SAMPLE DIAGRAM The Role of Gatekeepers in Preventing Late Life Suicide in an Older Woman

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SAMPLE DIAGRAMThe Role of Gatekeepers in
Preventing Late Life Suicide in an Older Woman

• Brief text describing why an older female at risk
  for suicide does not call for help

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Reasons for resistance to help seeking in older
persons

• Pervasive feelings of shame (I cant take care of
  myself).
• Suspicion of do-gooders (who put you in nursing
  homes).
• Fear of hospitalization and loss of personal
  control of ones life.
• Failing memory or failing mobility
• Fear of becoming a burden on others
• Onset of clinical depression

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Who is in contact with at-risk elders and can be
a gatekeeper for home-dwelling elders?

• Consider training Property appraisers, apartment
  and mobile home managers, telephone company
  personnel, police and sheriffs officers,
  ambulance companies, fire fighters, utilities
  personnel, postal carriers, pharmacists, trust
  and bank officers, meter readers, power company
  billing staff, fuel oil dealers, ministers, farm
  equipment dealers, telephone company staff
  anyone with frequent contact with at-risk elders
  can be a gatekeeper!

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What did we teach gatekeepers?

• Problems with personal appearance (unshaven,
  dirty clothes, body odors, unkempt hair, etc.)
• Conditions of the home (poor repair, calendar on
  wrong month, little or no food, strong odors, too
  many cats, garbage, walks covered with snow,
  etc.)
• Mental and emotional - confusion, disorientation,
  inappropriate responses, forgetfulness,
  repetitiveness, distrust, fear of strangers

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What more did we teach them to observe and look
for?

• Complaints of not eating
• Problems in sleeping
• Evidence of alcohol use (bottles piling up)
• Anger, irritability, hostility
• Appears sad or blue, talking of loss
• Physical losses? Compliant of hearing loss?
• Mobility losses? Now homebound?

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What else did we teach them to look for and
observe?

• Personality changes? Isolated, withdrawn,
  suspicions, angry? Is this different from
  earlier contact?
• Economic problems? Cant pay bills? Overpays or
  tries to?
• The warning signs of suicide. Multiple losses?
  Suicidal communications (e.g., giving away
  personal possessions?)

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What did we ask gatekeepers to do?

• One thing
• To call us with only this
• NAME,
• LOCATION
• and CONCERNS
• we would take it from there.
• The following diagram describes a real scenario,
  who was trained in how to recognize coded suicide
  warning signs, and how a trained gatekeepers
  helped save a life.

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Scenario clinically depressed, 73- year-old
widowed female, living alone. Health is failing.
She is isolated and has few friends. Only son
recently died by suicide and she has saved up a
lethal dose of her heart medication.
Traditional Detection Network
Diagram 1
Neighbor
Pastor
No Clues
Coded Clues
Elderly Lady in Crisis
Church Volunteer Driver
Coded Clues
Pharmacist
No Clues
Coded Clues
Behavioral Clues
Strong verbal hints
Power company billing dept.
Doctor
Relationship?

• Self-referral unlikely
• Hotline call unlikely
• Intervention unlikely

Visiting Nurse
Source Paul Quinnett, Ph.D., QPR for Suicide
Prevention
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Gatekeeper Detection Network
Diagram 2
Trained Non-trained
Pastor trained
Neighbor
Coded Clues
Coded Clues
Elderly
Church volunteer driver
Lady in in crisis
No Clues
Coded Clues
Pharmacist trained
Coded Clues
Stops payment
Gatekeeper Enhanced Opportunities
Clear Verbal Threats
Power company trained
Doctor
Gatekeeper referral
Pastor Visiting nurse Power company staff
Pharmacist

• Self-referral unlikely
• Hotline call unlikely
• Intervention now likely

Visiting Nurse
Source Paul Quinnett, Ph.D., QPR for Suicide
Prevention
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QPR Gatekeeper Network
Diagram 3
Gatekeeper trained Additional Resources
Pastor supports
Volunteer supports
Pharmacist
Lady out of Crisis
Power company notifies nurse
Gatekeeper Intervention
Home health
Referral
Referral

• Result of gatekeeper action?
• Problems solved
• Suicide attempt averted
• Social, emotional, medical and spiritual
  supports now in place

Home repair
Doctor supports
Meal on Wheels
Source Paul Quinnett, Ph.D., QPR for Suicide
Prevention
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In summary, effective gatekeepers

• - Know that suicide is preventable
• - Understand means restriction
• - Know how to ask about suicide
• Know how to listen, persuade and refer
• Know community resources
• Are supported by provider agencies
• Know something about the involuntary treatment
  laws and understand the link between mental
  illness, substance abuse and suicide

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Changing individuals is not enough, we must
change cultures, and we change them one community
at a time(close program to return to text)