Conversations about mental health struggles can feel overwhelming—but they can also be life saving. Knowing what signs to watch for, what to say, and how to connect someone to help can make all the difference.
In this conversation with Joshua Stein, MD, a Child and Adolescent Psychiatrist at PrairieCare, shares practical insights on suicide prevention and how tuning into others’ emotions and actions is key to bettering individual and community well-being. Drawing on the QPR (Question, Persuade, Refer) approach, Dr. Stein explains how each of us can play a role in keeping the people around us safe and supported.
Whether you’re a parent, educator, mental health professional, or simply someone who wants to do their part in prevention, these tools can help you step in with confidence and compassion when it matters most.
What You’ll Learn
- What warning signs and phrases can signal that someone is struggling?
- How can you start a conversation with someone you’re worried about?
- What simple actions can show encouragement and support during a hard time?
- What resources and care options are available at PrairieCare if someone needs help?
Quick Read
Many of us hesitate to reach out to someone who’s having mental health challenges because we worry about saying the wrong thing. The QPR (Question, Persuade, Refer) method offers an effective way to step in and connect someone to help. It was created to help people know how to respond when someone may be experiencing suicidal thoughts or showing concerning changes in behavior.
Warning signs can be direct or subtle. A person might say, “I’m having suicidal thoughts,” or hint at it with comments like, “I just can’t do this anymore.” They may also pull away from things they once loved or give away valued belongings. Dr. Stein encourages us not to dismiss these signs, but instead to ask caring questions and, if needed, connect the person to someone who can help.
Calling or texting 988 provides immediate crisis support. In addition, PrairieCare can quickly connect people to the right level of care. You can also support individuals with everyday gestures, such as checking in, offering a meal, or sending a note, that remind someone they’re not alone. Together, these steps can save lives and strengthen communities.
What is QPR and how does it work?
QPR stands for question, persuade, and refer. It was created by Dr. Quinnett, a clinical psychologist because when people we know are not acting like themselves or are experiencing suicidal thoughts, many of us don’t know what to do. We’re concerned, but we don’t know how to engage them. We’re worried we may make things worse or stress them out further. It can also be uncomfortable to talk about mental health and suicidal thoughts, even for some professionals.
QPR was created as a way to address that mix of emotions. Suppose someone is displaying signs, symptoms, or concerning trends. With QPR, the people around them have the tools to question what’s going on and persuade them to get help–whether the support person is a high school student, coach, physician, bartender, or hairdresser.
Trying to prevent suicide can sound overwhelming, but QPR is a straightforward approach and a valuable tool that saves lives and is effective in preparing people to intervene. It helps us feel like we can do something when faced with someone in crisis.
Can anyone use QPR?
One of the best things about QPR is that it can be specified for any audience to use. Some of my favorite moments while giving this training have been with audiences who are not in the healthcare field. I’ve presented QPR to construction workers, youth groups, and even coaches and athletic directors at a large school district here in the Twin Cities.
To practice QPR, you don’t need to have any previous training or medical background. As long as someone embraces the approach and is willing to help, they’ll come away with a great skill set for supporting people when they’re struggling. We can teach it to teenagers as well, as long as they can understand it, reference it appropriately, and feel strong enough to follow through with it.
What are the signs or phrases you should watch for that indicate someone is struggling?
QPR teaches us to recognize both direct and indirect signs of crisis. Someone might say something very direct, like “I’m having suicidal thoughts.” Other times, it’s more subtle, such as “I wish I could go to sleep and not wake up” or “I just can’t do this anymore.”
When we hear comments like this, the goal is to feel ready to step in and respond. You might say, “That sounds really serious. I’m worried about you—what’s going on?” or even ask directly, “Are you thinking about taking your life?”
How do you initiate a conversation with someone who is struggling?
Suppose you notice concerning signs in someone close to you, such as giving away meaningful belongings, withdrawing from hobbies or activities they once loved, appearing persistently blue or down, or making references to suicide. In that case, it’s essential to check in.
The first step is deciding if you can safely and comfortably start the conversation. If not, it’s okay to reach out to someone else who can, such as a coach, teacher, parent, or youth leader who may have a better skill set or connection with the person. If you feel comfortable, you might say, “I’ve noticed you’ve seemed down, and I’m worried about you. Can we talk?” or simply, “I care about you and want to make sure you’re okay.”
What resources and care options can you provide to someone to access the proper care?
If you’re concerned about someone and they’re ready to be referred to help, the 988 crisis hotline is available anytime by phone, text, or online chat. It’s a quick way to get immediate support, and if necessary, 988 operators can escalate the call to 911. If someone is in imminent danger, such as attempting to overdose on medications otherwise end their life, call 911 right away.
If an individual 35 and younger needs immediate mental health treatment, our inpatient hospital may be an appropriate care option. Anyone 18 and older, or parents of a minor, can call us at 952-826-8424 at any time of day to receive guidance on the best care options.
For individuals and families seeking non-urgent mental health services, PrairieCare also offers a complimentary care questionnaire that connects individuals to the right level of support, whether that’s outpatient therapy, full- or partial-day programs, after-school programs, or residential treatment.
Can you explain the ripple effect of suicide and how QPR is a key component to prevention?
A vital part of a suicide prevention training like QPR is that it can help so many people, not just the person who is struggling. Suicide impacts far more than the individual—it affects the people who love them, their classmates and coworkers, and their entire community. By learning QPR or other forms of suicide prevention, we’re helping to create a healthier community.
What are other ways we can keep people safe if they are struggling?
One critical approach is “means restriction.” This involves limiting access to potentially lethal or dangerous items in the home when somebody is having suicidal thoughts or urges.
Research shows that thinking about suicide to an attempt can transition quickly, often occurring within minutes to an hour of the decision. If lethal means aren’t available, that window can pass—they get past five minutes, and then they get past an hour. They’re able to get back to wisdom, to decision-making, and to getting the help they need.
This means locking up medications, removing firearms from the home, and reducing access to other potentially harmful items. The goal is to create as many barriers as possible, giving the person more time to reconnect with support and safety.
What encouraging actions or words can you offer someone who’s having a hard time?
We all know how to care for somebody who’s broken a leg or is physically ill, but when it’s a mental health concern, at times we feel uncomfortable or don’t know what to say. I would encourage people to trust that just being present helps.
We can show support by telling the person “We’ll get through this together,” by checking in frequently, by dropping off food like you would for someone who’s physically ill, by writing cards or bringing gifts. These are significant gestures of care that show the person that they matter to you and you’re not going anywhere.
About Dr. Stein
Dr. Stein is the Clinical Director of PrairieCare’s Brooklyn Park Partial Hospitalization Program (PHP), where he provides patient-centered mental healthcare that supports children, adolescents, and families in long-term recovery. With deep expertise treating anxiety, depression, emerging personality disorders, family dynamics, and more, Dr. Stein also supports our inpatient hospital and clinic services.
Beyond the clinic, Dr. Stein is active in our community, raising awareness about various mental health concerns, primarily in our schools. He provides trainings for multiple populations working with youth, ranging from special education teachers experiencing burnout to athletic directors seeking suicide prevention strategies.
To learn more about QPR training, visit the website here.
Mental Health Services in Minnesota
If someone in your life needs mental health support, our compassionate and specialized team can help. At PrairieCare, we offer comprehensive services for anyone who needs them. No matter where someone is in their journey, we’re here to guide them in the right direction.
PrairieCare’s mental health treatment options include a full continuum of care for children, teens, adults, and families across Minnesota.
- Inpatient Psychiatric Hospitalization: Short-term, 24/7 hospital-based care during a severe depressive episode or crisis for individuals 35 and younger. Ensures safety, offers immediate stabilization, and prepares patients for the next step of treatment.
- Residential Treatment: Longer-term, 24/7 care in a non-hospital setting for adolescents. Provides intensive daily therapy in a structured environment to address persistent depression.
- Partial Hospitalization Program (PHP): A full-day program without an overnight stay. Provides intensive therapy, structured routines, and medication management. Supports mood stabilization and helps prevent inpatient hospitalization.
- Intensive Outpatient Program (IOP): A partial-day program offering group therapy, coping skills training, and peer connection while allowing patients to live at home and continue daily routines.
- Clinic services: Provides ongoing support through sessions with a therapist. Focuses on coping strategies, identifying thought patterns, and building long-term tools to manage depression.
There’s no need to go through challenges alone—we’re here to help. Call our team at 952-826-8475 to start the healing process today.
Sources
- Mental Health & Prevention. 2024 Dec; 36: 200375.
- Clinical Psychol Psychotherapy. 2021 Nov–Dec; 28(6): 1427–1434.
- Health Education J. 2018 Jul; 77(8): 10.1177.
- Suicide Life Threat Behav. 2018 Feb;49(2): 353–370.