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For those who are interested in further training in the assessment and management of suicide risk, let me briefly review The QPRT Suicide Risk Management Inventory (Quinnett and Bratcher 1998). The QPRT (for “Question, Persuade, Refer, or Treat”) is a guided clinical interview designed to elicit a narrative report by the suicidal person that will provide a description of the problem(s) suicide would solve and of the events that precipitated the current crisis, as well as information regarding previous instances of suicidal behaviours, family and relationship dynamics, and other known risk and protective factors. The interview also includes a section on securing a commitment from the patient to remain safe and to abide by medical advice and so can be used to generate a shared risk management plan. In addition to the adult outpatient version, inpatient and pediatric versions of the protocol are available (Quinnett, Cardell, and Bratcher 1999; Quinnett and Sowers 1999). The inpatient version is designed to facilitate clinical decisions regarding the appropriate level of monitoring and other risk management practices.
The key clinical questions of the QPRT protocol were developed on the basis of a national survey of experts in suicidology. The authors of the protocol distilled the results into fifteen questions that would yield a standardised and highly effective clinical interview. The pediatric version of the QPRT was based on input from a number of highly regarded child psychologists and child psychiatrists.
As an example of how the protocol works, let us look at the first five questions from the Adult/Older Adult QPRT. The questions are asked after the therapist has established an initial rapport with the patient, and the patient has admitted to suicidal thoughts or feelings or to a suicide attempt, whether recent or remote.
The interviewer uses these stem questions to frame his or her own queries and records the patient’s replies. Answers to these and the remaining ten questions allow an interviewer to perform an appropriately detailed risk assessment and to gain the patient’s cooperation in a standard risk management plan, including a safety agreement, consent to a referral, or commitment to participate in treatment.
Competent use of the QPRT protocol requires training. The protocol is currently in use in more than 150 hospitals, mental health centres, and substance abuse treatment facilities nationwide. It has been listed as an example of best practices by the Center for Substance Abuse Treatment at the Department of Health and Human Services and positively reviewed by the Joint Commission (U.S. Department of Health and Human Services 2005; Joint Commission 1999). In 2005, the training program and protocol were adopted for statewide implementation by the mental health leadership in the state of Georgia, with the goal of reducing suicidal behaviour among consumers of mental health services.