Minnesota Department of Health Report to the Minnesota Legislature by xscape


									Minnesota Department of Health
Report to the
Minnesota Legislature:
Suicide Prevention Plan
January 15, 2000

       Commissioner’s Office
       85 East Seventh Place, Suite 400
       St. Paul, MN 55164-0882
       (651) 296-8401
Report to the
Minnesota Legislature:
Suicide Prevention Plan

January 15, 2000
For more information, contact:
Family Health Division
Minnesota Department of Health
85 East Seventh Place, Suite 400
P.O. Box 64882
St. Paul, Minnesota 55164-0882

Phone: (651) 281-9888
Fax: (651) 215-8953

As requested by Minnesota Statute 3.197: This report cost approximately $5750.00 to prepare, including staff time, printing and mailing

Upon request, this material will be made available in an alternative format such as large print, Braille or cassette tape.

Printed on recycled paper.
Table of Contents
Part I

Introduction and Background ................................................................................................................ 1

Overview ................................................................................................................................................ 2

Commissioner’s Recommendations and Action Plan ............................................................................ 2

Part II

Ad Hoc Advisory Group Recommendations ......................................................................................... 6

Part III

Supporting Documents
       A.     References
       B.     Public Health Data Chart and Graphs
       C.     Suicide prevention, Healthy Minnesotans: Public Health Improvement Goals 2004
       D.     Ad Hoc Advisory Group Members
       E.     Surgeon General’s Call to Action to Prevent Suicide
              Part I

    Introduction and Background


Commissioner’s Recommendations and
            Action Plan
Introduction and Background                              History

The United States Surgeon General, David                 In October 1998, at the request of the U.S.
Satcher, has declared suicide a serious public           Centers for Disease Control, MDH staff
health concern and has issued a call to action for       participated in a national suicide prevention
each state to implement strategies to prevent            conference in Reno, Nevada. The Healthy
suicide (1999, U.S. Public Health Service). At the       Minnesotans suicide prevention strategies were
request of the 1999 Minnesota Legislature (Ch.           reviewed in the conference and helped to inform
245, Article 1, Section 3), the Minnesota                the resulting Surgeon General’s Call to Action to
Department of Health (MDH) has been convening            Prevent Suicide. In addition to MDH,
and consulting with a large group of stakeholders to     representatives from Minnesota included the
develop a suicide prevention plan for the state of       Minnesota Department of Human Services,
Minnesota.                                               Hennepin County Community Health, the SA/VE
                                                         (Suicide Awareness/Voices of Education)
MDH has a responsibility to provide both                 organization, and others. This Minnesota
leadership and technical assistance on mental health     delegation joined with national researchers,
promotion to Minnesota’s communities, and has            clinicians, policy makers, advocates, and suicide
recognized suicide as a leading public health issue,     survivors to examine what is known and not known
promoted as such in Healthy Minnesotans: Public          about suicide and developed the set of national
Health Improvement Goals 2004. Healthy                   recommendations to prevent suicide presented in
Minnesotans was developed with the 49                    the Surgeon Generals’ report. These
Community Health Boards and 26 statewide                 recommendations serve as the framework for
organizations comprising the Minnesota Health            Minnesota’s suicide prevention planning process.
Improvement Partnership (MHIP). The document
promotes a common public health agenda and               Process
includes health promotion strategies, including
suicide prevention, requiring the engagement of          Beginning in August 1999, MDH convened bi-
diverse segments of the community. (1998, MDH)           weekly a small planning group, including those who
                                                         participated in the Reno conference. On October
Charge to the Group                                      25, 1999, in an effort to involve a broad
                                                         representation of stakeholders in the planning
For the first time in state history, at the request of   process, the Commissioner of Health hosted a day-
MDH, more than 120 Minnesotans representing a            long working symposium of over 60 participants.
broad range of constituencies have joined together       Symposium participants, as well as those who
to work toward the common goal of suicide                provided input via small group meetings with MDH
prevention. The charge to this ad hoc advisory           staff, telephone consultations, and written comment,
group is to consult with MDH on a study of suicide       have subsequently been invited to monthly
and to advise on the development of a suicide            meetings facilitated by MDH staff. Contributors to
prevention plan. The group is comprised of               this process have developed a set of 28 strategies,
representatives from community health, human             included in Part II of this report, to recommend to
services, mental health professionals, schools,          the Commissioner of Health to consider in
health plans, advocates, suicide survivors (those        developing the suicide prevention plan. MDH will
who have lost a loved one to suicide), and others.       continue to convene monthly meetings through June
Names and affiliations are included in Part III.         2000, as the plan is implemented.


Current Status:                                         The three leading methods of suicide in
The Minnesota Face of Suicide                           Minnesota, and nationally, are firearms,
                                                        suffocation and poisoning (1999, MDH).
The recently released Surgeon General’s Report on
Mental Health states that twenty-two percent of         While data on suicide attempts are scarce,
Americans have a "diagnosable mental disorder"          preliminary data (likely to be undercounts) from the
but nearly two-thirds of them never seek care. The      Twin Cities seven-county area appear to indicate:
top two reasons cited in the report for not seeking     ‚       among females age ten through 39,
care are concern about the stigma associated with               self-inflicted poisoning is the leading
mental disorders and lack of access (1999, U.S.                 cause of hospitalized injury;
Public Health Service).                                 ‚       self-inflicted poisoning is the second
                                                                leading cause of hospitalized injury
This report reflects the “Minnesota face of suicide.”           overall; and
Suicidal behaviors range from ideation and              ‚       self-inflicted cutting/piercing is the third
attempted suicide to self-inflicted death. In                   leading cause of hospitalized injury among
Minnesota, from 1993-1997:                                      ten- through 14-year-olds. (1999, MDH
‚       suicide ranks as the second leading cause               & The Minnesota Hospital and Healthcare
        of death among ten- to 34-year-olds;                    Partnership)
‚       suicide is the eighth leading cause of death
        for all ages combined (Nationally, suicide
        also ranks as the eighth leading cause of       Commissioner’s Recommendations and
        death);                                         Action Plan
‚       three times as many Minnesotans died of
        suicide than from homicide; and                 Prevent a Public Health Problem
‚       in the 15-24 age group, three-and-a-half        with a Public Health Approach
        times more young Minnesotans died of
        suicide than from cancer. (1999, MDH)           Suicide results in the tragic loss of human life as
                                                        well as agonizing grief, fear, and confusion in
The Minnesota data show that suicide is more            families and communities. It extends its reach
prevalent in some groups than in others:                across multiple generations of families,
‚       males comprise approximately 80 percent         communities, and systems. While suicide may not
        of all suicide deaths;                          be prevented through a single approach, it is ideally
‚       suicide is the second leading cause of death    suited to a community-based, public health
        for young males in all racial and ethnic        approach. As evidenced in the recommended
        groups;                                         strategies in Part II of this report, Minnesota
‚       the suicide rate for American Indians is        stakeholders have made a commitment to work
        consistently higher than for any other racial   together to cast an ever-widening net to save
        and ethnic group; and                           community members from taking their own lives.
‚       Minnesotans 65 years of age and older
        have the highest suicide rate of all age        While suicide involves multiple individual, social,
        groups. (1999, MDH)                             and environmental components, it is rarely random
                                                        or inevitable. Minnesotans can take measures

to prevent community members from                      ‚ employment,
attempting to kill themselves or from taking           ‚ law enforcement, and
their own lives. Many traditional prevention           ‚ corrections.
approaches target those who are exhibiting suicidal    By determining these actual costs, MDH and its
behaviors. This and the Surgeon General’s suicide      partners can inform efforts to balance the allocation
prevention report highlight the need for approaches    of efforts and resources between intervention needs
designed to promote the welfare of an entire           with prevention needs.
population. These include identifying high risk
populations, reducing risks, and building on           The 28 recommended Minnesota suicide
strengths in individuals and communities,              prevention strategies, in Part II of this report,
approaches commonly utilized by MDH to promote         represent the thorough and thoughtful work of a
healthy communities.                                   committed group of Minnesotans. These strategies
                                                       will serve to guide MDH in providing leadership
Based on public health principles, mental health       and technical assistance on mental health promotion
promotion strategies:                                  to Minnesota’s communities. However, support
‚ raise awareness;                                     and efforts from multiple partners are needed to
‚ reduce stigma associated with mental and             provide for a truly comprehensive approach to
   substance abuse disorders, suicidal thoughts,       suicide prevention. The following action plan
   and seeking help; and,                              reflects the capacities of MDH and its partners to
‚ facilitate ease of access to, and availability of,   work together to reduce suicide as a leading cause
   mental health care.                                 of death among so many Minnesotans.

Suicidal behaviors should be studied in-depth using    Minnesota Department of Health
the same epidemiological principles that inform our    2000 Action Plan
understanding and approach to other health
problems. Such ongoing study, with rigorous            Utilizing a population focus to maximize reach and
evaluation of multi-component prevention efforts,      to engage multiple stakeholders, the Minnesota
will help identify effective preventive strategies.    Department of Health is committed to addressing
This integrated public health approach has             suicide as a significant public health problem in
contributed to a greater than 40 percent reduction     Minnesota through the following activities:
in suicides in the United States Air Force (1999,
U.S. Public Health Service; 1999, Centers for          ‚ Suicide prevention reflects, and will be
Disease Control).                                        promoted through, the priorities set forth in two
                                                         of the department’s new Strategic Directions:
The benefits of saved lives are immeasurable,            1) eliminating disparities in health status, and 2)
including the social and emotional well-being of         bringing the community together on public
families and communities. Other benefits include         health goals. By coordinating and enhancing
not only savings in medical costs of suicide             collaboration among state, county, and
attempts, but also savings associated with the           community agencies to further develop mental
impact of untreated mental illness and brain disease     health policy in Minnesota, MDH will ensure
in a variety of settings and systems including:          that suicide prevention is a priority for the state
‚ health care,                                           of Minnesota.
‚ social services,
‚ education,                                           ‚ MDH will continue to seek input from the

    suicide prevention ad hoc advisory group in
    implementing the suicide prevention plan.
    MDH recognizes the Department of Human                   1) The Minnesota Health Improvement
    Services State Mental Health Advisory Council         Partnership (MHIP) will include suicide
    as a valuable resource to these efforts and will      prevention in its work to improve adolescent
    take leadership in enhancing collaboration with       health care and to expand understanding of the
    this body to ensure appropriate linkages are          underlying conditions affecting health.
    made as the plan is implemented.
                                                             2) MDH will work with the Office of
‚ MDH will evaluate the recommendation of the             Minority Health Advisory Group to understand
  ad hoc advisory group to establish a new                and respond to the indicated disparity of suicide
  statutorily-created Suicide Prevention Council          among American Indians.
  and alternatively consider adding suicide
  prevention as a charge to existing state advisory           3) MDH will recommend that the
  bodies.                                                 governor’s SAFE council explore the
                                                          discontinuation of reporting suicide as a crime
‚ MDH is reviewing 50 community health plans              statistic.
  recently submitted to MDH by all of the
  community health boards to determine                       4) MDH will advocate that mental health
  community needs and priorities regarding                care availability and quality be a priority for the
  suicide and mental health. For example, in their        administration’s 2001 health reform proposals.
  2000-2003 Public Health Plan, Dakota County
  ranked mental health as their county’s number              5) Statewide and local grantees of the
  one health problem, as determined by                    Tobacco and Youth Risk Behaviors
  community assessment. Information from the              Endowment will be encouraged to address
  50 plans will be utilized to inform MDH policy,         tobacco and other substance abuse as a risk
  budget, and technical assistance priorities.            factor for developing a mental disorder (1999,
                                                          U.S. Public Health Service).
‚ MDH will ensure that any data practice
  implications associated with implementing                 6) MDH and the School Mental Health
  suicide prevention strategies are identified and        Partnership will work with the Minnesota
  addressed with appropriate stakeholders.                Department of Children, Families, &
                                                          Learning and the Coordinated School Health
‚ Through the continuing leadership of MDH, the           project to explore the development of
  recommendations in this report will be                  an integrated K-12 suicide prevention
  promoted through the work of the Minnesota              program.
  Children’s Cabinet, the Rural Health Advisory
  Committee, the Maternal & Child Health                    7) MDH will ask the State Community
  Advisory Task Force, the Adolescent Health              Health Services Advisory Committee
  Action Plan, and others.                                (SCHSAC) to promote suicide prevention
                                                          awareness and education among local public
    Specific examples of how MDH will pursue              health policymakers and officials.
    these recommendations through other activities
    include:                                           ‚ MDH will develop a plan to assess and
                                                         organize its resources to address public health

  goals and strategies for mental health, including
  suicide prevention.
‚ MDH and the suicide prevention ad hoc
  advisory group will continue to solicit input
  from key stakeholders, gather information, build
  relationships with minority and under
  represented communities to address suicide
  prevention, tap into existing collaborations and
  efforts addressing related issues, and network
  with other state and national agencies and
  experts working in suicide prevention.

‚ The ad hoc advisory group will assist MDH in
  developing a comprehensive implementation
  plan, including identifying and clarifying the
  roles of key stakeholders, developing
  objectives for each strategy, and determining
  costs associated with individual components of
  the overall plan. This plan will be considered in
  the MDH planning process for the next biennial

‚ Because the 2000 legislative session is a non-
  budget year, MDH will not be seeking
  legislation to implement these recommendations
  prior to the next biennial budget. And,
  reflective of the governor’s emphasis on
  ensuring government is limited
  and accountable, pursuing this plan will not
  exclusively result in requests for additional
  government funding. We will challenge
  ourselves and our partners to re-focus and
  better leverage existing programs and activities.

      Part II

Ad Hoc Advisory Group
Ad Hoc Advisory Group Recommended                        IMPLEMENT THE PLAN AND
Minnesota Suicide Prevention Strategies                  STRATEGIES:

The following strategies are recommended by the          Make suicide prevention a priority for
ad hoc advisory group. MDH will evaluate and             Minnesota and continue coordination of
consider inclusion of specific statutory and fiscal      efforts.
requests relating to these recommendations for the
2001 legislative session.                                MDH staff should continue to coordinate the
                                                         implementation of the suicide prevention plan in
These strategies reflect the combined efforts of         collaboration with assigned staff from other state
over 120 statewide contributors, guided by the 15        departments and appropriate community advisory
key recommendations in the Surgeon General’s             bodies. In line with the Surgeon General’s
Call to Action to Prevent Suicide. Evidence-based        recommendations, this effort should be delivered
and prioritized by leading national experts, these 15    through a primary prevention, public health
recommendations are categorized as Awareness,            approach, with MDH staff designated to suicide
Intervention, and Methodology, or AIM:                   prevention to ensure continuity of these efforts.
                                                         Implementation of the plan should include a
    Awareness: Appropriately broaden the                 statewide technical assistance conference for key
    public’s awareness of suicide and its risk           stakeholders. MDH will ensure that suicide
    factors;                                             prevention is considered a priority public health
                                                         issue for the state of Minnesota, especially as it
    Intervention: Enhance services and                   reflects the goals of the MDH Strategic Directions.
    programs, both population-based and                  *Fiscal impact from all sources: $150,000
    clinical care;                                       annually.

    Methodology: Advance the science of                  Enhance and formalize statewide collaboration
    suicide prevention.                                  of multiple stakeholders.

The strategies presented here provide a framework        Establish by statute and staff, a statewide Suicide
for further collaboration, implementation, and           Prevention Advisory Council, with members
evaluation of a comprehensive, ongoing state plan        appointed by the Governor, to advise MDH and
to prevent suicide. Strategies are prioritized by the    other state agencies on the implementation of the
group, in the order listed, and the group’s intentions   suicide prevention plan. Ensure representation
are that strategies be dependent upon staffing           from greater Minnesota; minority populations;
capacity within MDH. Each strategy, while unique         suicide survivors; clinicians; elementary, secondary,
to Minnesota, corresponds to one of the AIM              and higher education; mental health advocates;
categories in the Surgeon General’s report:              consumers of health and mental health services;
Awareness, Intervention, and Methodology.                health plans; older Minnesotans; youth; children’s
                                                         advocates; and government agencies. *Fiscal
*   Preliminary cost estimates are provided,             impact from all sources: $50,000 annually.
    include existing funds, and will be refined
    in the implementation planning effort.               Each of the following strategies must be
                                                         implemented through culture- and age-specific
PRIORITY ACTIVITIES NECESSARY TO                         approaches and include rigorous evaluation

        AWARENESS STRATEGIES                           Awareness-4.     Eliminate the reporting of
                                                       suicide as a crime statistic. Report suicide as
Broaden statewide awareness and                        public health data to reduce criminal stigma
outreach to reduce stigma and increase                 associated with suicide and suicide behaviors.
help-seeking behaviors. Fiscal impact
from all sources for strategies Awareness 1            Awareness-5.     Increase awareness and
through 5: *$1,500,000 annually.                       education to state, county, and local
                                                       policymakers and officials on suicide, suicidal
Awareness-1.      Develop and promote the use of       behavior, depression, mental illness, brain disease,
common language, uniform terminology, and              and substance abuse and their impact on health
consistent messages regarding suicide,                 care, social service, education, law enforcement,
depression, mental illness, brain diseases,            employment, and corrections systems.
substance abuse, symptoms, warning signs, risk
factors, and help-seeking actions and behaviors of
those at risk and of community helpers and             Finance core community-based
“gatekeepers” (who are in a position to identify       programs. Secure funding to assure core
warning signs and make referrals). Determine and       community-based programs to provide outreach,
utilize effective language and approaches to diverse   advocacy, and education to populations at risk for
audiences.                                             suicide and to provide education, training,
                                                       networking opportunities, and skill development in
Awareness-2.     In coordination with existing         communities and schools. Determine a fair,
statewide efforts (i.e. Minnesota Department of        coordinated, and efficient way of financing
Human Services), implement an ongoing,                 programs, including grants, funding of direct
coordinated multi-strategy, multi-media, and multi-    services, and funding from public and private
partner public awareness and anti-stigma               sources. *Fiscal impact from all sources for
campaign, utilizing influential spokespersons ,        strategies Awareness 6 and 7: $3,000,000
targeting high risk populations and "gatekeepers."     annually.
Utilize common language, uniform terminology, and
consistent messages, as detailed above. Include        Awareness-6.     Build community capacity to
culture- and age-specific approaches. Ensure the       provide outreach, advocacy, and education through
campaign raises awareness of suicide as a public       home- and community-based programs to high risk
health issue and that many suicides are preventable.   populations who are socially
                                                       and physically isolated (minority populations, youth,
Awareness-3.     Establish partnerships with           persons in correctional programs, the elderly, and
Minnesota media vendors to promote increased           persons who are gay, lesbian, bisexual and
public service for suicide prevention. Create          transgender). Ensure programming includes
public/private collaborations that                     symptoms of depression, substance abuse, mental
support and educate media vendors, associations,       illness, and brain diseases, warning signs of suicide,
reporters, advertising vendors,                        resource         identification and use, healthy
and entertainment industry about suicide, suicidal     coping and help-seeking behaviors.
behavior, mental illness, substance abuse, and help-
seeking and promote the development of fair,           Awareness-7.   Identify community-based agencies
effective, accurate, and culturally-appropriate        that can promote suicide prevention through their
media policies and practices.                          networking, outreach, referral activities,
                                                       understanding of suicide, and ability

to reduce stigma. Facilitate networking and           Promote education, training, skill
referrals between these and other public, private,    development in communities and
and community-based mental illness and substance      schools. *Fiscal impact from all sources for
abuse prevention and treatment agencies.              strategies Intervention 5 through 9: $250,000

       INTERVENTION STRATEGIES                        Intervention-5.  Study and develop a statewide
                                                      K-12 prevention and intervention program,
Study access to mental health care.                   including integrated curriculum, socially and
*Fiscal impact from all sources for strategies        culturally responsive and emotionally and physically
Intervention 1 through 4: $100,000 annually.          safe school policies and practices, community-
                                                      based resources and networks. Address trust-
Intervention-1.    In coordination with existing      building and confidentiality issues
studies in Minnesota, study universal access to,      between students and school staff. Ensure the
coverage of, and related costs of adequate            program provides for staff support to implement
mental health care . Study to include access to       identified protocols. Identify, utilize, and evaluate
mental health consult within 24 hours of inpatient    existing evidence-based materials and evaluate new
admission; access to mental health services in        program components. Ensure program
correctional programs and in other licensed           development includes input from minority
facilities, including foster care; aftercare upon     populations, greater Minnesota, youth, parents, and
discharge; assessment of the                          representatives from high risk populations.
effectiveness of the parity law and its limitations
given federal law, to access necessary medications    Intervention-6.  Promote employee assistance
(i.e. co-pay costs, access to psychiatry). Identify   and workplace programs to support and refer
gaps and barriers, develop collaborative strategies   employees with mental illness, depression,
to improve access and promote availability of         substance abuse behaviors, and brain
mental health professionals, and prioritize           diseases in collaboration with employer and
recommendations.                                      professional associations, unions,
                                                      labor industry, and safety council.
Intervention-2.Study the feasibility of extending
and expanding the senior drug program to cover        Intervention-7.    Develop and promote the
mental health medications , including                 implementation of culturally-specific and age-
psychotropic medications, for consumers with          appropriate patient education on suicide, suicidal
DSM -IV diagnosed disabilities. Develop               behavior, depression, mental
recommendations.                                      illness, brain diseases, use of medications,
                                                      substance abuse, access to lethal
Intervention-3.Study impact of patients' rights       methods, referrals and help-seeking, as indicated.
laws on access to crisis mental health care.          Identify, utilize, and evaluate
Develop recommendations addressing barriers.          existing evidence-based materials. Work with
                                                      employers of health professionals to ensure
Intervention-4.  Study associated costs and           adequate staff support to implement protocols.
recommend adequate mental health                      Ensure development includes input from community
professional/student ratio in schools, colleges,      stakeholders, health care organizations and
 and universities.                                    subsidiaries.

Intervention-8.  Educate and promote the role of        Intervention-11.  Require and provide start-up funds
natural community “helpers” (clergy, spiritual          for Continuing Medical Education-, Clinical
leaders and advisors, coaches, community business       Pastoral Education-, and other Continuing
people, community education, private                    Education-eligible training, both
organizations, etc.) to support self-preservation       basic and advanced, on prevention, intervention,
instincts and encourage culture- and age-specific       screening for, and co-occurrence of, suicide,
help-seeking behaviors. Education to “helpers”          suicidal behavior, depression, mental illness, brain
should include the symptoms of depression, mental       diseases, and substance abuse for education,
illness, substance abuse, brain diseases, the warning   health, corrections, social services, and
signs of suicide, prevention skills, how to restrict    religious/spiritual professionals, including foster care
access to lethal methods, and how to make               providers. Curricula to include trust-building and
effective referrals to culture- and age-specific        confidentiality issues. Study and recommend state
interventions and/or resources.                         standards for education and
Intervention-9. Educate communities and
schools staff on the co-occurrence of substance         Intervention-12. Work with professional
abuse with depression, mental illness, and brain        licensing, certifying and re-certifying, and
disease. Explain the relationship between impulsive     accrediting bodies to include education
behaviors in children and youth and access to lethal    requirements on prevention, intervention, and
methods. Provide examples of how to intervene.          screening for suicide, suicidal behavior, depression,
                                                        mental illness, brain diseases,
                                                        and substance abuse (and their co-occurrence).
Ensure professional training. Secure
funding for state departments, in consultation with
the Suicide Prevention Advisory Council, to assess
professional training needs and facilitate education,   Strengthen crisis response, "safety net,"
professional training, cross-training, and networking   and follow-up care, especially in
opportunities, including community-based crisis         schools. *Fiscal impact from all sources for
response teams. *Fiscal impact from all sources         strategies Intervention 13 through 14: $35,000
for strategies Intervention 10 through 12:              annually, assuming staff capacity.
$250,000 annually.
                                                        Intervention-13. Identify gaps, barriers to, and
Intervention-10. Work with educational institutions     costs for basic suicide crisis, "safety net," and
to include course work and curricula on                 follow-up services, especially in schools.
prevention, intervention, and screening for suicide,    Provide recommendations to ensure trained suicide
suicidal behavior, depression mental illness,           crisis teams and networks in every community,
substance abuse, and                                    including schools, colleges, and universities. In
brain diseases (and their co-occurrence) in             addition to requiring credentials of providers,
education, health, mental health, corrections, law      ensure providers receive adequate training
enforcement, social services, clergy and other faith-   regarding suicide, suicide ideation, and suicide
based professions’ associate and baccalaureate          attempts (including correctional and law
programs. Course work to include trust-building         enforcement staff). Promote collaborations of
and confidentiality.                                    consumers, providers, families, and other
                                                        stakeholders to create comprehensive “safety net”

of community response to people at high risk for

Intervention-14.Strengthen emergency services            Promote a Minnesota research agenda.
requirements in the Comprehensive Mental                 *Fiscal impact from all sources for strategy
Health Act (CMHA).                                       Methodology 4: $125,000 annually.

                                                         Methodology-4.   Identify Minnesota’s research
    METHODOLOGY AND RESEARCH                             agenda; establish partnerships to promote
           STRATEGIES                                    scholarships/fellowships and provide technical
                                                         assistance to secure funds for research to
Conduct a study of suicide in Minnesota.                 understand risk and protective factors related to
Ensure and enhance state and community capacity          suicide, suicidal behaviors, effective prevention
to collect and utilize data necessary for analysis and   programs, clinical treatments, and culturally-
evaluation of prevention efforts. Secure funding for     specific interventions.
MDH to collaborate with federal, regional, state,
county, and other local agencies in conducting a
study of suicide and suicidal behaviors in               Restricting access to highly lethal
Minnesota. *Fiscal impact from all sources for           methods of suicide. *Fiscal impact from all
strategies Methodology 1 through 3: $500,000             sources for strategies Methodology 5 through 7:
annually.                                                $50,000 annually.

Methodology-1.    Establish state capacity to            Methodology-5.   Promote and enforce means
collaborate with federal, regional, state, county, and   restrictions (i.e. safe storage of firearms,
other agencies to collect, analyze, and report           medications, and toxic substances; use of trigger
Minnesota-specific data on suicide and suicidal          locks, etc.).
behaviors (i.e. statewide inpatient, outpatient
coding of external cause of injury on medical            Methodology-6.   Educate the public, law
records, including psychiatric hospitals;                enforcement, and judges on the Child Access
follow-back studies). Include demographically-           Protection (CAP) law, intended to hold adults
specific data (regional and community-specific),         responsible for keeping firearms away from
data on those who are insured vs. uninsured,             children. Assess effectiveness of the law and
suicide attempts post-hospitalization outcomes, and      develop recommendations.
associated costs of suicide and suicidal behaviors
(health, social services, law enforcement, etc.).        Methodology-7.   Study policies of public and
                                                         private licensed institutional care , including
Methodology-2.   Conduct state interagency review        foster care and jails, regarding suicide prevention
of all child suicides under age 15.                      and intervention practices and access
                                                         to methods to commit suicide. Provide
Methodology-3.  As not all suicides are reported as      recommendations.
such, study suicide reporting practices and
make necessary recommendations.

      Part III

Supporting Documents

Centers for Disease Control and Prevention (CDC) (1999). Suicide prevention among
       active duty Air Force personnel - United States, 1990-1999. MMWR
       (Morbidity and Mortality Weekly Report), 48(46); 1053-1057.
       Superintendent of Documents, U.S. Government Printing Office, Washington,
       DC 20402-9371

Minnesota Department of Health (1999). 1992-1998 Death Certificates, Minnesota
      Center for Health Statistics, Minnesota Department of Health.

Minnesota Department of Health (1998). Healthy Minnesotans: Public Health
      Improvement Goals 2004, Division of Community Health Services,
      Minnesota Department of Health.

Minnesota Department of Health & The Minnesota Hospital and Healthcare
      Partnership (April 1999). Hospitalized Injury in Minnesota: Residents of the
      Seven-County Metropolitan Area; Incidence, Outcomes and Causes, April
      1997-March 1998. Injury and Violence Prevention Unit, Minnesota
      Department of Health.

U.S. Public Health Service (1999). The Surgeon General’s Call to Action to Prevent
       Suicide. U.S. Public Health Service, Washington, DC.

U.S. Public Health Service (1999). Mental Health: A Report of the Surgeon General.
       U.S. Public Health Service, Washington, DC.
                                      10 Leading Causes of Deaths by Age Group
                                                Minnesota 1993-1997
       <1              1-4            5-9              10-14             15-24           25-34            35-44             45-54           55-64           65+               All ages
       Congenital      Unintentional Unintentional     Unintentional     Unintentional   Unintentional    Cancer            Cancer          Cancer          Heart Disease     Heart Disease
1      Anomalies       Injury        Injury            Injury            Injury          Injury           1,255             3,244           6,402           44,735            52,035
       574             155           121               151               1,027           895

       SIDS            Congenital     Cancer           Suicide           Suicide         Suicide          Unintentional     Heart Disease   Heart Disease   Cancer            Cancer
2      349             Anomalies      38               39                393             497              Injury            2,064           4,035           31,685            43,192
                       66                                                                                 875

       Other Perinatal Cancer         Congenital       Cancer            Homicide        Cancer           Heart Disease     Unintentional   Chronic Obstr. Stroke             Stroke
3      Conditions      41             Anomalies        37                227             378              840               Injury          Pulmonary Dis. 13,902             15,035
       196                            17                                                                                    631             628

       Short Gest./ LowHomicide       Heart Disease    Congenital        Cancer          AIDS/HIV         Suicide           Stroke          Stroke          Chronic Obstr.    Chronic Obstr.
4      Birthwt.        23             9                Anomalies         112             283              564               344             588             Pulmonary Dis.    Pulmonary Dis.
       175                                             19                                                                                                   7,338             8,179

       Maternal        Pneumonia & Homicide            Homicide          Heart Disease   Heart Disease    AIDS/HIV          Suicide         Unintentional   Pneumonia &       Unintentional
5      Complications   Influenza   9                   18                64              222              456               335             Injury          Influenza         Injury
       179             16                                                                                                                   491             6,676             8,141

       Placental      Heart Disease Pneumonia &        Heart Disease     Congenital      Homicide         Cirrhosis         Cirrhosis       Diabetes        Diabetes          Pneumonia &
6      Complications* 14            Influenza          13                Anomalies       203              186               277             471             3,735             Influenza
       110                          5                                    37                                                                                                   7,057

       Respiratory     Septicemia     Septicemia       Stroke            Stroke          Stroke           Homicide          Diabetes        Cirrhosis       Unintentional     Diabetes
7      Distress        4              3                6                 20              49               148               240             309             Injury            4,638
       64                                                                                                                                                   3,732

       Unintentional   Stroke         Stroke           Pneumonia &       Chronic Obstr. Diabetes          Diabetes          AIDS/HIV        Suicide         Nephritis         Suicide
8      Injury          4              2                Influenza         Pulmonary Dis. 44                141               158             208             1,866             2,416
       63                                              6                 14

       Perinatal       Perinatal      AIDS/HIV         Chronic Obstc.    AIDS/HIV        Congenital       Stroke            Chronic Obstr. Pneumonia &      Atherosclerosis   Nephritis
9      Infections      Conditions     1                Pulmonary Dis.    12              Anomalies        120               Pulmonary Dis. Influenza        1,342             2,018
       58              4                               5                                 39                                 139            150

       Heart Disease   AIDS/HIV**     Benign           Septicemia****    Pneumonia &     Pneumonia &      Pneumonia &       Pneumonia &     Nephritis       Septicemia        Atherosclerosis
10     39              3              Neoplasms***     1                 Influenza       Influenza        Influenza         Influenza       77              882               1,409
                                      1                                  12              29               67                96

                                                                                                                          Minnesota Department of Health
                                                                                                                      Source: Minnesota Death Certificates
                                                                * Includes cord and membrane complications

                                               ** Other causes resulting in 3 deaths for this age group: benign neoplasms

               *** Other causes resulting in1 death for this age group: chronic obstructive pulmonary disease, cirrhosis, nephritis, perinatal conditions

                             **** Other causes resulting in 1 death for this age group: benign neoplasms, nephritis, perinatal conditions
                                                   Suicide by Age Group
                                                        1990 - 1998
                                                     ( 9 year average )




Rate per 100,000







                            05-14   15-24   25-34     35-44     45-54     55-64   65-74   75-84   85+
                   Male      1.7    23.5    23.0       22.6     19.0      21.3    24.1    33.3    40.5
                   Female    0.5     4.4     4.9       6.1       5.9       5.2     3.1     3.4    2.5
                                                              Age Group
                                                                Suicide in Minnesota


Age-adjusted rate* per 100,000



                                        1990    1991     1992         1993          1994      1995     1996   1997     1998

                    * - Rate adjusted to the 1940 standard U.S. population.

                                                                       Minnesota Residents
                                               1990    1991     1992      1993        1994     1995    1996   1997   1998
                                        Rate   12.0    11.2     11.1         10.6      10.3     10.8   10.0   8.5    9.5
                                         N     542     503      511          498       488      519    489    422    463
                                           Minnesota Suicide Rate by Race/Ethnicity

          White                                                   10.4
                                                                  10.5                           1993-1995
          Asian                                      8.1                                         1996-1998

African American                                                 10.3

 American Indian                                                                            18.8

 Latino/Hispanic                             5.7

                   0.0               5.0                   10.0             15.0             20.0                  25.0

                                             Age-adjusted rate* per 100,000 population

                                                    1990 to 1992            1993 to 1995            1996 to 1998
                                                    N             Rate      N        Rate           N        Rate
                         White                     1476           11.3     1420      10.4       1283         9.2
                         Asian                      21            10.5      21       8.1         26          9.4
                         African American           29            10.7      33       10.3        35          10.5
                         American Indian            30            19.8      29       18.8        30          19.5
                         Latino/Hispanic            18            11.1      11       5.7         22          10.6

                    * - Rate adjusted to the 1940 standard U.S. population
                                                                   Suicide Prevention Strategies:
                                                     Healthy Minnesotans: Public Health Improvement Goals 2004

Examples of Strategies & Organizational Roles

The list below represents a sampling of strategies that can be used to work on this public health problem. Organizations that may play a role in the implementation
of a particular strategy are indicated.

                                                                        Category: VIOLENCE
                                                                          Problem: Suicide

                                                            Organizations with Potential Collaborative Roles
                               Governmental Public      Health Plans    Hospitals & Clinics   Educational    Community-based       Business/        Other
                               Health Agencies                                                Systems        Organizations         Work Sites

 Educate professionals and
 the community to recognize
 suicidal ideation and                                                                                       Counseling
 behaviors in adolescents              T                        T                T                    T      Centers, Social             T
 and adults, to respond                                                                                      Services, Faith
 appropriately, and to make                                                                                  Communities
 referrals for treatment and
 necessary supports

 Facilitate access to crisis
 and mental and chemical
 health programs and                   T                        T                T                    T              T                    T
 support services

 Collect and analyze data to
 inform interventions,                 T                        T                T
 policies, and the community
                         Governmental Public   Health Plans   Hospitals &   Educational   Community-based   Business/    Other
                         Health Agencies                      Clinics       Systems       Organizations     Work Sites

Promote relational
models, specific to
culture and sexual
preference, of                  T                     T              T             T             T                T
attachment, self-
efficacy, community
connectedness, and
healthy coping

Promote and enforce
means restrictions,
including limiting
access to firearms,             T                     T              T             T             T                T      Law Enforcement
promoting safe storage
of firearms, and
encouraging use of
trigger locks

Assess (including self
assessments) families,
communities, and
systems and build upon          T                     T              T             T             T                T
those strengths to
address risks for
suicide and suicide
            Ad Hoc Advisory Group

List includes symposium participants and speakers,
       focus groups, telephone consultations,
             and written contributions.
        j Denotes significant contributions.
jLillian Abelson                   BJ Anderson                          Learning, Roseville, MN
ISD #728                           Coordinated School Health            jTed Arneson
Elk River, MN                      MN Dept. of Children, Families &     Minneapolis, MN

Elizabeth Appel                    Donna Alt                            Mark Anderson
Wabasso Public School              Edina, MN                            Senator Wellstone’s Office
Wabasso, MN                                                             St. Paul, MN

Austin Youth Group                 Sharon Autio                         Roberto R. Aviña
Austin, MN                         MN Department of Human Services      La Familia Guidance Center, Inc
                                   St. Paul, MN                         St. Paul, MN

Shannon Bailey                     Randy Baker                          Stan Barber
Dakota Co. Public Health           BEC                                  MN Correctional Facility
Apple Valley, MN                   Mankato, MN                          Red Wing, MN

Marian Barcus                      Alison J. Becker                     Jan Biebl
Itasca Co. HHS                     Wright County Public Health          St. Paul/Ramsey Public Health
Grand Rapids, MN                   Buffalo, MN                          Roseville, MN

Lynn Boergerhoff                   jDave Boyd                           Rachel Boyum
Hennepin Co. Community Health      SA/VE                                Olmsted Co. Public Health
Minneapolis, MN                    Edina, MN                            Rochester, MN

Ron Brand                          jKaralee Brunjes                     Janny Brust
MN Association of Community        Greater MN Christian Counseling      Allina
Mental Health Programs             Services                             Minneapolis, MN
St. Paul, MN                       So. St. Paul, MN

Nettie Bunn                        Theresa Carufel                      David Chollar, LISW
Mayo Medical Center                Centre for Mental Health Solutions   Regions Hospital
Rochester, MN                      Edina, MN                            St. Paul, MN

Kathy Christensen                  jJackie Casey                        Millie Caspersen
Riverview Clinic                   SA/VE                                Hennepin Co. Medical Center CIC
Mankato MN                         Minneapolis, MN                      Minneapolis, MN

Tracy Clark                        Deborah Condon                       jMary Crossen
White Earth Indian Health Center   Crisis Connection                    MN Department of Children,
White Earth, MN                    Minneapolis, MN                      Families & Learning
                                                                        Roseville, MN
Laurie Dahl                         jRuthie M. Dallas                 Renee Dahring
Immanuel St. Joseph’s/Mayo Health   MN Department of Human Services   Hennepin co.
System                              St. Paul, MN                      Minneapolis, MN
Mankato MN

Vicki Dalle Molle                   jJane Dietzman                    District 202 Youth Group
NAMI Olmsted Co.                    Tobacco Control                   Minneapolis, MN
Rochester, MN                       Minnesota Department of Health

Alexandra Drivas                    Kathy Dubbels                     Suzanne Dugan
MN School Psychologists Assn.       Olmsted Co. Public Health         Mankato State University Security
St. Paul, MN                        Rochester, MN                     Mankato, MN

Michael Earhart                     jDave Eichers                     jLarraine Felland
BHSI                                WIC                               MN Department of Human Services,
Minneapolis, MN                     Minnesota Department of Health    Mental Health
                                                                      St. Paul, MN

jSue Fiedler                        Bruce Field                       jMichelle Finstad
SA/VE                               La Familia Guidance Center        Hennepin Co. Community Health
Excelsior, MN                       St. Paul, MN                      Minneapolis, MN

jKris Flaten                        Terry Fleetham                    jJeanne Forbes
State Advisory Council on Mental    Ramsey Co. Crisis Center          Minneapolis Public Schools
Health                              Minneapolis, MN                   Woodbury MN
St. Paul, MN

Kathie Foreman                      Dana Fox                          Teri Funk
Immanuel St. Joseph’s-MHS, Sex      UBH                               Safe Haven for Youth
Assault Resource                    Minneapolis MN                    Prior Lake, MN
Mankato, MN

Anna Gaichas                        Joyce Gallery                     Lili Garfinkel
Injury & Violence Prevention        3 Counties for Kids               PACER.
Minnesota Department of Health      New Ulm, MN                       Minneapolis, MN

Tom Gaffney                         Ellie Garrett                     José González
Itasca Co. HS                       MN Council of Health Plans        Minneapolis Dept. Of Health
Bovey, MN                           St. Paul, MN                      Minneapolis, MN

Barb Goodwin                        Kerri Gordon                      Deborah Goschy
HCMHC                               Senator Leo Foley’s Office        MRCI, Employment Supt Spec.
Minneapolis, MN                     St. Paul, MN                      Eagle Lake, MN
jGeri Graham, Coord Schl Hlth   Gretchen Grewe                     Louise Griffith
MN Department of Children,      Elk River, MN                      Lakeville, MN
Families & Learning
Roseville, MN

Barbara Grodin                  Patrick Gromek                     Marge Haff
Hennepin County                 Burnsville, MN                     Golden Valley, MN
Minneapolis, MN

Tammy Hammerlund                George Hanson                      jPaula Haraldson
Grand Rapids, MN                MN Dept. of Children, Families &   Cornelia Place
                                Learning                           Minneapolis, MN
                                Roseville, MN

Marlene Hardy, Director         jLois Harrison                     David Hartford, Behavioral Care
Mille Lacs CD Outreach          MCSHN                              St. Joseph’s Hospital
Onamia, MN                      Minnesota Department of Health     St. Paul, MN

Merrily Hazelton                jPeg Heaver                        Dina Hennen
Winona Co. PHN Service          Coordinated School Health          LeSueur, MN
Winona, MN                      Minnesota Department of Health

Peggy Sue Hesse                 Stella Hofrenning                  jSandy Holmstoen
Mankato Psychology Clinic       Rural Health & Primary Care        MN Association for Children’s
Mankato MN                      MN Department of Health            Mental Health
                                                                   Bloomington, MN

Joann Holt-Angerman             jJim Holmseth                      Joline Hovland
Victim Services, Advocate       Immanual St Joseph’s/Mayo Health   Sex. Viol. & Abuse Crisis Ctr.
Rochester, MN                   Systems                            Wilmar, MN
                                Mankato, MN

jMary Huggins                   Debra Jahnke                       jKathy Jefferson
Hennepin Co. Mental Health      Rural Health & Primary Care        MN Department of Human Services
Minneapolis, MN                 Minnesota Department of Health     St. Paul, MN

Carol Jensen                    Jan Jernell                        Mary Pat Jewison
MSU Security                    Family Health                      Olmsted Co. PHS
Mankato MN                      MN Department of Health            Rochester, MN

Gloria Johnson                  Patty Johnson                      Tom Johnson
Parkview Home                   SA/VE                              NAMI
Hancock, MN                     Edina, MN                          St. Paul, MN
Judith A Kahn                        jBetty Kaplan                    Karen Lilledahl
U of MN Konopka Institute            Healthy Beginnings               Mental Health Association
Minneapolis, MN                      Minnesota Department of Health   Minneapolis, MN

Nancy Kern                           jMark Kinde                      jMary Kluesner
Maternal & Child Health              Injury & Violence Prevention     SA/VE
Minnesota Department of Health       Minnesota Department of Health   Edina, MN

jAl Kluesner                         Becky Kowalkowski                jCandy Kragthorpe
SA/VE                                MCASA                            Family Health
Edina, MN                            Alexandria, MN                   Minnesota Department of Health

Diana Kuklinski                      Jane Larson                      Pamela Lausche
Bemidji Area Indian Health Serv.     HRC Mental Health Ctr            Leech Lake Soc Srvs, MH
Bemidji, MN                          Superior, WI                     PHS Indian Hospital
                                                                      Cass Lake, MN

Karen Lilledahl                      Katie Linde                      jKaren Lloyd, Ph.D.
Mental Health Association of MN      BlueCross BlueShield of MN       HealthPartners
Minneapolis, MN                      Eagan, MN                        Minneapolis, MN

Kim Loidolt                          Alan Loose                       Wendy Machmer
Child’s Mntl Hlth, Pact 4 Families   Lutheran Social Services         Mental Health Assoc. of MN
Melrose, MN                          St. Paul, MN                     Duluth, MN

Gary Mager                           Family Health                    Chisago Co. Public Health
MN Department of Human Services      Minnesota Department of Health   Center City, MN
St. Paul, MN
jPati Maier                          Janice Maine                     Esther Maki

Fetal Alcohol Syndrome               HCMC, Behavioral                 jJill Marks
Minnesota Department of Health       Minneapolis, MN                  Minneapolis, MN

Maureen Malloy

Maureen Marrin                       Wayne Marzolf                    Ted Matthews
Consumer/Survivor Network            MN Dept.of Agriculture           Community Education
St. Paul, MN                         St. Paul, MN                     Morris, MN

jRita Mays                           Nancy McCloone                   Kevin McHenry
Nutrition                            CPNP Mankato Clinic              Sen. Leo Foley’s Office
MN Department of Health              Mankato MN                       St. Paul, MN
Bonnie McIntyre                    Sandy Menge                          Donna McDonald
MN Department of Children,         Centre for Mental Health Solutions   Gerard
Families & Learning; Children’s    Minneapolis MN                       St. Louis Park, MN
Mental Health; Roseville, MN

David McRoberts                    Mari Mevisson                        Mary Jo Moore
Parkview Home                      Injury & Violence Prevention         Olmsted Co. Public Health
Hancock, MN                        MN Department of Health              Rochester, MN

Brian Morseth, Henn. Co. MH Ctr.   Amy Moser                            Dick Myers
Health Services Bldg.              Youth & Aids Projects                MN Children with Special Health
Minneapolis, MN                    Minneapolis, MN                      Needs
                                                                        MN Department of Health

Maureen Myhre                      Marcia Nagel                         Lin Nelson
Supportive Living Services         Mankato West                         MN Department of Health
Brooklyn Center, MN                Mankato MN

Ginny Nimmo                        Kristi Obrecht                       Susan Obremski
ISD #77                            Carlton Co. Public Health            Crisis Connection
North Mankato MN                   Cloquet, MN                          Richfield, MN

Katie Ojanpa                       Amy Okaya                            Sheryl Olson
Mankato East High School           Sexual Assault Prevention            Anoka Co. Community Health
Mankato, MN                        MN Department of Health              Anoka, MN

jMiriam Olson                      Ted Olson                            Melissa Ostercamp
SA/VE                              MN Dept of Human Services            Hennepin Co. Health Promotion
Edina, MN                          St. Paul, MN                         Minneapolis, MN

Kunle Oyeyemi                      Kimberley Peck                       Tom Peterson
Integrated Community Res           MN Employee Assistance Program       MH Consumer/Survivor Netwrk
Minneapolis, MN                    St. Paul, MN                         St. Paul, MN

Hal Pickett, Child & Adol Psych    Kristy Pierce                        jTracy Pierson
Univ of MN, Dept of Psychiatry     Collab. Mvment for Improvemnt        SA/VE
Minneapolis, MN                    St. Paul, MN                         Richfield, MN

jLara Pratt                        Linda Quistad-Berg                   Pat Rautiola
Hennepin Co. Comm. Health          Winona Co. PHNS                      Hennepin County, CTC Progrm
Minneapolis, MN                    Winona, MN                           Eagan, MN
Trisha Prentice                      Tim Reardon                        Mary Regan
Red Lake Substance Abuse Prog        The Alliance for Fams & Children   MCCCA
Red Lake, MN                         St. Louis Park, MN                 St. Paul, MN

jRalph Rickgarn                      jDolore Rockers                    jJon Roesler
Minneapolis, MN                      Home Place                         Injury & Violence Prevention
                                     Austin, MN                         MN Department of Health

Mary Rose                            Susan Roth                         Tamara Rubin
American Indian Family Center        MN Planning                        New Hope, MN
St. Paul, MN                         St. Paul, MN

Laura Ryan                           Susan Rynda                        Sandi Savage
Alternative Learning Center          LeSeuer Co. Human Services         Fond du Lac, Min No Aya Win
Waseca, MN                           LeCenter, MN                       Cloquet, MN

Paula Schaefer                       Gerry Schmidt                      jRachel Schott
MN DOC                               Blue Earth Co.                     Light for Life Foundation of MN
St. Paul, MN                         Mankato, MN                        Mankato, MN

Mary Schulte                         David Schultz                      Lee Schultz
Centre for Mental Health Solutions   MN Department of Human Services    MN Planning
Edina, MN                            St. Paul, MN                       St. Paul, MN

Rochelle Schultz                     PACT 4, Hlth & Human Srvcs.        jPat Shortall
Rural Health & Primary Care          Wilmar, MN                         Immanuel - St. Joseph’s Hosp
Minnesota Department of Health                                          Mankato, MN
Bill Sheehan

jTerry Haugen-Sjostrom               Cheryl Smoot                       Linda Snyder, PHN
Crisis Connection                    Maternal & Child Health            ISD #622, Tartan High School
Minneapolis MN                       Minnesota Department of Health     Oakdale, MN

Galen Stahle                         Val Stanton                        Mike Stetzler
American Psychiatric Society         Supportive Living Services         MN Department of Human Services
Minnetonka, MN                       Brooklyn Center, MN                St. Paul, MN
                                                                        Lt. Kevin H. Stoll

Minneapolis Police Dept.             Washington Co. PH & Envrnmt        Center for Health Statistics
Minneapolis, MN                      Stillwater, MN                     MN Department of Health

Jean Streetar                        jDavid Stroud                      Vince Stuehrenberg
Mankato Police                    Esther Tatley, PHN                    jKristen Teipel
Mankato MN                        Shoreview, MN                         Adolescent Health
                                                                        Minnesota Department of Health

Mary Tomes                        Diane Torrel                          jCindy Turnure
ISD #622, LC Webster Elementary   Northland Ctr, St. Louis Co. Health   Center for Health Statistics
No. St. Paul, MN                  Virginia, MN                          Minnesota Department of Health

Erin VanEps                       Nancy Vanderburg                      Regan Warren
Kandiyohi Co. Public Health       MCSHN                                 Safe Haven For Youth
Willmar, MN                       Minnesota Department of Health        Prior Lake, MN

Dorothy Webb                      Joe Whitehawk, Director               Jean Wilhide
Mercy Hosp AdBH/AnokaHenn         Upper Sioux Community                 Crisis Connection
Coon Rapids, MN                   Granite Falls, MN                     Richfield, MN

jDawn Williams                    Gloria Winter                         Delight Wreed
Minneapolis MN                    MRCI                                  N. Mankato, MN
                                  Mankato, MN

John Yoakam                       jCary Zahrbock                        Kristi Zellman
U of MN Youth & Aids Projects     BHSI                                  Watonwan Co. Public Health
Minneapolis, MN                   Minneapolis, MN                       St. James, MN

Wendy Zierman
Health Care for the Homeless
Minneapolis, MN

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