Gatekeeper training for suicide prevention

Gatekeeper training is a community-based intervention to aid in preventing suicide. Suicide is a major public health concern, but it is preventable and that requires the contribution of the entire society including people, groups and communities. Centers for Disease Control and Prevention (CDC) list gatekeeping training as one of the suicide prevention strategies that are backed by evidence. The World Health Organization also describe gatekeeper training as a type of "selective" suicide prevention strategy because gatekeepers can identify and help individuals who are vulnerable or are at risk of suicide. They further highlight how it is important for certain members of the society such as teachers, first responders and healers to be trained and act as gatekeepers because they are in regular contact with important and potentially vulnerable groups in the community. Gatekeeping trainings dates back to late 1960s Philadelphia and Dr. John Snyder is credited for writing the first report on the topic which was published in Bulletin of Suicidology in 1971. There are many models of gatekeeping training and the type of training offered varies with respect to country and organization. While many academic articles have recommended gatekeeping training as an effective suicide prevention strategy , further research on its effectiveness is underway.

Gatekeeper Training Programs

Applied Suicide Intervention Skills Training (ASIST)

LivingWorks offers this 90-minute online training program to all individuals above the age of 13 years to teach about the impact of attitudes on views related to suicide and prevention, providing assistance and suicide first aid to a person at risk, identifying elements of a suicide safety plan and actions needed for its implementation, improving and integrating suicide prevention resources in the community, and recognising other aspects of suicide prevention such as self-care.

Question. Persuade. Refer. (QPR)

QPR, an abbreviation for Question, Persuade and Refer, is an emergency mental health intervention for suicidal persons created in 1995 by Paul Quinnett. The program uses a multimedia format to equip gatekeepers strengthen their ability to identify an individual who may be at risk for suicide by recognising the warning signs of suicide, intervene with them effectively through proper questioning to determine their suicide intent/desire, persuade them to agree to seek help, and refer them to appropriate resources for help. This program is underpinned in the "chain of survival" approach. In India, Suicide Prevention India Foundation (SPIF) provides the online QPR Gatekeeper training for students and professionals.

Kognito Suicide Prevention Simulations

Kognito, a health simulation company, provides online suicide prevention training to educators, college and university students, and youth between 13 and 18 years of age in the form of an interactive role-play simulation. The program utilises a behaviour change model that integrates several evidence-based models and techniques such as motivational interviewing, shared decision-making, emotional self-regulation, empathy, empathic accuracy, and reappraisal strategy, game mechanics, and learning principles (hands-on-practice, contextual learning, personalised feedback, storytelling, and case-based approach) to help trainees identify the warning signs of psychological distress, talk to individuals who are uncomfortable talking about their issues and motivate them to seek help .

NIMHANS Gatekeeper's Training for Suicide Prevention

The National Institute of Mental Health and Allied Sciences (NIMHANS), Bangalore, offers this highly skill-based three-hour training program, facilitated by a multidisciplinary team composed of a psychiatrist, a psychiatric nurse and a psychiatric social worker, to three groups of twenty participants each every alternate month. The training program has three parts to it that aim to empower trainees to identify persons at risk of suicide, assess suicidal risk, provide immediate intervention for suicidality, and signpost and mobilise resources in the community. This is achieved through the use of a participatory training approach and by application of multiple training methods (lecture cum discussion, role plays and video show) using standardised case vignettes & standardised scale (SIRI) for pre and post assessment. Later, all three groups are called for an advanced session in which the gatekeepers are requested to share their practical experiences and the difficulties in handling the suicidal person, and are given even more case scenarios and hands on training in handling these cases

Safe Space's Suicide First Aid Certification

Safe Space, which is a training and education centre for mental health and suicide prevention, provides this six-hour certificate program to impart knowledge on the theory and practice of suicide intervention. The training program is facilitated by experienced suicide prevention trainers who teach about the impact of experience with suicide, barriers to help-seeking, prevalence of suicidal thoughts and suicidal behaviour, signs of suicide and the Suicide-Safety Guide, partnership working and community resources using a multimodal approach using a combination of socratic learning, role-plays, mini-lectures, group work and audiovisual presentations within an interactive framework. The course aims to help trainees learn about reasons for suicide and the magnitude of suicide behaviour in the community, get an insight into the approach to and process of suicide intervention and their role in it, and understand the importance of self-reflection and personal impact when working with suicide and people at risk

Research on Gatekeeper Training

The gatekeeper training is an effective community-centric support system in identifying people at risk of suicide. Community gatekeepers can be of great value in this sphere as at-risk youth, often approach family and friends. Community level intervention after receiving the gatekeeper training helped in reducing suicide numbers in a rural Indian setting.

Even if the training is of a short duration, studies show that it increases knowledge and skills required for assistance. This in turn leads to better detection of risk factors. It improves perceived self efficacy in intervening. Thus, the gatekeeper training can be effective in eliciting a more proactive response in identifying and addressing those at risk. It creates awareness which also leads to a lowering in stigma because it can reduce the hesitation some people feel in intervening.

The gatekeeper trainings have been conducted with various groups of people, such as students, professionals and also within communities. They have demonstrated their effectiveness in all these spheres.

References

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