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Concerns for attorneys’ mental health seem to only be discussed in the aftermath of the death by suicide of a respected colleague. The news prompts a round of second-guessing and a hunt for clues that were missed. Early intervention, particularly the strategy of QPR — question, persuade, refer — is crucial to prevent mental health issues from escalating.

So what is QPR and how can it help? 

QPR stands for “Question, Persuade, Refer” and it’s used to intervene to prevent suicide.

You ask: How can QPR enhance my company’s well-being efforts, helping turn the tide against attorney suicides?

QPR is intended to be analogous to CPR (cardiopulmonary resuscitation; chest compressions during a heart attack), or the Heimlich maneuver (used to assist a choking victim), and other immediate interventions that anyone can learn to stop a medical emergency. The QPR method treats suicidality as an acute mental health emergency, just like cardiac arrest or choking is a physical health emergency. People with QPR training are equipped to:

  • Recognize the warning signs that someone may be at risk of suicide,
  • Understand common myths and misconceptions about suicide,
  • Ask questions to assess suicide risk,
  • Offer hope to people who are at risk of suicide,
  • Persuade people at risk of suicide to get help, and
  • Refer a person at risk of suicide to appropriate mental health resources.

The QPR method treats suicidality as an acute mental health emergency, just like cardiac arrest or choking is a physical health emergency.

“Seeking help early on is crucial to prevent mental health issues from escalating. Corporate counsel should not hesitate to reach out to mental health professionals, lawyer or employee assistance programs, or support organizations specializing in attorney well-being. Prioritizing mental health is not a sign of weakness but a proactive step towards overall well-being and professional success.”

- Former ACC Global Board Member and current CLO for The Broadhurst Group, Jim Patton

Much like CPR, the goal of QPR is to stop the immediate crisis until a professional with more advanced training can provide further care and treatment, up to and including inpatient care if necessary. It’s part of a “chain of survival” intended to increase the probability that a life-threatening crisis can be survived.

The initial learning process around the QPR technique can easily become a part of a company training seminar since it can be completed in just one to two hours. More extensive QPR certification training can also be implemented, making it more likely that suicides can be prevented with immediate intervention from colleagues, friends, and family. 

What’s interesting about this approach is that you don’t have to be a mental health professional to use it. In fact, QPR is designed to train anyone how to offer hope and take action when they are concerned that someone may be at risk for suicide. Once someone is trained they are recognized as a “QPR Gatekeeper” so they can use the technique.

The term “Gatekeeper” refers to anyone who may benefit from learning how to use QPR to intervene to stop a suicide. Gatekeepers are people who may be in a position to recognize warning signs of suicide and that someone is considering taking their own life.

Over the past 20 years, more than 2,500 organizations have implemented the QPR Gatekeeper training program. Over 8,500 instructors have been certified, delivering the QPR intervention to over one million people worldwide.

Although attorneys are often good at masking emotions and a personal crisis, it’s important to understand that about 90 percent of people in a suicidal crisis or suicidal ideation will give some kind of warning to those around them. Warning signs can include previous suicide attempts, alcohol and drug abuse, statements revealing or suggesting a desire to die, sudden behavior changes, depression, giving away personal belongings, and purchasing a gun or stockpiling pills.

Use the QPR technique when you see signs of suicide in a friend or colleague. fran_kie /

Although we can’t predict suicide for any individual, we can prevent suicide if someone reveals their plans and we can intervene quickly and effectively. This is where QPR training comes into play. It can help you ask the right questions at the right time to potentially save a life.

While it’s impossible to predict or prevent every suicide, early intervention can significantly increase the likelihood of preventing a tragic outcome, much like CPR can increase survival rates following cardiac arrest. QPR training equips individuals with the skills to identify warning signs, engage in meaningful conversation, and connect those at risk with appropriate care. By learning to ask the right questions at crucial moments, we can enhance our collective ability to offer lifesaving support, acknowledging that, despite our best efforts, outcomes are not guaranteed.

Mental health related CLEs

Education and training can be critical resources for attorneys and firms to prevent and address mental health and well-being issues. There are numerous CLE courses that cover various aspects of attorney well-being, from stress management, to addiction, work/life balance, meditation and mindfulness, and more. Here are a few relevant CLE courses:

How to Navigate Stress and Overwhelm for IHL Lawyers - for Career Success: Discover techniques to cultivate self-awareness, emotional regulation, and resilience. Learn how prioritizing self-care and setting boundaries can empower you to thrive amidst adversity.

Wellness Wednesday Webinar: Virtual Isolation: Is Hyperconnectivity Helping or Harming the Legal Professional? Since it doesn’t appear that the “always-on” culture will be switching off any time soon, we need to develop key strategies that can help safeguard our personal life.

The Impaired Lawyer: A Call for Action: This program dives into the danger of enabling behavior among the peers of the impaired lawyer or judge and how it can actually prevent treatment by reinforcing the denial that so called "high functioning" impaired individuals often exhibit.

Lawline's entire Attorney Well-Being catalog can be found here. Any course can be watched at zero cost with a Lawline Free Trial. Financial aid is also available for many attorneys.

The QPR approach has three steps:

Q = Question

If you believe someone is considering suicide, ask them directly “Are you thinking about suicide or wanting to kill yourself?” Don’t say “Do you want to hurt yourself?” as self-harm can be non-lethal and it’s not the same as wanting to die. Also remember that if you ask someone if they want to kill themselves, this does not drive them toward that action. That’s a myth that’s not accurate. Don’t be afraid to ask the question.

P = Persuade

Persuade the person to allow you to assist them in getting help right now. Say “Will you go with me to get help?” or “Will you let me assist you to get help?” If persuasion doesn’t work, call a local mental health center, crisis hotline, or emergency services.

R = Refer

Refer the person to an appropriate resource for assistance including the emergency confidential contact at bar associations, often called Lawyer Assistance Programs. It’s ideal if you can personally escort them to see a healthcare professional, but the next best thing would be to assist in making arrangements for help. Less preferable is to provide referral resources for them to sort through on their own.

If, as a result of learning QPR, just one person uses the approach and that person saves a single life, then the training will have been worth it!

Support Services

Lawyers Concerned for Lawyers (LCL) For immediate assistance, please call: 651-646-5590 or 1-866-525-6466

National Mental Health Association (NMHA) 1-800-273-TALK (8255) to reach a 24-hour crisis center, or text MHA to 741741 at the Crisis Text Line

SAMHSA's National Helpline (substance abuse and mental health services) 24/7 free and confidential treatment referral and information about mental and substance use disorders, prevention, and recovery. Call 1-800-662-HELP.

Crisis Text Line Text START to 741-741.

The Trevor Project 1-866-488-7386 or text 678-678 24/7 confidential crisis support for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) young people.

Veterans Crisis Line 1-800-273-8255 or text 838-255, 24/7, confidential crisis support for Veterans and their loved ones.

How can we stop the “silent spiral”?

As an employer

Concerns for attorneys' mental health seem to only be discussed in the aftermath of the death by suicide of respected colleague. The news prompts a round of second-guessing and hunt for clues that were missed. Early intervention is crucial to prevent mental health issues from escalating.

While some legal departments have started to build robust well-being programs, some remain resistant, often due to concerns that addressing mental health and the silent spiral into suicide is not appropriate for a work setting. A 2022 white paper produced by the National Guidelines for Workplace Suicide Prevention outlined common reservations from human resources professionals and employment counsel:

Fear: If we reach out to a struggling employee, we’ll trigger an ADA or FMLA claim.

Reality: Encouraging early help-seeking, investing in resources to support employees before and during emotional health challenges, and working to intentionally maintain a strong connection are top strategies for maintaining productivity and retention, reducing turnover, and minimizing litigation risk.

Fear: Employees who request accommodations take up a lot of administrative and managerial time.

Reality: Reframe the situation: It should be an opportunity, not a legal threat. Early engagement between HR and legal can mak the formal accommodation process smoother.  

Fear: If we impose discipline on an employee we are accommodating, we may get into legal trouble.

Reality: Employees rarely decide “Today, I am going to be the worst employee ever!” Explore drivers of distress and revisit accommodations if performance doesn’t improve.

Fear: If we extend accommodations to one employee, we’ll have to offer the same perks to everyone else.

Reality: This concern is best managed through transparent communication to work teams by building trust.

Fear: Employees in crisis often need extended leaves of absence, resulting in burdensome work disruption.

Reality: Courts generally impose two limitations on proposed leaves of absence: (1) the employee must provide an estimated date to restart their duties and (2) the employee must be able to return to work in the near future, which has been construed to be less than six months.

Who’s at risk?

Not only are companies, employment counsel, and HR professionals reticent about discussing mental health and suicide, but so are lawyers as a profession. They are some of the least inclined to seek mental health assistance, even though the suicide rate is rising in the profession. 

Lawyers don’t have a monopoly on stress, but studies suggest the stress of practicing law, especially when combined with other factors, can be especially detrimental to mental well-being. Studies also show lawyers who report feeling high stress are 22 times more prone to suicidal ideation than low-stress professions. Think about that — 22 times more likely to contemplate suicide.

Lawyers are more prone to suicide than other professionals. Black Salmon /

They are some of the least inclined to seek mental health assistance, even though the suicide rate is rising in the profession.

The basic stress-inducing culprits are familiar: long hours, tight deadlines, complex tasks and demanding clients — not to mention the fundamentally adversarial nature of the work itself.

In one US-based survey, attorneys were asked, “How often have you had thoughts that you would be better off dead, or of hurting yourself?” Those who said, “Several days,” “More than half the days,” or “Nearly every day,” were classified as endorsing suicidality.

Therapy and Counseling Options

Lawyers Concerned for Lawyers (LCL): Provides support, counseling, and resources for lawyers dealing with substance abuse and mental health issues.

Lawyers Depression Project: A free, online peer support community for legal professionals. confidential member forum, weekly meetings.

Mental Health America (MHA): MHA provides a wide range of resources on mental health topics, including screening tools and information on finding therapy.

Mental health resources for attorneys and legal employers  Receive QRP gatekeeper and certification training for individuals and organizations.

For those contemplating suicide in the US or are in a life crisis, simply DIAL 988 toll-free 24 hours. 

Stressed, Lonely, and Overcommitted: Predictors of Lawyer Suicide Risk. Patrick R. Krill et al.

The Role of HR and Employment Law in Workplace Suicide Prevention: New Report Addresses Concerns and Provides Recommendations. This document offers sample procedure tips, case studies, and manager approaches to help employers make the best decisions to support employees experiencing mental health emergencies.

About 4.2 percent of all US-based adults fall into that category, compared with 8.5 percent of lawyers. Within the attorney cohort, however, a portrait of those at greatest risk emerged.

According to the study, male lawyers are twice as likely to contemplate suicide – a “surprising” finding, since the researchers also found that women lawyers had more risk factors such as anxiety, depression, and hazardous levels of alcohol use.

They’re also lonely. The study theorizes that such feelings of social isolation could be related to the profession's demanding nature and its often competitive and individualistic culture.

In addition, lawyers who are overly committed to their work are also more likely to contemplate self-harm.

While statistical analysis found that a lawyer’s race by itself wasn’t a predictor of suicidality, the raw survey data indicated that lawyers who identified as Asian, followed by Black and Latino, more often thought about self-harm compared with those who are Caucasian/White — numbers that could be a cause for pause and seen as a reflection of the legal profession’s lack of diversity and the associated struggles among minority lawyers.

The most unhappy lawyers are also apt to be young. The survey data showed that lawyers under age 30 were most likely to report feelings of suicidal ideation, while those 61 and older were least likely to do so, though age alone also wasn’t a predictor of suicidality.

According to data, young male lawyers are more likely to struggle with mental health compared to other attorneys. NassornSnitwong /

These findings underscore the urgency for legal departments to respond now with initiatives, such as QPR, aimed at identifying overstressed individuals and reducing suicidal ideation or the ultimate final decision to commit suicide. 

The basic stress-inducing culprits are familiar: long hours, tight deadlines, complex tasks and demanding clients — not to mention the fundamentally adversarial nature of the work itself.

In one US-based survey, attorneys were asked, “How often have you had thoughts that you would be better off dead, or of hurting yourself?” Those who said, “Several days,” “More than half the days,” or “Nearly every day,” were classified as endorsing suicidality.

How to make a difference

Attend a QPR training, particularly if you fit one of the “gatekeeper” categories or you believe you may come into contact with people who may be considering suicide.

Just as CPR prepares you for stepping in to assist with a cardiac emergency, QPR will give you the skills and knowledge to intervene to possibly prevent a suicide. Remember: if you ask the question, you may just save a life.

Prioritizing mental health in the legal profession is not only essential for the well-being of attorneys but also professional success. By acknowledging the challenges faced by legal professionals and providing resources, including QPR training, we can create a more compassionate and resilient legal community. Together, let's work towards breaking the stigma surrounding mental health in law and fostering a supportive environment where attorneys can thrive both personally and professionally.

Well-being apps and online tools

Headspace: A mindfulness app with guided meditation and stress-relief exercises to help attorneys manage stress and improve focus.

Calm: An app that offers guided meditation, sleep stories, and relaxation exercises to reduce anxiety and promote better sleep.

Happify: A digital platform with scientifically backed activities and games to boost resilience and overall well-being.

Disclaimer: the information in any resource collected in this virtual library should not be construed as legal advice or legal opinion on specific facts and should not be considered representative of the views of its authors, its sponsors, and/or ACC. These resources are not intended as a definitive statement on the subject addressed. Rather, they are intended to serve as a tool providing practical advice and references for the busy in-house practitioner and other readers.