It would be easier if I weren’t here anymore.” When we see multiple of these things happening at the same time, it can be especially concerning. How can we respond?

QPR is an evidence-based training, meaning that studies have shown that the tools taught in the class are effective at helping to prevent suicide. The name intentionally sounds like CPR, because in both trainings anyone can learn to provide life-saving measures until professional help can be found.

When we are concerned that someone is thinking of suicide, we should ask them directly about it. Asking the question is the “Q” in QPR. It can seem very difficult to ask someone, “Are you thinking of ending your life?” But it often opens a door for someone to share their struggle, and for us to let them know that there is hope. Just knowing that someone cares enough to ask can have a tremendous impact.

Many of those who have survived a suicide attempt report that they realized they did not really want to die, they only wanted the pain they were enduring to end, but they did not see another way to make that happen.

The second step of QPR is “P” for persuade. We want to persuade someone to see that there is hope if they get help. Help then comes through the “R,” which stands for refer. We want to go with someone, if possible, to get professional help. Offer to sit with them while they make a call or help connect them to someone they trust to walk alongside them. One of the best resources we have now is calling 988, the National Suicide and Crisis Lifeline. Like calling 911 in a medical emergency, anyone can call 988 for mental health support and for resources.

Loneliness, isolation, and suffering do not discriminate. Suicide deaths occur among all ages of people and all demographics. In fact, the highest rates of suicide currently are among those aged 85 and older, a group who are typically well-acquainted with loneliness and loss.

We are commanded multiple times in Scripture to help those in need. In Galatians 6:2 (NIV), we read, “Carry each other’s burdens, and in this way, you will fulfill the law of Christ.” Matthew 25:40 (NIV) tells us, “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me,’” and in 2 Corinthians 1:3-4 (NIV), Paul says, “Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God.”

Providing hope to those who are thinking of suicide can be one way in which we fulfill the law of Scripture to love each other as we have first been loved.

What a privilege it is to be able to share the love of Christ with all those who suffer!

Alicia Levitt is the director of academic excellence at The Lutheran Schools Partnership in Fort Wayne, Ind., as well as serving as a QPR suicide prevention trainer.

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