QPR for Psychosis

First Episode Psychosis (FEP) is associated with increased risk of suicidal behaviours in youth. Sponsored by the Washington State Division of Behavioral Health and Recovery, and led by child psychiatrist Dr. Jon McClellan, this 2-hour training program is designed to help people identify and intervene with youth who may be experiencing the onset of a serious and possibly life-threatening mental illness.

With a special focus on warning signs in psychosis, the course includes training in the QPR intervention (how to Question, Persuade, and Refer someone who may be at risk of suicide), which is designed to achieve four outcomes:

Early recognition of signs of distress, including suicide warning signs
Early intervention and referral
Early assessment
Early treatment

The course also training in a brief edition of the Counseling on Access to Lethal Means (CALM) best practice registered training program. Both program descriptions can be found at: http://www.sprc.org/bpr.

Of note, Dr. McClelland and colleagues published the Practice Parameter for the Assessment and Treatment of Children and Adolescents with Schizophrenia in the Journal of the American Academy of Child and Adolescent Psychiatry in September of 2013. This training program reports and embraces these findings and recommendations.

Early is always better than later.

Throughout medicine, the earlier a problem is recognized and effective treatment begun, the better the long term functioning and survival. Psychosis is treatable. Early effective treatment opens the path to recovery and wellbeing and, as a result, lessens the risk that the person will attempt suicide.

According the National Institutes of Health, an estimated 95% of those who die by suicide are suffering from an unknown, untreated, or under-treated serious mental illness. In addition to major depressive disorder, anxiety disorder, bipolar disorder, and substance use disorder, untreated psychotic illnesses contribute greatly to suicide risk.

The sooner someone experiencing a significant disorder in brain function can be recognized, the sooner treatment can be initiated and the better the outcome for everyone: patient, family, school, and our communities.


From part 1 of this training program (First Episode Psychosis), participants should be able to:

  •  Understand the nature of psychotic illnesses
  •  Describe the challenge of differential diagnosis in mental health practice
  •  Identify people who may be experiencing symptoms of a psychotic illness
  •  Employ basic helping skills to establish a trusting and helpful relationship
  •  Know how to inquire about symptoms of possible psychosis
  •  Describe emerging best practices in the support of youth experiencing First Episode Psychosis
  •  Assist the youth and his or her family by providing access to trustworthy resources and referrals
  •  Describe at least three evidence-based best practices in the treatment of psychotic disorders

From part 2 of this training program (QPR Gatekeeper Training for Suicide Prevention), participants should be able to:

  • Understand the common myths and facts surrounding suicide
  • Recognize someone at risk of suicide
  • Demonstrate increased knowledge about suicide and its causes
  • Identify unique verbal, behavioral, and situational suicide warning signs
  • Know how to inquire about suicidal intent and desire
  • Apply QPR with potentially suicidal people
  • Demonstrate QPR intervention skills in a text-only challenge

Things to keep in mind as you take this training program

While our main focus in this training program is on youth at risk for suicide by reason of the onset of a possible psychotic illness, here are several points to consider as you go through the course:

  • Most people who have a mental illness do not become suicidal, but most suicidal people are suffering from a mental illness
  • Most young people who have psychotic-like symptoms - on competent diagnosis - do not have a psychotic illness
  • If we correctly diagnose and treat the mental illness causing the symptoms, suicide risk is greatly diminished and recovery is possible
  • Among people with a psychotic illness only 5-10% percentage go on to die by suicide

A note about QPR gatekeeper training:

QPR training was originally developed specifically to detect persons who may be thinking about suicide or planning a suicide attempt.  However, QPR training has evolved into a universal intervention to identify and confirm the presence of psychological distress for any reason. The Q (question) in QPR often detects the early onset of a mental illness that needs diagnosis and treatment, and includes persons who may be experiencing psychotic symptoms.

Please note: If you have already completed QPR training, you may wish to complete only first part of this training program.  However, we recommend that you review and complete the QPR training as well, as research shows practice enhances skills, retention, and perceived self-confidence and competence to carry out what may be a lifesaving intervention.

While expert opinion may differ as to what helper competencies are required to assist suicidal youth achieve the most beneficial outcomes, little controversy exists about the lack of qualified manpower to help the thousands of people who think about, attempt, and sometimes die by suicide. For this reason alone, new state laws are being passed to improve the capacity of health professionals to respond effectively to suicidal patients.

Even among licensed professionals there is a serious lack of systematic training in how to a) detect suicide risk, b) assess immediate risk for suicidal behaviors and c) provide helpful crisis mitigation services to suicidal persons.

The primary mission of the QPR Institute has been to provide technology transfer of evidence-based knowledge into useful skills and helpful interventions for those wishing to assist suicidal persons. The history and source of these training programs is derived from earlier research and development work in partnership with Washington State University, The Washington Institute for Mental Health Research, the Washington State Youth Suicide Prevention Program, Spokane Mental Health (now Frontier Behavioral Health), and Spokane County Regional Health District.

This training is not a substitute for a university degree in counselling or other mental health profession, nor can it provide the face-to-face supervised experience those in the helping professions are provided in the course of their professional career development. The program does not teach suicide risk assessment skills. Suicide risk assessment training is provided in other QPR Institute programs.

  • Participants may be adolescents and adults.
  • If employed by, or volunteering for, an organization, participants agree to accept all expectations and employment rules of their parent organization. The QPR Institute does not vet or otherwise qualify students for this course.

Modularized in a rich mix of text, video, voice-over PowerPoint™ lectures, interactive practice sessions, and other state-of-the-art interactive and e-learning technologies, the QPR for Psychosis training program provides a dynamic introduction to psychosis symptom recognition, suicide risk detection, intervention, means restriction, referral and follow up.

Topics covered include early symptom onset, hallucinations, delusions, disordered thought, schizophrenia, bi-polar disease, treatment, and many other subjects.