The death toll from suicide, opioids and alcohol continues to rise in Minnesota, a state agency reported on Monday.

The Minnesota Department of Health reported 422 lost lives in Minnesota from opioids in 2017, 636 from alcohol and 783 by suicide. All three numbers have increased steadily since 1999, according to the health department's report: by 79 percent for suicide, by 94 percent for alcohol and by 681 percent for opioids.

"It is frustrating and difficult," said Melissa Heinen, suicide epidemiologist for the health department, about the trend. "These are not only individuals who die. These are communities that are struggling and families that are grieving. But we know that we can make a change."

Minnesota is far from alone in suffering an increase of what some social scientists have called "deaths of despair." But Heinen and health department colleagues who were interviewed by phone on Monday rejected that label, using the term "clusters of death."

"Where we see an increase in suicides, we often see an increase in overdose deaths in the same communities, and alcohol, and so on," Heinen said. "There's something about the conditions in which people are living that is increasing these deaths."

Dr. Amy Greminger, an Essentia Health physician and assistant professor on the Duluth campus of the University of Minnesota Medical School, said she sees community in general as a missing element.

"I personally wonder ... if our lack of connectedness with each other and with people in the community, if our migration toward online and less interpersonal connection doesn't destroy some of what makes us who we are," she said. "We're social beings."

We also need to do a better job of providing people with access to mental health services, Greminger said.

The clusters don't affect everyone equally. Nate Wright, lead drug and opioid epidemiologist for the state health department, said the opioid overdose rate is higher in St. Louis County than elsewhere in the state. There also are higher rates of suicide and alcohol deaths in Northeastern Minnesota than other areas, he said.

Greater Minnesota has higher suicide rates than the seven-county metro area, Heinen said. And although Minnesota's suicide rate is lower than the national average, its rate of youth suicide is higher than average.

One bright sign is that the rate of suicide for females in Minnesota decreased between 2016 and 2017. Heinen said that could be because more services have been made available, and women are more likely to seek those services than are men. But it's too soon to draw those conclusions based on a one-year improvement, she said.

Some racial groups are hit harder than others as well.

The drug overdose mortality rate for white Minnesotans in 2017 was 12.1 per 100,000 people, according to the health department data. For African Americans, it was 27.6. For American Indians, it was 76.2 - up from 47.3 in 2015. "These types of disparities unfortunately are common across all of Indian Country," wrote Jennifer Garbow, a Bois Forte member and University of Minnesota Extension educator who leads the state's American Indian Resource and Resilience Team, in an email. "Tribal communities that are more rural often have additional barriers to access services that combat health-related issues."

Those issues can't be understood without understanding the historical trauma experienced by Native Americans, Grabow wrote.

Heinen touted items in Gov. Tim Walz's proposed budget as means to address the problem. Among them are funding for a statewide suicide prevention lifeline network, "fatality reviews" to understand how overdose deaths came about and funding a "zero suicide" initiative designed to identify people who are at risk for suicide and keep people from falling through the cracks as they pass from one phase of care to another.

"Our highest risk period for an individual for suicide is after discharge for a suicide attempt," Heinen said.

The zero suicide initiative calls for a "warm handoff," so that someone is making sure the at-risk individual shows up for referrals and is calling those who don't show up.

To get help

National Suicide Prevention Lifeline

• (800) 273-8255

Crisis Text Line

• Text MN to 741741

South St. Louis, Lake, Cook & Carlton counties/Fond du Lac Band

• (218) 623-1800 or (844) 772-4742

North St. Louis County/Bois Forte Band

• (218) 288-2100

Itasca County

• (218) 326-8565 or 211*

Koochiching County

• •(800) 442-8565 or 211*

* St. Louis County 211 services are not crisis-related