Sept. 20 still is a tough day for Jo Angell.

"I'm glad you didn't call yesterday, because I didn't talk to anyone," the 66-year-old Cloquet woman said over the phone on Sept. 21. "I had a really tough day yesterday. It doesn't always hit that way, but boy, yesterday it was like a train."

On Sept. 20, 2007, her son Doug Angell took his own life. He was 26.

The next year, a new hire, fresh out of the University of Minnesota Duluth, started at the Carlton County Health and Human Services Department with dual roles as a health educator and suicide prevention coordinator.

In her new job, Meghann Levitt organized a suicide prevention task force, and Angell came to meetings, cautiously at first.

"She's like, 'I could just come for a little bit of time at the beginning,'" recalled Levitt, 32. "'But I knew I wanted to do something.' "

Angell's idea: a walk to honor the memory of those who had taken their own lives, and to provide healing for their survivors.

"It just was on my heart to recognize loved ones lost to suicide, not as a fundraiser," Angell said.

Levitt and the task force were on board, and 70-some people showed up for the walk in the fall of 2009. By last year, the number of participants had grown to more than 300, and organizers are preparing for the 10th annual walk a week from Saturday.

They 'tilted the landscape'

The suicide awareness memorial walk is one example of what has made medium-sized Carlton County a leader in Minnesota in mental health and the effort to stem the rising tide of suicide.

Meghann Levitt has been at the center of that effort.

"Meghann knows how to make those connections with community leaders to elicit their support and get them to the table," said her boss, Dave Lee, director of Carlton County Public Health and Human Services.

The county's efforts have helped bring suicide prevention to the forefront, said Kathy Hermes, who works in youth programming for Lutheran Social Service.

"I think Meghann and others in Carlton County have really tilted the landscape a bit in favor of pre-emptive conversation," Hermes said. "Meghann's been tireless in getting out in front of student populations."

Carlton County came to its focus on suicide prevention through a sense of need. In 2010, the county's suicide rate was double that of the state as a whole. Historically, the 10 counties with the state's highest suicide rates have been in northern Minnesota, Levitt said.

"Both Dave Lee and our county commissioners have been really, really supportive of the effort," she said. "They know it's needed."

'Something very different'

But by 2010, it was apparent a traditional approach featuring toll-free numbers that someone thinking of suicide could call for help weren't necessarily connecting with youth, Lee said.

"Meghann had just been working, working, working ... and it's just real disheartening," he said. "That's when we took a timeout and said we have to up our game here, we have to do something very different."

They discovered that of four 800 numbers listed on a business card for teens and others to call if they were suicidal, two of them weren't being answered consistently, Lee said.

Moreover, he said, it was apparent, even then, that young people weren't placing calls anymore; they were texting.

Levitt was aware of a school district in Nevada that was experimenting with a text line for students who were experiencing a mental health crisis. She contacted them, she recalls, and they stressed the importance of getting the word out that the line was available.

Shortly after that, in the spring of 2011, two members of the Moose Lake High School community - a faculty member and a student - took their own lives. The tragedies accentuated the sense of crisis. A grant for suicide prevention purposes was available from the federal Substance Abuse Mental Health Services Administration (SAMHSA), but the time frame was short - the Carlton County team wrote their request in 10 days, Levitt said. Grants normally were approved for "best practices," not "promising practices."

Moose Lake student volunteers helped with a pilot project, sending texts back and forth with counselors.

The three-year grant for $1.4 million was approved in August 2011, and TXT4LIFE was born.

Carlton County had applied for the grant on behalf of itself and six other counties: Cook, Lake, St. Louis, Aitkin, Itasca and Koochiching.

The text line produced a sea change in terms of young people reaching out for help. Before the text service was offered, the Minnesota National Suicide Prevention Lifeline was receiving between 5 and 25 calls per month from youths and young adults, Levitt said. In 2012, TXT4LIFE counselors were involved in about 300 text conversations per month.

Originally, the vast majority of texts came from the seven-county area. But because it was advertised on social media, texts also came from 42 other Minnesota counties and all 49 other states, Levitt said. When the grant funding ran out, the state took over, and the number of counties involved grew to 43. Twin Cities-based Canvas Health took over leadership of the program, which now receives a thousand texts a month.

More texts come from 14- and 15-year-olds than any other age group, Levitt said. But according to data from the first seven months of this year, 14 percent of those who texted for help were ages 13 or under. At the other end of the spectrum, 5 percent were ages 55 to 64.

There's now a national text line, and Minnesota has joined it. As of April, Minnesotans in a suicidal crisis can text MN to 741741.

Meanwhile, Carlton County, in partnership with the Fond du Lac Reservation, received a grant of more than $320,000 this year from the state Department of Human Services on behalf of 30 northern Minnesota counties and seven northern tribal nations to promote the crisis text line and work on suicide prevention in other ways. Levitt is leading that effort, working with coordinators across the region. Lee pointed out that although Levitt remains a full-time Carlton County employee, her regional work is funded by the state.

Saving lives

Results of the suicide prevention efforts and the text line are difficult to quantify, but there's no doubt based on anecdotal evidence that it has saved lives, Levitt said.

"I'll go into a school, and it's been around now long enough where there's kids who come up to me and say, 'Hey, I used that text line last year, and it saved my life,'" she said.

Lee noted that while the overall suicide rate continues to increase, national data released in June showed that, in Minnesota, the rate is stabilizing for middle school and high school-aged youth.

In fact, Levitt said, middle-aged males now have the highest suicide rate in Minnesota, reflecting a national trend. That presents a particular challenge to Levitt and her colleagues.

"One of our goals ... is to do some targeted outreach to middle-aged males," she said. "It's so hard, you know. ... School age is easy. You have a captive audience in that age group."

Levitt, who lives in Duluth with her husband and child born this year, came to her work through a process of elimination. A native of Chanhassen, Minn., she entered UMD with interests in medicine and elementary education. An adviser suggested she consider combining those interests with a career in public health.

"And she was exactly right," Levitt said. "I got into the classes and just loved it."

But she said she wasn't entirely prepared for a job that involved mental health.

"It was just a lot of learning up front," she said. "When I wasn't in school there wasn't - it's not any knock against the program - there just weren't a lot of mental health pieces woven into the curriculum. I feel like it was very much more focused on physical health."

After 10 years, Levitt is a "natural go-to" on the subject, said Karen Snyder, middle school principal and associate head of school at Marshall School.

Last week, Levitt led a workshop for the school's staff on QPR, a method for intervening when an individual may be suicidal. (It's an acronym for "Question. Persuade. Refer.")

"What Meghann does is she makes it feel less overwhelming," Snyder said. "She presents it in a way that she allows people to say this is scary, this is hard. It's hard to say the word 'suicide' to students, and she makes it OK. She shares examples, she shares a lot of ways that we might approach those conversations."

As the training at Marshall suggests, the suicide prevention effort Levitt leads goes beyond texting.

"We need to have local trainings in place where we're getting the information in how to respond in time of a crisis to our local school personnel," Levitt said. "To families, to friends, to local nonprofits, to bartenders, to hairdressers. You know those people who are going to figure out that, 'Wow, this person really isn't doing well, maybe I should ask about suicide.'

"Because that's another level where people feel comfortable. You know, you open a lot to the people cutting your hair."

Jo Angell said she has noticed a change in the 10 years since the first walk for life. The stigma against talking about suicide and mental health issues is disappearing, she said.

In Carlton County and in Minnesota, Levitt has played a major role in that, Angell said.

"She's just an amazing person," Angell said. "She just has a heart for people. Gosh, I don't think the task force and all the education and all that's been done in that area, I don't know that it would be where it is today without Meghann."

To get help

• Text MN to 741741

• Birch Tree Center, 24-hour crisis line, (218) 623-1800

Suicide awareness memorial walk

What: 10th annual suicide awareness memorial walk

When: 9:30 to 11:30 a.m. Oct. 13

Where: Carlton High School, 405 School Ave., Carlton

Details: The short walk will be followed by refreshments and a short talk. The event is not a fundraiser, but participants may wish to wear something with the name and/or picture of the person they are honoring. Registration is not required.