Colorado’s suicide rate among veterans is higher than the rate in other states and among the general population. The factors are complex — from access to care to homelessness to joblessness — but a new program in Larimer County aims to intervene early by teaching cadets in the Reserve Officers Training Corps (ROTC) ways to identify and handle self-harm.
Carly Rayburg is the ROTC Liason for the Alliance for Suicide Prevention of Larimer County, and a former cadet who graduated from Colorado State University last year. Following the death of an ROTC alumni by suicide six years ago, Rayburg and her training partner, Marshall Spring, are now working with Arnold Air Society, a national ROTC service organization, to offer free training for cadets nationwide.
“The goal of this training is to get you all aware and able to hold the conversation surrounding suicide and suicide prevention,” Rayburg said during a recent online session for cadets from Colorado and Florida.
The type of training is called QPR, which stands for a three step process: question, persuade, refer. QPR is often compared to first aid or CPR, but for a suicidal crisis instead of a medical emergency.
“Be persistent. Don’t be afraid of feeling like you’re bothering them or being too pushy. It’s not going to make them want to attempt more,” Rayburg said.
She recommends being direct: ‘I’m wondering, are you thinking about suicide?’
Rayburg also walks the cadets through how not to ask the question:
“Saying, ‘You wouldn’t do anything stupid like that would you? You’re not thinking of killing yourself, are you? Suicide is a dumb idea.’ Things like this, it’s very accusatory, very direct in a non-approachable way,” Rayburg said.
After Q comes P (persuading the person to seek help), and then R (referring them to resources).
QPR has been around for decades. Rayburg and Spring began offering QPR to ROTC cadets in March. Spring, a military veteran who now works for the Alliance for Suicide Prevention of Larimer County, has recently done QPR trainings for the construction and firearms industries as well as law enforcement.
“For QPR to be effective, we have to train millions to save hundreds,” Spring said.
Spring, who uses QPR on a weekly basis, says it gives him the confidence to focus on the emotional well-being of someone in crisis, instead of panicking and thinking about the threat.
He gives the example of a young man he met early last year who was in crisis and drinking heavily. They cycled through QPR several times but kept getting hung up on the ‘refer’ step; the young man was refusing to go to a crisis center, but he was willing to do things for Spring.
“So I asked him if you would do me a favor and put the crisis number in his phone. He did. And I asked him to do me a favor and give them a call, do a test call,” Spring said. “He was very resistant, but he did. And then he ended up being on the phone with them for over an hour.”
Later on, Spring got the individual’s mother involved and set him up with a counselor.
“I haven't talked to him since. But I do know he’s alive. And so it worked,” Spring said.
A 2018 study from researchers at the Substance Abuse & Mental Health Services Administration (SAMHSA) and ICF, a global consulting firm, found that in-depth suicide prevention training resulted in more individuals being referred to services. Because QPR is quick and cost effective, more people could be trained to spot signs of self-harm. But, going a step further, pinpointing how many lives have been saved through QPR is difficult.
“It's really hard to measure because we might train somebody in QPR and we won't know if they're going to connect with somebody in a year or three months or three weeks from now,” said Kimberly Pratt, a master QPR trainer in Fort Collins who works with Spring and Rayburg .
Pratt is the project manager for the Colorado National Collaborative in Larimer County, a national experiment to reduce suicide by 20% in five years. Colorado is the pilot state; QPR is one of the solutions on the table.
“We also know that it's effective really from a lot of anecdotal conversations,” Pratt said. “So people will come to us a week later or a month later and say, ‘Oh, my goodness, I use this. And it was so helpful. Can you come and train more people for us?’”
Finding solutions that work is particularly urgent for Colorado’s military population. In 2018, 173 veterans died by suicide in Colorado. Nationally, 6,435 veterans died this way. In talking with ROTC cadets, Rayburg frames it as an issue they are sure to encounter.
“It’s going to be staring at you straight in the face when you go to your first duty station. And I want you to be the best prepared for when you enter active duty to have to have these conversations,” Rayburg said.