Officials in Beltrami County suspected they had a high suicide mortality rate. They just didn't have the proof. So they asked the Minnesota Department of Health to look into the numbers. The department poured over death certificates from public records and injury details from hospital discharge data.
Epidemiologist Jon Roesler was surprised by what he found.
"Not only does Beltrami County have a problem with suicide, but they have probably one of the worst problems of suicide in the whole state of any of the counties," he says.
When adjusted for age and population, Beltrami County had an average of 19 suicides per year per 100,000 people from 1996 to 2005. That compares to a statewide rate of 10 suicides per 100,000, Roesler says.
"Not only are the rates higher for the county overall, but in particular the rates are higher for the youth ages 15 to 24. That really seemed to be where the problem of suicide was the greatest."
The suicide rate among youth reached 21 in Beltrami County - that's two additional suicides per 100,000 people. For the same age group, the statewide average is 9.
The Health Department also looked at suicide rates for different races. They found that among the county's Native American population the suicide mortality rate was more than three times the statewide average.
"I have to tell you I just wasn't surprised," says Rebecca Snyder, a member of the Headwaters Alliance for Suicide Prevention. She was one of the Beltrami County officials who brought the suicide issue to the attention of the state.
She and her colleagues really began noticing a suicide problem in the county in 2004, more than a year before the Red Lake school shooting that claimed 10 victims and traumatized hundreds of others.
"We were already struggling with this issue before the Red Lake tragedy happened and so I think that that shows you that we were already in a vulnerable position. As far as kids, for one reason or another, (they) were struggling," she says.
Snyder doesn't know why the suicide rate in Beltrami County is so high. She says there could be many factors ranging from drug and alcohol abuse to crime to the availability of mental health services. She says in the years since the Red Lake shooting, Beltrami county has actually received fewer mental health resources and she says all indications are that next year will be even worse.
"It's unbelievable to me. I feel that in some ways especially the federal government has let us down as a county."
But Snyder is also optimistic about her county's ability to reverse its suicide problem. In the early 1990s, Beltrami's suicide rate was about the same as the rest of the state. She says if it didn't take long for it to grow, maybe it won't take very long to rein it in with the right approach.
State lawmakers are aware of the suicide problem in Minnesota. It is one of the top 10 causes of preventable deaths in Minnesota. This past session the Legislature approved several hundred thousand dollars for suicide prevention programs. Grant applications are still being reviewed.