Suicide Prevention
Zero Suicide Academy® Participants 2018 and 2019

Located: Cass Lake
Agency Lead: Mary Suagee-Beauduy, Mary.Suagee-Beauduy@ihs.gov
The Cass Lake Indian Health Service Unit is owned and operated by the federal government as a Public Health Service, Indian Health Service Facility. It serves 9,740 youth age 10-24 annually, with eight service sites and 165 employees throughout those sites. The service unit operates a Critical Access Hospital (CAH) and Outpatient Ambulatory Care Clinic that offers medical, dental, pharmacy, laboratory, radiology, physical therapy, audiology, podiatry, and optometry services. Cass Lake Indian Health Service Unit also provides 24/7 access to urgent care/emergency care services. In 2015, Cass Lake Indian Health Service Unit received five year funding through a Methamphetamine Suicide Prevention Initiative (MSPI) grant. These funds have helped provide a solid starting point for suicide prevention efforts to begin with the Cass Lake/Leech Lake areas. Through MSPI, a traditional healer has taught patients and community members that they can find wellness through cultural practices. Cass Lake Indian Health Service Unit is in the process of implementing the Zero Suicide model within their agency and across the continuum of care. Over the past year they have implemented universal screenings across systems to include behavioral health and law enforcements, using the PHQ-9 and Colombia screening tools. They have broadened and strengthened their relationship with schools, police, ambulance, tribal health and behavioral health by creating Leech Lake Caring Partners. Within their hospital they have implemented a suicide prevention care policy as well as trained 97% of their staff in a suicide prevention gatekeeper training.

CentraCare Health
Located: St. Cloud
Agency Lead: Ryan Engdahl, PhD, LP EngdalR@centracare.com
CentraCare Health is a not-for-profit health care system that provides comprehensive, high-quality care to people throughout Central Minnesota. They have six hospitals, six long-term care facilities, 21 clinics, one out-patient care center, three outpatient surgery centers, and four pharmacies within central Minnesota. CentraCare Health serves 33,287 youth between the ages of 10-24 annually, with 19 service sites and 10,500 employees throughout those sites. Within St. Cloud Hospital patients can access: inpatient behavioral health services, partial `hospitalization, and outpatient programs and services. CentraCare Health is moving towards an integrated behavioral health model and feels the Zero Suicide model will be a natural rollout and mirror of what is already being done. CentraCare Health continues to implement the Zero Suicide model within their family medicine, internal medicine and behavioral health departments. Recently they hired someone to oversee their Zero Suicide prevention efforts within CentraCare and the community.

Hennepin Healthcare
Located: Minneapolis
Agency Lead: Stephen (Brent) Walden, PhD, LP Stephen.Walden@hcmed.org
HCMC has long been known as a Level 1 Trauma Center and safety net hospital with a number of regionally and nationally recognized programs and sociality clinics located in the heart of Minneapolis. Clinics are also operating in south Minneapolis, Brooklyn Center, Brooklyn Park, Golden Valley, Richfield, and St. Anthony Village. Behavioral health care has been an integral part of HCMC for many decades, they are proud to offer a full spectrum of services at all levels of care. They have a psychiatry department with a large inpatient psychiatry service that comprises approximately one-quarter of the total hospital beds at HCMC. A wide range of outpatient services are also available, including acute psychiatric services (24/7 psychiatric emergency room), crisis residence, Partial Hospital Program, the Mother-Baby Program, the Hope Program (first episode psychosis program), the William W. Jepson Day Treatment Program, the DHS-certified Dialectical Behavior Therapy Intensive Outpatient Program, a neuropsychology service, the child adolescent psychiatry service, and the Adult Psychiatry Clinic. HCMC services about 40,000 youth 10-24 years of age annually and employees about 6,000 clinical and non-clinical staff. HCMC’s goal remains to implement the Zero Suicide model within their HOPE Program and the Crisis Residence programs.

Hennepin County Public Health, Clinical Mental Health, Health Promotion, and Epidemiology Programs
Located: Minneapolis
Agency Lead: Kay Pitkin, PhD, LP Kay.Pitkin@hennepin.us
Hennepin County is the most populous county in Minnesota, comprising 21 percent (1.2 million) of the state’s population, and is home to 40 percent of the state’s non-white and foreign-born population. There is more than 100 languages spoken, and approximately 24 percent of the county’s population is non-white. The number of services offered through the clinical programs is about 50,000 and growing. This is an opportunity to provide extensive growth within suicide prevention. Hennepin County Public Health’s original plan was to implement Zero Suicide within two sectors of public health, they soon realized this was something they needed to implement across all sectors. They have been working to expand leadership support as well as expanding their knowledge of needs within their community based off from patients who had died by suicide. Their focus is to bring the public health approach to suicide prevention in behavioral health.

Leech Lake Behavioral Health
Located: Cass Lake
Agency Lead: Angela Bellanger MSW, LICSW Angela.Bellanger@llojibwe.org
Leech Lake Band of Ojibwe is governed by the Leech Lake Reservation Tribal Council. The Tribe consists of 19,400 federally recognized tribal members. Of the 19,400 members, approximately 9,509 actually live on the Reservation. The total population on the Reservation is estimated at 10,660 per the 2010 census report. The Leech Lake Reservation is located in northwestern Minnesota. The Reservation includes 1,300 square miles, 36 townships and four counties and is comprised of 11 tribal communities. Leech Lake Behavioral Health (LLBH) has been providing culturally sensitive community based services to American Indian children and their families since 1988. They are an outreach program that provides services in various settings based on the unique circumstances of each client (at home, school, or community based). LLBH serves about 5,000 youth between the ages of 10-24 per year, has four service sites and employees 34 clinical and non-clinical staff. Leech Lake Behavioral Health has implemented a universal screening tool, utilizing the PHQ-9 during initial patient visits. They have four Applied Suicide Intervention Skills Trained (ASIST) trained staff. One staff trained in Counseling on Access to Lethal Means. They have broadened and strengthened their relationship with schools, police, ambulance, Indian Health Service and tribal health by actively participating in the Leech Lake Caring Partners meetings.

Leech Lake Tribal Health
Located: Cass Lake
Agency Lead: Brian Brunelle, Tribal Health Director Brian.Brunelle@llojibwe.org
Leech Lake Band of Ojibwe is governed by the Leech Lake Reservation Tribal Council. The Tribe consists of 19,400 federally recognized tribal members. Of the 19,400 members, approximately 9,509 live on the Reservation. The total population on the reservation is estimated at 10,660 per the 2010 census report. The Leech Lake Reservation is located in northwestern Minnesota. The reservation includes 1,300 square miles, 36 townships and four counties and is comprised of 11 tribal communities. Leech Lake Tribal Health provides preventive, chronic, and urgent care services. They also offer specialty services: child and teen check-ups, chiropractic, acupuncture, and clinical nutrition, contraception, diabetes clinic, food care, health education, mental health, nursing services, physical exams, pre-pregnancy counseling, primary and acute care services, reproductive health, STD testing and treatment, and a Women’s Clinic. Leech Lake Tribal Health serves 590 youth 10-24 years of age at seven different services sites as well as employing 128 staff. Leech Lake Tribal Health continues to work towards implementing the Zero Suicide model within all of their community clinics and community based programs. They have broadened and strengthened their relationship with schools, police, ambulance, Indian Health Service and tribal behavioral health by actively participating in the Leech Lake Caring Partners meetings.

Lower Sioux Indian Community Health and Human Services
Located: Morton
Agency Lead: Darin Prescott, DNP, MBA, RN, CNOR, CASC darin.prescott@lowersiouxhealth.com
The Lower Sioux Indian Community (LSIC) is a federally-recognized sovereign Dakota Nation located in southwestern Minnesota. LSIC is one of four federally recognized Dakota tribes in Minnesota. It is located on the bluff lands overlooking the Minnesota River and surrounded by small towns and agricultural prairie lands. LSIC’s is approximately 1,743 acres held in Trust by the federal government. The Tribe has a 10-mile federally designated service area surrounding the reservation and spanning three counties. LSIC has 1,118 enrolled members. Nearly all, 88 percent, live on the reservation and or within LSIC’s federally designated services area. Approximately 250 Lower Sioux members are between the ages of 10-24, and 48.5 percent are under 25 years old. The Lower Sioux Health and Human Services is a collaboration of five departments: Chemical Dependency, the Lower Sioux Clinic, Community Health, the recreation center and social services. The entire Tribe employees about 100 employees. Like so many communities LSIC has had deaths by suicide, in response to these tragedies, the tribe and community members organized the ‘saving and protecting our youth (SPY) committee.’ The committee is composed of tribal staff, elders, youth, and area partners including the school and local non-profits. This organization is very active within the LSIC and plans to play an integral role as it relates to suicide prevention. Lower Sioux Indian Community Health and Human Services plans to collaboratively implement the Zero Suicide model within all departments. A tribal resolution was passed to communicate across health and human service agencies with regards to a suicidal patient. They are currently working with emergency rooms when they have a community member presenting as suicidal. They have five ASIST trained community members to provide intervention to someone who may be having thoughts of suicide. They have provided safeTALK and QPR gatekeeper training within the community this past year as well.

Northern Pines Mental Health Center
Located: Brainerd
Agency Lead: Kathleen Suillivan ksullivan@npmh.org
Northern Pines is a comprehensive community mental health center established in 1964. Northern Pines serves six counties in Central Minnesota, covering Aitkin, Cass, Crow Wing, Morrison, Todd and Wadena. They provide a full range of mental health services to all ages including: mobile crisis outreach, adult, sub-acute, residential crisis services, outpatient clinic services, children and family services, birth to 5 years specialty, school based therapy and skills in 50 different schools, Assertive Community Treatment (ACT and Youth ACT), substance use disorders treatment, supportive housing services, community based services and care coordination. Northern Pines is growing and currently employs 300 individuals including: psychiatric providers, psychologists, therapists, practitioners and support staff. As one of six Community Behavioral Health Clinics (CCBHC) in Minnesota, Northern Pines is honored to collaborate with the Department of Human Services (DHS) and Department of Health (MDH) and local providers to develop innovative partnerships addressing mental health and substance use challenges in rural Minnesota. Northern Pines Mental Health Center believes the Zero Suicide model seamlessly integrates within the CCBHC framework and continues to be grateful to be a part of this important work. Over this past year, NPMH has trained all their staff in CAMS as well as the use of the Columbia. They have two postvention trainers on staff as well as 15 QPR trainers.

Northwestern Mental Health Center
Located: Crookston
Agency Lead: Mike Anderson, MSW, LICSW mianderson@nwmhc.org
Northwestern Mental Health Center (NWMHC) provides an array of mental health services in an eight county region in northwestern Minnesota. Some of those services include: adult community support program, adult foster care, ARMHS, children’s mental health case management, mobile mental health crisis response, diagnostic assessment for all ages, early childhood services and family and individual therapy provided in-home, Children’s Therapeutic Service and Support (CTSS) psychiatric evaluations, targeted case management for adults, and school mental health services. They employee 140 staff and provided service to 1,317 individuals between the ages of 10-24 this past year. NWMHC has seen a 48 percent increase in clients served over the past five years. NWMHC is one of six sites in Minnesota providing services through the Certified Community Behavioral Health Clinic (CCBHC) pilot project. The CCBHC mission is to directly provide several required types of services, with an emphasis on the provision of 24-hour crisis care, utilization of evidence based practices, care coordination, and integration with physical health care. It appears as though the goals of the Zero Suicide model and the mission of the CCBHC are aligned. NWMHC continues to implement the Zero Suicide model in their outpatient, adult service, children and families, psychiatry, and crisis response service programs. They currently screen all clients at every visit with a PHQ-9 if question 9 is triggered the client is then administered the Columbia Suicide Severity Rating Scale (CSSR-S). Created a standardized training for safety plans. They received a recognition from Riverview Healthcare, one of their Zero Suicide partners for the excellent work they are doing across systems. They have noticed an increase in staff comfort with persons at risk of suicide. They are keeping people out of the hospital they would have likely sent to the hospital in the past.

RiverView Healthcare Association
Location: Crookston
Agency Lead: Laura Mishne Heller, MSLP, MSS, LGSW LHeller@riverviewhealth.org
RiverView Healthcare Association (RHA) is a community-owned, membership-based, non-profit organization that was formed in 1898 and continues to be the sole community hospital in Crookston, Minnesota. RHA operates a 25 bed critical access hospital, a 24 bed hospital attached memory care skilled nursing facility, emergency department, RiverView Recovery Center; a chemical dependency outpatient treatment program, RiverView Home Care and five primary care and specialty clinics in the hospital’s service area, employing 412 staff members. RHA served 1,200 youth 10-24 year olds within their emergency department and 8,477 in the clinic. Part of RHA’s mission is to provide a healthcare experience that delivers exceptional outcomes and to enhance lives through engagement in the best practice to heal people and promote healthy communities. With this in mind. RHA has integrally been involved with various partners around crisis response and prevention. RHA continues to implement the Zero Suicide model within primary care clinics as well as the hospital emergency department. They have also extended their implementation to the physical and occupational therapy departments, as they learned that a number of therapy clients display suicide ideation. RHA has strengthened their relationship with Northwestern Mental Health Center. Using a performance improvement process within the emergency department for screening someone presenting with suicidal ideation.

Sanford Health Behavioral Health Center
Location: Bemidji
Agency Lead: Vanessa Wananu MSW Vanessa.Wananu@SanfordHealth.org
Sanford Health Behavioral Health Center, formerly Upper Mississippi Mental Health Center, is a Rule 29 Mental Health Center and Rule 31 Chemical Dependency Treatment Program and is home to Sanford Health’s Headwaters Assertive Community Treatment (ACT) Team. They serve 456 youth annually between the ages of 10-24 with three service sites and 70 employees. Sanford Health Behavioral Health Center has both mental health and chemical health services, some of those services include: 24/7 mobile crisis response services including transportation services, outpatient psychotherapy and psychological testing for children and adults including same day walk-in services, Adult Rehabilitative Mental Health Service (ARMHS), Children’s Therapeutic Service and Support (CTSS) Children’s Targeted Mental Health Case Management, ACT Team, Sexual Abuse Treatment (SAT) program for youth and adults, Domestic Violence Intervention (DVI) program, Rule 25 assessments, comprehensive assessments, intensive outpatient treatment services and relapse prevention for both youth and adults; First steps for Healthy Babies program for pregnant and parenting mothers. Sanford Behavioral Health Center has key relationships with outside partners to collaborate suicide prevention efforts. Sanford continues to work within their behavioral health department to implement Zero Suicide. This past year they have trained staff in gatekeeper trainings to include safeTALK and ASIST. Two staff were trained as trainers in the counseling on access to lethal means training (CALM). Sanford created updated suicide safety plans, and are working on developing a procedure for intake screening and prioritizing those who screen at heightened risk for suicide.

Western Mental Health Center
Location: Marshall
Agency Lead: Sarah Ackerman, MBA SAckerman@wmhcinc.org
Western Mental Health Center (WMHC) serves a large, rural five county region in southwestern Minnesota. Each year, they serve approximately 836 youth between 10-24 years old. Their main outpatient clinic is located in Marshall, MN with six satellite clinics throughout the area. WMHC employees 80 full-time and 20 part-time staff. 30.6 percent of WMHC’s service are population falls within 200 percent of the Federal Poverty Level and 12.8 percent of the population are uninsured. Their service area includes a total population of approximately 64,963 people. WMHC is a non-profit corporation governed by a Board of Directors composed of two citizens from each county. WMHC is a Rule 29 clinic licensed by the Minnesota Department of Human Services. WMHC has a variety of programs to include: outpatient mental health services and psychiatry programs, Adult Rehabilitative Mental Health Service (ARMHS), Community Support Services, Certified Peer Specialists, 24 mobile crisis services, Children’s Therapeutic Service and Supports (CTSS), and school linked mental health services. WMHC continues to implement Zero Suicide across the entire organization. They recently became a Certified Community Behavioral Health Center, providing both mental health and substance use coordinated treatment. They also trained entire staff including administration and maintenance in gatekeeper training.

White Earth Home Health Agency
Location: White Earth
Agency Lead: Lindsi McArthur, RN, BSN, PHN lindsi.mcarthur@whiteearth-nsn.gov
White Earth Home Health Agency is under the direction of the White Earth Tribal Council. The White Earth Reservation covers 837,268 acres of land spread over 1300 square miles, encompassing all of Mahnomen County and almost half of northern Becker and southern Clearwater Counties. White Earth Home Health Agency serves 800 youth age 10-24 annually. Their service sites vary as they provide services within the community, home and school. Services are provided in nine villages throughout the reservation and two school districts, Waubun and Circle of Life Academy. White Earth Home Health Agency employs 70 staff. White Earth Home Health Agency is comprised of a gamut of services provided under one umbrella. The largest service they provide is within their home care service. The home care department consists of registered nurses, licensed practical nurses, and home health aides. Services include but are not limited to: wound care, medication management, and generalized skilled nursing visits. The long-term care service department is comprised of registered nurses and licensed social workers. These services are home based and generally focus on Personal Care Assessments, and CAC/CADI waivers. The maternal child health program or LIFE program sees pregnant moms and children up to three years of age. Anger management programming is also offered under the LIFE program; they see youth and adults in school, group or individual settings. Public Health is another program under the White Earth Home Health Agency that provides public health education, harm reduction services, school nursing, and tobacco cessation. White Earth Home Health Agency continues to implement the Zero Suicide model throughout their entire agency. They have an enhanced working relationship with White Earth Mental Health and mobile crisis as well as White Earth Indian Health Service Unit. They have two ASIST trainers on-staff and two CALM trainers.

White Earth Mental Health
Location: White Earth
Agency Lead: Verna Mikkelson, BA Verna.Mikkelson@whiteearth-nsn.gov
White Earth Mental Health (WEMH) is under the direction of the White Earth Tribal Council. The White Earth Reservation covers 837,268 acres of land spread over 1,300 square miles, encompassing all of Mahnomen County and almost half of northern Becker and southern Clearwater Counties. Providers also cover urban populations residing in Bemidji, Duluth, and Minneapolis. Three of the reservation counties are represented with Minnesota’s highest population of American Indian Youth age 20 years: Mahnomen 55.9 percent, Clearwater 14.2 percent, and Becker at 11.6 percent. WEMH provides culturally appropriate, community-based and clinic-based services to American Indian youth and adults. Services include: psychiatry, tele-psychiatry, psychological testing, psychotherapy, CTSS, ARMHS, Children’s Mental Health Case Management, Adult Case Management and 24/7 crisis response services. WEMH serves 150 youth 10-24 annually with 16 service sites. They employ 59 staff. WEMH is currently working to enhance community awareness that suicide is 100 percent preventable; implementing intensive crisis follow-up services; coordinating Gathering of Native Americans (GONA) trainings and creating bereavement support programs. WEMH continues to work towards implementing Zero Suicide across their program., working across the system with White Earth Home Health and White Earth Indian Health Service Unit. WEMH created a mental health consent form to allow for staff across agencies to discuss patient safety concerns and care coordination. One new ASIST trainer was added this year, and they continue to create gatekeeper training opportunities across the community.

White Earth Indian Health Service Unit
Location: White Earth
Agency Lead: Danile Frye, daniel.frye@ihs.gov
The White Earth Service Unit (WESU) is owned by the federal government as a United States Public Health Service, Indian Health Service facility. The WESU has three service locations (White Earth Health Center, Naytahwaush Health Center, and the Pine Point Health Station) and served over 1800 youth aged 10-24 years in 2017. The WESU employs 175 clinical and non-clinical staff who provide health care services including: medical care, dental, optometry, radiology, lab, occupational and physical therapy, and pharmacy. The WESU is accredited as a Patient Centered Medical Home through AAAHC. A Medical Home model encourages each patient and their team of health care providers to work closely together to ensure that the patient’s care is comprehensive, coordinated, and consistent from visit to visit. The benefits of being cared for by a Medical Home include: better accessibility to provider who understand the patient’s history; accessibility to the care team in person, by phone, or electronic messaging; personalized care plans based on the patient’s input and medical evidence; attention to prevention; medication reviews to help patients understand the medications used in their care; and connection to community resources. For these important reasons, all departments that interact with patients are included in the implementation of the Zero Suicide model. WESU created an enhanced working relationship with White Earth Behavioral Health and White Earth Home Health.

Additional Resources

Zero Suicide Academy
Zero Suicide