GATEKEEPER TRAINING

AND ITS IMPORTANCE

PRESENTER- DR LAHARI RAVIKUMAR
MODERARTOR – DR HEMENDRA SINGH
OUTLINE
• INTRODUCTION
• BRIEF INTRODUCTION ABOUT GATEKEEPERS
• TYPES OF GATEKEEPER TRAINING
• MAIN OBJECTIVES OF A GATEKEEPER
• STEPS IN TRAINING
• ADVANTAGES
• CONCLUSION
• REFERENCES
INTRODUCTION
• World Health Organization (WHO) statistics show that globally more
than 800,000 people die by suicide every year, that is, one death by
suicide occurs every 40 seconds.
• For every completed suicide there are 10-20 suicidal attempts that are
reported.
• In India, as per National Crime Records Bureau of India 1.53 lakh
people have died by suicide in the year 2020 (vs 1.39 lakh in 2019)
• According to WHO, 2014 – suicide prevention addresses
1. Reducing access to lethal means
2. Responsible media reporting of suicide
3. Community awareness programs
4. Gatekeeper training
5. School based suicide prevention programs
6. Training of general practitioners and frontline staff
7. Psychotherapy
8. Follow-up for individuals with a recent suicide attempt
WHO ARE GATEKEEPERS?
• Gatekeepers are defined as “individuals in a community who have
face-to-face contact with large numbers of community members as
part of their usual routine”
• A person who believes suicide can be prevented
• Willing to give time and energy

Gatekeeper’s Training for Suicide Prevention was developed to build a

network of “gatekeepers” and equip them with the knowledge and skills
to identify and provide timely help to suicidal persons.
WHO CAN BE A GATEKEEPER?
• Teachers
• Physicians
• Nurses
• Social workers
• Community leaders
• Religious leaders
• Police
• Office colleagues
Types of gatekeeper training
• Question, Persuade, Refer (QPR) - participants learn the suicidal
warning signs, as well as the skills to assess at-risk person, to manage
the situation appropriately and to refer them to health professionals for
treatment if necessary

• Applied Suicide Intervention Skills Training (ASIST)- It is a 2 day

interaction workshop for participants to gradually build comfort and
understanding about suicide and suicide intervention
• C.A.R.E Suicide Prevention Gatekeeper Training Program – It is a
program designed to train individuals who are potentially exposed to
those with suicidal thoughts.
(i) Catch the signs
(ii) Acknowledging emotional pain
(iii) Risk formulation
(iv) Encourage collaborative care
GATEKEEPER TRAINING IN NIMHANS
• 20 participants for each module is involved, brief session of 3 hours skill
based training.
• Consists of three parts :-
1. Part I – The training programme starts with strengths game in which
participants are paired and given 10 minutes to identify strengths in
each other (which is self reflective and reflecting the strength of their
partners) and reflect back individual strengths even in a crisis situation. 
2. Part II –  Teaching assessment of risk and identifying level of risk for
suicide in the form of role-play followed by feedback of client and
gatekeeper.
3. Part III – Video enabled learning focuses on interventions, signposting
and resource mobilization.
MAIN OBJECTIVES OF GATEKEEPER
TRAINING
• Recognise warning signs of suicidal behaviour at an early stage

• Respond positively in order to:

– Keep lines of communication open
– Encourage help-seeking behaviour and linking to specialist services
where appropriate
STEPS IN GATEKEEPING
1. ENGAGE
2. IDENTIFY
3. ENQUIRE
4. INTERVENTION
5. FOLLOW THROUGH
ENGAGE
1. Gives the person a chance to unburden
2. Encourages help-seeking behaviour
3. Can impede or delay acting on suicidal impulses
4. Keeps the lines of communication - open keeps the person connected
• Gatekeeper’s way of approach –
1. Reasonably comfortable in discussing the topic of suicidality with
the person involved
2. Confidentiality should be ensured (not secrecy)
3. Importance of active listening
IDENTIFY
DEFINITIONS-
• Warning Signs- the earliest observable signs that indicate the risk of
suicide for an individual in the near-term (within minutes, hours or
days.)
• Risk Factors- long standing conditions, stressful events or situations
that may increase the likelihood of a suicide attempt or death.
(statistically significant)
• Protective Factors- the positive conditions, personal and social
resources that promote resiliency and reduce the potential of suicide
and other high-risk behaviours.
WARNING SIGNS
• Threatening to harm or end one’s life
• Seeking or access to means
• Evidence or expression of a suicide plan
• Expressing (writing or talking) ideation about suicide, wish to die or
death
• Hopelessness
• Rage, anger, seeking revenge
• Acting reckless, engaging impulsively in risky behavior
• Expressing feelings of being trapped with no way out
• Increasing or excessive substance use
• Withdrawing from family, friends, society
• Anxiety, agitation, abnormal sleep (too much or too little)
• Dramatic changes in mood
• Expresses no reason for living, no sense of purpose in life
RISK FACTORS
• Unemployed or recent
• Financial difficulties
• Divorced, separated, widowed
• Social Isolation
• Prior traumatic life events or abuse
• Previous suicide behavior
• Chronic mental illness
• Chronic, debilitating physical illness
PROTECTIVE FACTOR
• Strong connections to family and community support
• Skills in problem solving, coping and conflict resolution
• Sense of belonging, sense of identity, and good self-esteem
• Cultural, spiritual, and religious connections and beliefs
• Identification of future goals
• Constructive use of leisure time (enjoyable activities)
• Support through ongoing medical and mental health care relationships
• Effective clinical care for mental, physical and substance use disorders
• Easy access to a variety of clinical interventions and support for seeking help
• Restricted access to highly lethal means of suicide
ENQUIRE
• Ask about thoughts of self harm or suicide
Direct question -
• Have you been thinking of killing yourself?
• Do you want to be dead and away from all these?
Normalizing question -
• Sometimes when people are feeling disturbed, they think of suicide, is
this something you’re thinking?
INTERVENTION
• Being a good listener and pay full attention
• Being non-judgmental
• Being supportive and instilling hope
• Offering help by asking ‘Can I help you?’
• Building a contract by asking ‘Will you promise me not to kill yourself
till I find a help for you?’
• As a part of the contract, provide a crisis plan as a safety net
• Motivate and support help seeking behaviour
• Remove anything that could be dangerous
Crisis plan will include instructions such as:
• Distract yourself from the suicidal thoughts by involving yourself in
activities like watching TV, painting, drawing, shopping, cooking or
talking to friends.
• Get involved in physical activities such as walking or exercising.
• Write down your thoughts in a diary
• Repeat to yourself ‘I have promised not to hurt myself’
• Call your confidante and talk to her and look for possible solutions to
your problems
• Call and talk to the counsellor
• Call a suicide helpline (provide numbers)
GATEKEEPER BEHAVIOUR SCALE

A study on 8,391
community based
gatekeepers by Glenn et
al, in 2016 validated the
use of scale.
ADVANTAGES
• Available mental health professionals in India are 0.75 per 100,000
population for psychiatrists, but while the desirable is 3 according to
National mental health survey.
• Gatekeepers can help in bridging this gap.
• Most of the people in the community, especially the youth are hesitant
approaching mental health professionals for help for suicide due to
stigma attached with suicide and lack of awareness of avenues of help
available and fear of being judged.
• Brief gatekeeper training found effective in improving knowledge
about suicide. Also, increasing participants accuracy to identify
warning signs, risk factors and protective factors about suicide.
• So that early identification of warning signs and early referral can
prevent death by suicide
After proving a standardized training program to 1276 gatekeepers in Germany, Hungary, Ireland, and Portugal, this article
concluded that Gatekeeper trainings in community settings are successful in improving knowledge, reshaping attitudes,
and boosting the confidence of gatekeepers. 
 Youth Aware of Mental Health Program (YAM)

The SEYLE sample consisted of 11,110 students from 168 students in 10 European countries. QPR gatekeeper training
Was done which concluded that YAM is associated with significant reduction in suicide attempts and severe suicidal
Ideation compared to control group at 12 months follow up.
CHALLENGES
• National suicide prevent strategies 2022 has not emphasized on gate
keeper training
• Mental health care act 2017 though decriminalized the suicide,
however there is lack of help seeking due to stigma and lack of
awareness regarding warning signs of suicidal behavior
• There is lack of training for informal professionals
• 6 months after QPR training Knowledge, Self Efficacy, and Behavioural
Ideation of the gatekeepers had declined
CONCLUSION
• Educational institutes (like schools, colleges and universities) and
workplaces should have a crisis management team who have had
gatekeeper training from professionals.
• Crisis team should include people from the administration and
employees who are willing to undergo gatekeeper training and help in
suicide prevention.
REFERENCES
• Hemendra S, Swati C. Role of Gatekeepers in Suicide Prevention During COVID-19 Pandemic.
Glob J Addict Rehabil Med. 2022; 6(5): 555698.
• Glenn Holmes, Amanda Clacy, Daniel F. Hermens & Jim Lagopoulos (2019): The Long-Term
Efficacy of Suicide Prevention Gatekeeper Training: A Systematic Review, Archives of Suicide
Research.
• Melanie R. Rosen, Kurt D. Michael & J. P. Jameson (2020): CALM gatekeeper training is associated
with increased confidence in utilizing means reduction approaches to suicide prevention among
college resident assistants, Journal of American College Health
• Tompkins, T.L., Witt, J. The Short-Term Effectiveness of a Suicide Prevention Gatekeeper Training
Program in a College Setting with Residence Life Advisers. J Primary Prevent 30, 131–149 (2009).
• Albright GL, Davidson J, Goldman R, Shockley KM, Timmons-Mitchell J. Development and
Validation of the Gatekeeper Behavior Scale. Crisis. 2016 Jul;37(4):271-280. doi: 10.1027/0227-
5910/a000382. Epub 2016 Jun 1. PMID: 27245815.
THANK YOU!