Use a Tiered Approach to Training on Suicide Prevention in the Workplace

As workplaces start to develop suicide prevention as a health and safety priority, a tiered training program offering skill-building an empowering compassionate connection is key.
By Sally Spencer-Thomas
May 6, 2020

How is basic suicide prevention training like CPR? We all understand the value of the CPR approach to saving lives. We give everyone in a community a brief, skills-based training in the hopes that when someone is in a crisis, one of the people who has been trained will have the confidence and competence to step in and do what is necessary to sustain the distressed person until the appropriate supports have been put in place.

The same approach applies to suicide prevention.

Many people believe the only people who should have conversations about suicide are mental health professionals. The problem is that mental health professionals are often behind closed doors helping their clients, often one at a time. They are not out in the community to notice changes in mood, behavior or life circumstance that can be the early warning signs that someone is thinking about taking their life.

Thus, just like CPR, we need to empower people to notice when things are not right and take quick and effective action to make a difference. Understanding this analogy is key to how the construction industry will successfully “bake in” suicide prevention as a health and safety priority.

Think about what makes CPR effective? Following are a few reasons.

1. Repeated training

CPR is not a one-and-done, check-the-box training. CPR training is often given regularly. Many in construction have taken the training so many times they have lost count, but they do so because they know the refresher courses help keep the skills top of mind. Similarly, having just one training for suicide prevention will not stick. Instead, a “state trooper” effect is likely. That is, people feel motivated to change their behavior (e.g., slowing their speed), when confronted with the information (e.g., police car), but as soon as the experience is in the rearview mirror they go back to doing what they did before. Thus, just like CPR, suicide prevention trainings need to be given regularly over the course of one’s career at all levels of a company or professional association.

2. Learning from Evidence

CPR best practices have evolved over time—the ratios of compressions to breaths have been modified as we learn more about what helps people best. Similarly, suicide prevention efforts get more sophisticated as we learn more about what is effective. That said, even if you don’t get the recommended ratio of compressions to breaths 100% correct, the person is still getting more air and blood flow than they were when nothing is being done. Similarly, with suicide prevention, we can do it imperfectly and make a difference.

3. Simplicity

CPR is simple so people can remember the steps when they are confronting an adrenaline fueled situation. Three steps is pretty much all humans can recall when they are under a great deal of stress. Fortunately, similar to CPR, most basic suicide prevention trainings encompass three basic steps: notice the problem, listen well and be a liaison to supports.

4. Saturation

CPR trainings seek to reach everyone knowing not everyone will be able to engage in the life-saving behaviors when needed. Many reasons exist why people are not able to perform CPR skills—situations are often daunting, just like they are in suicide prevention.

5. Behavioral Rehearsal

One of the core aspects of CPR training is practice. When you are learning, it all seems simple until you get on top of that dummy. Then it becomes real. With the adrenaline flowing, trainees often realize performing the needed behaviors is not as easy as it seems. Same with suicide prevention. It turns out it’s a lot harder to say the word suicide than most people expect. Most trainings also offer role plays because when we engage our full selves in a skill-building exercise, we are far more likely to remember the steps later. This outcome is because the memories of the skill are laid down in our brains in a far more robust way than if the steps are just given to us in a knowledge transfer.

What are Some of the Best Basic Suicide Prevention Trainings?

Luckily, there are established evidence-based and evidence-informed training programs that operate just like the CPR model. In the world of suicide prevention, these are called Gatekeeper Trainings. The name is a little unfortunate because in the business world, a gatekeeper can often create barriers to resources; but in the world of suicide prevention, a gatekeeper opens the gate and helps the distressed person connect to treatment and tools that can help them stay.

Table 1: Some of the Best Known Gatekeeper Training Programs

Other specific trainings exist for special groups like the military and specific occupations, but the core tenants of these trainings are similar—warning signs and risk factors, how to ask a direct question about suicide and how to empathically connect people to resources.

Each of the trainings listed here are appropriate for anyone older than 15 years. The trainings are not intended to make someone a counselor or to give them the authority to do a suicide risk assessment. Rather, the trainings help build stronger links in the chain of survival.

As the founder of the QPR, Dr. Paul Quinnett once said, “The person most likely to prevent you from taking your own life is someone you already know.”

A Tiered Approach: The 'EMT Level' of Suicide Prevention

In the CPR model for saving lives, the trained good samaritan responder moves aside when an emergency medical technician (EMT) or paramedic arrives on the scene to continue ensuring basic life support (BLS) or advanced life support (ALS), respectively, until the patient can be transported to a hospital. Similarly, in suicide prevention, the ALS level involves a specially trained peer network of trustworthy coaches who can help guide the process to get fellow co-workers through tough times. The ALS level of suicide prevention involves an advanced peer network of trustworthy coaches who can help guide the process to get others through tough times. Peer supporter or peer specialist programs have been effectively deployed in many workplace settings in first responder communities, transportation industries, military/veteran communities and mental health workforces.

In a workplace or professional association, these advanced peers are carefully selected. Often through a process of self- and peer-nomination, peers being the process of reflecting on whether or not they are a good fit in a peer support role. Training and supervision are key to helping advanced peers be effective supports. Their service should be recognized and rewarded by leadership and evaluated to help with continuous quality improvement.

As workplaces start to develop suicide prevention as a health and safety priority, a tiered training program offering skill-building an empowering compassionate connection makes sense. Trainings repeated over time from on-boarding days through promotions and even post-retirement can help the confidence and competence of a workforce sharp. When subgroups—including trained peers, human resources, wellness coordinators, safety trainers and supervisors—have advanced skills in suicide intervention, the safety net becomes even stronger. As E.R. Brown once wrote, “One earnest worker can do more by personal suggestion to prevent accidents than a carload of safety signs.” This is true for slips and falls; it’s also true for suicide prevention.

by Sally Spencer-Thomas
Sally Spencer-Thomas is a clinical psychologist, mental health advocate, faculty member and survivor of her brother’s suicide. She sees the issues of suicide prevention from many perspectives. Currently, Dr. Sally Spencer-Thomas is the CEO and Co-Founder of the Carson J Spencer Foundation, an award-winning organization leading innovation in suicide prevention and umbrella organization for Dr. Sally Spencer-Thomas is the Co-Lead of the Workplace Task Force with the National Action Alliance for Suicide Prevention.

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