About this story

Jenny Peek and Kate Prengaman reported this story with other journalism students in a UW-Madison class taught by Professor Deborah Blum, in collaboration with the nonprofit, nonpartisan Wisconsin Center for Investigative Journalism and the Investigative Journalism Education Consortium, which includes Midwestern university journalism professors and students working on news projects in the public interest. The Consortium is supported by a grant from the Robert R. McCormick Foundation. Read the IJEC consortium stories
Main story: Gaps persist in campus mental health services

Interactive map

Explore data on mental health services across the UW System

If you’re in crisis, call:
National Suicide Prevention Lifeline
1-800-273-TALK (8255)
TTY: 1-800-799-4TTY (4889)
Español: 1-888-628-9454

Veterans crisis line
1-800-273-TALK (8255): Press 1
Or text to 838255
Or chat confidentially on the crisis line website

UW-Madison’s 24-hour mental health crisis line: 608-265-5600

Campus resources

Interactive map with links and summaries of University of Wisconsin counseling centers.

UW-Madison chapter of the National Alliance on Mental Illness (NAMI)
uw.nami@gmail.com
608-268-6000

Active Minds
Chapters exist at Marquette University, UW-Madison, UW-Milwaukee, the Milwaukee School of Engineering, UW-Parkside and Carthage College.

Supporting Peers in Laidback Listening (SPILL)
Chapters exist at UW-La Crosse, UW-Madison and UW-Whitewater.

Off-campus organizations and links

National Institute of Mental Health

NAMI Wisconsin
608-68-6000
800-236-2988

Mental Health America of Wisconsin
Milwaukee office:
414-276-3122 or toll-free 866-948-6483
info@mhawisconsin.org
Madison office:
608-250-4368
shelgross@tds.net

Helping Others Prevent and Educate about Suicide (HOPES)
608-274-9686

Wisconsin Department of Health Services: mental health and substance abuse programs

Prior mental health coverage from the Wisconsin Center for Investigative Journalism

Minor offenders, major consequences
Wisconsin mental health system braces for major cuts under Walker
A tribal tragedy: High Native American suicide rates persist
Wisconsin suicide toll rises, exceeds that of neighboring states

The Center also collaborates with Wisconsin Public Television, Wisconsin Public Radio and other news media. Works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or its affiliates.

Kirk Gunderson of Onalaska, Wis., hanged himself in the La Crosse County jail in 2005, when he was 17. Photo courtesy of Vicky Gunderson

By Julie Strupp
Wisconsin Center for Investigative Journalism

Two days after Christmas 2005, Kirk Gunderson hanged himself with a sheet looped around a smoke detector in his solitary confinement cell in the La Crosse County Jail.

He was 17.

He formed letters out of moistened, rolled up toilet paper to spell the message: “I’m sorry 143 family.” The number is slang for “I love you” — one letter in I, four letters in love, and three letters in you.

Gunderson was in adult jail for stabbing his father and brother. Although he faced attempted murder charges, his family says what he really needed was mental health services — which he could have received in the juvenile justice system — to deal with the effects of head injuries from sports and Oxycontin abuse.

Gunderson’s death transformed his parents into activists. Their goal: Abolish a 1996 Wisconsin law that requires all 17-year-old offenders be treated as adults.

Vicky Gunderson became involved in juvenile justice issues after the 2005 suicide of her 17-year-old son, Kirk, while he was in the La Crosse County jail. Erik Daily/La Crosse Tribune

“We live with this every single day, that our son died alone, in hell,” says Vicky Gunderson, Kirk’s mother. “It just doesn’t go away.”

Wisconsin is one of 13 states that automatically place 17-year-olds in the adult criminal justice system. In the past few years, nearly one-third of states have passed laws to keep more young offenders in the juvenile justice system. But not Wisconsin.

In three previous legislative sessions, state Rep. Fred Kessler, D-Milwaukee, has introduced a bill that would place 17-year-olds back in juvenile court. He plans to offer it again. Kessler, a former Milwaukee juvenile court judge, says the existing law is too harsh for most young offenders.

“I just feel the adult consequences were devastating to them,” says Kessler, whose bill would still allow juveniles in serious cases to be tried in adult court.

Graphs: Arrests, Crime, Recidivism

(click to enlarge)
Juvenile arrests in Wisconsin, 2000 – 2010

Source: "The State of Juvenile Justice in Wisconsin," October 2011, Wisconsin Council on Children and Families

Arrests of 17-year-olds in Wisconsin by crime

Source: "Juvenile Arrests in Wisconsin 2010," Office of Justice Assistance

Recidivism rates in Wisconsin by age group, 2002

Source: 2008 Legislative Audit Bureau report, "17 year old offenders in the adult criminal justice system," p. 7.

State Rep. Fred Kessler, D-Milwaukee, is introducing legislation that would put 17-year-olds back in the juvenile justice system.

About 250,000 17-year-olds have been arrested since Wisconsin’s 1996 law was put in place, according to an October study by the nonprofit Wisconsin Council on Children and Families. About 75,000 of them spent some time in adult jail, the study found.

Some defend Wisconsin’s law, saying the threat of an adult sentence deters young people from breaking the law, and treating them sternly may dissuade them from re-offending.

“I don’t think we are good at making people understand there are consequences to their crimes,” says Rep. Robin Vos, R-Burlington, an outspoken supporter of keeping 17-year-olds in the adult system. “If you commit a crime, you deserve the consequences.”

Vos says the law has been working well for the past 15 years. Ultimately, any age set for automatic consideration as an adult for criminal prosecution will be arbitrary, he says, and 17 is a good place to draw that line.

State Rep. Robin Vos, R-Burlington, says the state law that treats 17-year-olds as adults in the criminal justice system deters crime.

“What concerns me is making sure the victim gets justice,” Vos says. “We coddled (17-year-olds) in the past, and that didn’t work. If we treat them like an adult, hopefully they won’t offend.”

Many researchers disagree, citing a growing body of neurological and statistical evidence suggesting Wisconsin’s policy is counterproductive. But they and other advocates are finding themselves stymied, in part because of concerns over cost.

The juvenile system offers more rehabilitative services than the adult system, which makes it more costly. The Wisconsin County Human Service Association, the group representing local human services departments, estimates putting 17-year-olds back in the juvenile system would collectively cost the state’s 72 counties an additional $75 million a year.

John Reinemann, legislative director for the Wisconsin Counties Association, says if the law changes, the state would need to provide the counties more funding.

“We support the restoration of 17-year-olds to the juvenile system, but our increase in cost has to be met,” says Reinemann, whose group represents the interests of Wisconsin counties. “The only other way we could get funds would be to economize other programs. … I just don’t think there is a lot of fat left to cut.”

A blunt tool

Under Wisconsin law, 17-year-olds cannot vote, buy cigarettes or drink alcohol. They are considered juveniles in almost every way — except when they commit a crime.

The juvenile and adult systems are very different: The former is geared more toward changing future behavior through treatment and programming; the latter focuses on punishment along with rehabilitation.

Jim Moeser is a former Dane County juvenile court administrator who now is deputy director of the Wisconsin Council on Children and Families, which backs changes in the law. Moeser says juvenile court provides more services to help young people change and opportunities for family involvement. Sentences are shorter and more individualized.

Some call the policy of treating all 17-year-olds as adults a blunt tool, noting Wisconsin law already allows anyone 10 and older — one of the lowest age limits in the nation — to be tried in adult court if they commit certain crimes, such as first-degree homicide.

The law also means that 17-year-olds, like Gunderson, can be held in adult jails before they are convicted, potentially putting young people in with hardened adult criminals. Critics say these young offenders should be held in juvenile institutions.

Racine County District Attorney Mike Nieskes supports the state law that treats 17-year-olds as adults in the criminal justice system. Courtesy of Pete Selkowe

But Racine County District Attorney Michael Nieskes argues Wisconsin’s juvenile system is designed for younger teenagers and children, not 17-year-olds. He sees age 17 as a “tipping point” between being an adult and being a child.

Nonetheless, the policy of automatically trying minors in adult court is declining across the United States as new evidence emerges challenging these “tough on crime” approaches.

Recent studies show that minors in adult facilities have higher rates of recidivism — and re-offend in more serious ways — than comparable offenders in the juvenile system. While proponents argue the tough policy deters young people from committing crimes, deterrence is hard to prove, and research is inconclusive.

And recent neurological evidence suggests young people simply don’t have the same capacity to appreciate the consequences of their actions, casting further doubt on the fairness of treating youthful offenders the same as adults.

During the past five years, 15 states have altered their statutes to raise the age of juvenile court jurisdiction, to remove young offenders from adult jails and prisons and to change transfer laws to keep more minors in juvenile court, according to the Campaign for Youth Justice, a group that favors keeping young people in the juvenile justice system.

In the Midwest, Illinois and Indiana have changed laws to keep more juveniles out of adult court, and several more states are contemplating changes, the group says.

Super predators?

Throughout most of American history, juvenile offenders have been treated differently than adults, with increasing emphasis on rehabilitation. But a jump in juvenile crime, beginning in the late 1980s and peaking in 1994, sparked nationwide fears about a generation of uniquely violent “super predator” youth.

The Central Park jogger case of 1989 highlighted the prevailing fears: Five young men, ages 14 to 16, were charged with beating and raping a 28-year-old woman. In 2002, their convictions were overturned after it was discovered they had falsely confessed to the crime and real perpetrator was identified. But by then, many states had toughened their juvenile codes to make it easier to try juveniles as adults.

Wisconsin’s tough-on-juveniles approach was sparked in 1991 when an 11-year-old boy shot and killed a 21-year-old man in Racine. He couldn’t be charged in adult court because of his age. The incident spurred Racine County Circuit Judge Dennis Barry, now deceased, to help revise the juvenile justice code, which he and others felt didn’t adequately protect victims and the public.

A law moving jurisdiction of 17-year-olds to adult court was passed by the state Legislature and took effect in 1996.

Since then, there has been a steady decrease in juvenile crime across the United States and in Wisconsin. The worries about a generation of “super predators” never came to fruition.

Immature brains

Questions about the fairness of treating youthful offenders as adults have been driven in large part by growing knowledge about how the brain develops.

It is now widely accepted that most young adults are still developing their judgment, planning and decision-making capabilities even into their early 20s.

The brain of a 17-year-old is developmentally much different from that of a 25-year-old, says Michael Caldwell, a researcher at the Mendota Juvenile Treatment Center in Madison, a secured state mental health clinic for young male offenders.

This means young people are more impulsive than adults, Caldwell says.  Their reckless behavior tends to diminish as their brains mature, he says.

The crimes Wisconsin juveniles commit are typically nonviolent, such as curfew or liquor violations. Only 2 percent of juvenile arrests in 2010 were for violent crimes, according to a recent study by the state Office of Justice Assistance.

In the 2005 Roper v. Simmons decision, the U.S. Supreme Court acknowledged the new science showing a fundamental difference between juvenile and adult brains. The 5-4 ruling held that imposing the death penalty on offenders who were under 18 when they committed their crime is unconstitutional.

But defenders of Wisconsin’s law argue that 17-year-olds can still tell right from wrong and should be held accountable in the same way as older adults.

“I’ve read all those brain development studies, but they say a brain doesn’t mature until 25,” says prosecutor Nieskes. “We need to choose an age, and I think 17 works well. … 17 is old enough for them to pay the full consequences of their actions.”

Is adult prison right for kids?

Studies also show that young people are at a much greater risk of victimization and death in adult jails and prisons than in juvenile facilities.

While awaiting trial on charges of attempted homicide, Kirk Gunderson was jailed with older inmates. His parents say their son sought their help after an adult offender exposed himself to the boy, saying, “I’m going to have you.” They say jail authorities, when told of this threat, responded by limiting Gunderson’s movements. He couldn’t go to church anymore.

At 17, Kirk Gunderson drew these two self-portraits in jail. He made the one on the left during the summer of 2005, when he was first incarcerated, and the one on the right about a week before he took his own life that December. Courtesy of Vicky Gunderson

Vicky Gunderson says her son was taking Prozac, an antidepressant, but needed further mental health help. Her son agreed to plead to much lesser charges, and was probably on track to be released soon. But days later, he got caught with materials to give himself a tattoo. His punishment — being placed in solitary — was more than he could handle, Gunderson says.

Juveniles are 19 times more likely to commit suicide in jail than young people in the general population, and 36 times more likely to kill themselves in an adult jail than in a juvenile detention facility, according to a 2007 study from the Campaign for Youth Justice, the Washington, D.C.-based nonprofit.

There’s also a significant racial dynamic. A Wisconsin Council on Children and Families study that tracked 1,000 Wisconsin 17-year-olds charged over six years found young blacks were much more likely to be incarcerated than whites. Eighty percent were sent to jail or prison compared to 46 percent of young whites.

Pam Oliver, a sociology professor at University of Wisconsin-Madison who studies incarceration, says Wisconsin has one of the worst racial disparities in the nation, both at adult and juvenile levels. Young black people also typically enter prison at a younger age, magnifying the impact on this group, she says.

In 2008, Oliver served on then-Gov. Jim Doyle’s Commission on Reducing Racial Disparities in the Wisconsin Justice System. It recommended returning 17-year-olds to juvenile court, concluding that the current policy was exacerbating the “school to prison pipeline” for blacks.

But nothing changed — for reasons that Oliver believes has less to do with a sober assessment of public policy than a concern about costs.

“You’d like the system to try to rehabilitate young people and not throw them away,” she says. “Many people don’t think it’s a good idea to treat 17-year-olds as adults. Honestly, it saves the state a lot of money. The money is what’s really going on.”

Obstacles to change

The juvenile system is significantly more expensive than the corrections system for adults. While it costs about $50 per day to house a jail inmate and about $87 per day to house a state prison inmate, the daily cost in juvenile facilities ranges from $140 to $215, a fiscal analysis from the Department of Corrections shows.

Dane County Juvenile Court Administrator John Bauman says returning 17-year-olds to juvenile court  would add a financial burden to the juvenile system. Bauman believes Wisconsin should raise the age to 18, but he says cost has been the main deterrent.

“It really boils down to how are we going to do this without seriously jeopardizing the rest of the system,” Bauman says.

Proponents counter that the move would eventually pay for itself — less recidivism means lower societal and prison costs.

“Long range, you save money — there’s no question,” says Sister Esther Heffernan, a sociology professor at Edgewood College in Madison who researches corrections policies.

Heffernan notes Wisconsin’s juvenile facilities used to be overcrowded. But since 2000, the rate of juvenile arrests is down 37 percent, according to a 2011 Wisconsin Council on Children and Families study. In fact, three state juvenile correctional institutions were consolidated into one site in July.

Kessler says bipartisan support for his bill is growing. However, given the dominant mood of the Legislature to be tough on crime and to reign in spending, “I think this is going to be a tough sell in this climate right now,” Kessler admits.

Vicky and Kermit Gunderson of Onalaska, Wis., with their son Jay at their second annual awareness run in October 2011. The family organized the hometown event in memory of Kirk. Courtesy of Vicky Gunderson

Vicky Gunderson vows to keep fighting. After her son Kirk died, she and her husband Kermit visited his solitary cell. They lobbied to remove the smoke detectors the boy had used to hang himself.

In fall 2006, the detectors were removed.

The Gundersons say they will continue to push for Wisconsin to change its law that automatically treats 17-year-olds as adult criminals. They’ve spoken to Congress, given interviews, written letters to the editor and recently held the second annual run to raise awareness of the issue in their son’s name.

“He’s still my son,” she says. ”You just don’t give up on your kids, no matter what.”

Julie Strupp can be reached at jstrupp@wisconsinwatch.org.

The nonprofit and nonpartisan Center (www.WisconsinWatch.org) collaborates with Wisconsin Public Television, Wisconsin Public Radio, other news media and the UW-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

Allie Tempus

Our package titled “A Tribal Tragedy” started with a map that accompanied our February story on Wisconsin suicides. Reporter Allie Tempus, new on the job, peered at the one dark-blue spot on the map, the county with the highest suicide rate in the state: Menominee County, near where she’d grown up. She started to look into it, and learned about the persistently high suicide rates among Native Americans in Wisconsin — and the rest of the nation.

This issue, we knew, deserved a wide audience.

Early on we brought aboard Wisconsin Public Radio’s assistant news director, Brian Bull, who is also a Nez Perce from Idaho. And we began sending out feelers to Wisconsin and national Native American media, many of whom we’d never worked with before.

Many stepped up, mightily.

Brian Bull, WPR assistant news director

Bull produced a two-part series on Native American suicides. Wisconsin Public Television interviewed counselor Ken Ninham, one of the sources from Tempus’s story. And IndianCountryTV.com did a video interview with Dr. Arne Vainio, a tribal member whose family took his own life. Thanks to Loris Taylor at Native Public Media, the coverage also is being made available to dozens of Native stations. Among the tribal news organizations planning to use the report are the tribal newspapers of the Menominee and Oneida tribes. New America Media published the report and distributed it to ethnic media nationwide. And at least 10 Wisconsin news organizations used the report.

It’s not over yet. Native America Calling just had Tempus on for a one-hour program on the issue today (link to audio). Hopi Radio in Arizona is planning a talk program, too.

It’s our goal to collaborate with ethnic media whenever we can. We’re grateful to everyone who worked with us to shine a light on this under-reported problem.

Schuyler Webster was 14 when he took his life on the Menominee Indian Reservation. Unknown to his mother, the teen had begun “huffing” glue and talking about suicide. He was 13 when this photo was taken. He died in 1995. Photo courtesy of Evora “Tinker” Fish Webster.

On this page

• Learn more Educational resources, statistics and prevention materials specific to Native American suicides
• Suicide prevention tips
• Where to seek help Counseling and support from state or national organizations

Related story: A Tribal Tragedy: State’s Native peoples have alarmingly high suicide rates Nov. 21, 2010

Learn more

These educational resources are specific to suicide among Native Americans and offer statistical information as well as awareness and prevention materials.

Suicide Prevention Resource Center
877-GET-SPRC (877-438-7772)
www.sprc.org

One Sky Center
503-494-3703
www.oneskycenter.org

Office of Minority Health and Health Disparities
404-498-2320
www.cdc.gov/omhd/Populations/AIAN/AIAN.htm

Suicide prevention tips

According to Helping Others Prevent and Educate about Suicide (HOPES), a nonprofit organization based in Madison, people considering suicide may:

• Talk about killing themselves and become fixated on death
• Make statements of hopelessness and belittle their own worth
• Suddenly become happier or calmer
• Lose interest in hobbies
• Start visiting or calling loved ones
• Start putting affairs in order and making arrangements
• Start giving things away

More than 90 percent of those who kill themselves have treatable mental illnesses, such as depression or substance abuse.

Some signs of depression:

• Substance abuse
• Irritability, increased crying, anxiety and panic attacks
• Difficulty concentrating and remembering.
• Disrupted eating and sleeping patterns.
• Loss of interest in ordinary activities.
• A persistent sad mood.

What to do when you notice a warning sign:

Talk with the person about depression and suicide in a nonjudgmental way to prompt him or her to seek help.

Some questions to ask include: “Do you ever feel so badly that you think of suicide?” and “Do you have a plan?” and “Do you have access to what you would use?” These questions will help to gauge whether the danger is immediate, and if immediate help is needed. Always take action when you learn of suicide plans, including calling 911 or taking the person to the emergency room.

Don’t try to minimize the person’s problems, convince him or her that things will get better or that he or she has many reasons to live. This may only increase feelings of guilt and hopelessness. It’s better to let the person know that help is available, depression is treatable and suicidal feelings are temporary.

If you deem the danger not immediate, acknowledge the person’s suffering as legitimate and offer to help work through the pain. Help to find a doctor or a mental health care professional right away.

Where to seek help

If you are contemplating suicide or have lost a loved one to suicide, these state and national organizations offer services such as counseling and support, or can connect you with help:

National Suicide Prevention Lifeline (Call this number if you are in crisis)
800-273-TALK (8255)

Helping Others Prevent and Educate about Suicide (HOPES)
www.hopes-wi.org
608-274-9686

Mental Health America of Wisconsin
www.mhawisconsin.org
Milwaukee office: 414-276-3122 or toll-free 866-948-6483
Madison office: 608-250-4368

National Alliance on Mental Illness (NAMI)-Wisconsin
www.namiwisconsin.org
608-268-6000
800-236-2988

Schuyler Webster was 14 in 1995, when he took his life on the Menominee Indian Reservation. Unknown to his mother, the teen had begun “huffing” glue and talking about suicide. He was 13 when this photo was taken. Photo courtesy of Evora “Tinker” Fish Webster.

By Allie Tempus
Wisconsin Center for Investigative Journalism

NEOPIT — Fifteen years after Schuyler Webster took his own life at age 14, his mother still sees him everywhere.

He’s in her front yard “Schuyler Tree,” planted by his Menominee Tribal School eighth-grade class. He’s in her grandson, also named Schuyler, now nearing 14 himself. He’s even in her dreams.

“When I dream about him now I can see him at every age that he would have been, every four or five years the changes in him. And I think that’s the power of a mother,” says Evora “Tinker” Fish Webster, a lifelong resident of the Menominee Indian Reservation in northeast Wisconsin.

By the time Schuyler ended his own life, his impulsive nature was getting him in trouble at school and home. Unknown to his mother, the young man had started “huffing” glue and talked to his friends about suicide. When a relative called the police over Schuyler’s glue-sniffing, the panicked teen shot himself.

Less than two weeks after Schuyler’s death on June 11, 1995, his friend Warren Smith across the street in Neopit took his own life, quickly followed by the suicide of fellow Menominee Ruth Tourtillott, family members confirm. In less than three months, three tribal members had died by suicide.

Native suicides: A collaborative report

The Center joined other news media to examine the problem of Native American suicides.

• Wisconsin Public Radio’s Brian Bull reported a two-part series on Nov. 18 and Nov. 19 for its News from 72 series. Hear the reports here.
• IndianCountryTV.com interviewed an Ojibwe suicide survivor, Dr. Arne Vainio.

Photo gallery

Click to view photos of Evora “Tinker” Fish Webster and other Wisconsin suicide survivors.

Chart: Suicide rates

Suicide among Native Americans in Wisconsin is much more prevalent than among other groups.

Learn more or find help

Suicide prevention tips and resources compiled by the Center.

Such a spate of needless deaths may seem unusual, but high rates of suicide have been identified among Native Americans in the United States since the 1970s.

Despite 40 years of insight and ongoing prevention efforts, many native communities still struggle with keeping members from taking their own lives. Between 1999 and 2008, at least 86 Native Americans in Wisconsin have died by suicide — a figure that is likely lower than the actual toll, given that experts believe suicides are sometimes mislabeled as accidental overdoses, shootings and car crashes.

An analysis of Wisconsin suicide data from 1999 to 2008 by the Wisconsin Center for Investigative Journalism found:

• The overall suicide rate among Native Americans was 16 deaths per 100,000 people — at least 25 percent higher than Wisconsin’s overall rate of about 12 deaths per 100,000.
• The suicide rate among native people was significantly higher than rates for the other ethnic and racial groups — including about 12 per 100,000 for whites, 9 for Asians, 7 for blacks, and 6 for Hispanics.
• Menominee County, dominated by the Menominee Indian Reservation with a majority Native American population, had the highest suicide rate of any Wisconsin county with nearly 30 deaths per 100,000 — two times higher than the national rate for non-Hispanic Native Americans.

Nationally, the Centers for Disease Control and Prevention reports that suicide death rates among non-Hispanic Native Americans, such as those living in Wisconsin, have remained consistently higher than the general population over the past two decades. (The minority of Native Americans who identify themselves as Hispanic have low rates of suicide comparable to those of other Hispanics.)

Between 1999 and 2007, for example, the nationwide suicide rate among non-Hispanic Native Americans was 14 per 100,000, about 25 percent higher than the overall national rate of 11.

The disparity has drawn high-level attention to the quality of mental health care for Native Americans. In March, Coloradas Mangas, a young Chiricahua Apache, testified before the U.S. Senate Committee on Indian Affairs after six of his friends on the Mescalero Apache Indian Reservation in New Mexico took their own lives.

“I come from a people whose pride runs deep, but I also understand that sometimes, pride can keep us from asking for help,” said Mangas in his testimony. He said he thwarted a seventh suicide by responding quickly to a friend’s call for help.

In June, Sen. Byron Dorgan, D-North Dakota, launched an investigation into the federal Indian Health Service following a 2009 cluster of 11 suicides on the Standing Rock Sioux Reservation straddling North and South Dakota. Dorgan also sponsored a bill to improve American Indian health care that became part of President Obama’s health care reform agenda.

Higher rates of suicide have long been tied to alcoholism and drug use, depression and poverty that are prevalent in many American Indian communities. Schuyler Webster abused drugs and alcohol as his behavior problems worsened. Andrea Thundercloud, another Menominee tribal member, and Jonelle Pettibone, a member of the Ho-Chunk Nation, are friends who have both attempted suicide and turned to drugs to alleviate mental pain that persists from chaotic and abusive childhoods.

But mental-health providers on Wisconsin reservations cite a deeper and more profound trigger for some suicides: the historical trauma that has disrupted and even destroyed intricate native cultures.

Richard Monette, an associate professor of law at University of Wisconsin and expert in laws involving native people, puts it this way: “They had societies where they had their own norms, their own values, they had customs and traditions … all of which kept their life in balance with their community, with their individuality, their families. They lost all that, and not voluntarily.”

Map: Suicide rates by county

Click the thumbnail to view the full-size map.

Menominee County experiences the highest rate of suicide in Wisconsin, more than double the national suicide rate for other non-Hispanic Native Americans. It is the only county in the state dominated by an Indian reservation, in this case the Menominee Indian Reservation.

Related story: Wisconsin suicide toll rises, exceeds rates of neighboring states – February 2010

Menominee highlights suicide risk

Dominated by the Menominee Indian Reservation with its thick forests, pristine lakes and the mighty Wolf River, Menominee County and its 4,513 people represent a microcosm of why suicide rates are so high among Native Americans.

The University of Wisconsin Population Health Institute ranks the county last in several key health indicators.

Menominee is Wisconsin’s poorest county. Just over half of Menominee County children live in poverty, compared to 15 percent statewide. While single-parent families account for 9 percent of Wisconsin’s households, in Menominee County, it’s 26 percent. The county’s unemployment rate is nearly always the worst in the state; in September, it was 14.5 percent.

Menominee County Sheriff and tribal member Butch Summers recalls being called out of a 2008 suicide prevention training session — held on the one-year anniversary of a Menominee teenager’s suicide — to respond to yet another suicide death.

“There ain’t that many jobs here on the reservation,” Summers says. “And you got alcoholism and drugs. And they’re turning to that instead of going out and finding jobs off the reservation.”

Amy Zimmer, a drug and alcohol counselor with Menominee County Health and Human Services, estimates that half the people she counsels have thought about or attempted suicide at some point in their lives.

More than 2,800 people — well over half the county population — seek help from Menominee Tribal Clinic’s mental health program annually, says Jerry Waukau, the clinic’s health administrator. He said patients seeking a consultation with the psychiatrist will likely wait five weeks for an appointment at the facility, funded primarily by the Indian Health Service.

Mental health providers and prevention groups hand out these cards with the suicide hotline number for Menominee County. The county’s Health and Human Services Department, which serves a mostly native population of 4,513, got 32 suicide-related calls in 2009, one of which resulted in death. Allie Tempus/WCIJ

The tribe also has an alcohol and drug abuse counseling center called Maehnowesekiyah (mah-no-way-SAY-key-ah) Wellness Center, which means “We will all feel better” in the Menominee language. Because of both the tribal and county services, “I think we’re lucky here because I think we have better access to some mental health services than other counties do,” Zimmer says.

But Maehnowesekiyah Director Shannon Wilber, who grew up on the Menominee reservation, says problems persist because depression and mental illness there are often shrouded in shame and misunderstanding.

“Our people aren’t equipped with the tools to be able to identify when a person is at risk for suicide,” Wilber says.

Warning signs

Other Wisconsin reservations have comparable services and accessibility. On the Lac du Flambeau reservation in northwest Wisconsin, for example, patients often wait weeks for a counseling appointment at the tribe’s Family Resource Center, says counselor Denise Wildcat.

Then there is the question of the quality of care. Ken Ninham, a psychotherapist who has worked with several Wisconsin tribes over 30 years, says health-care providers often have trouble breaching the cultural divide to see warning signs. He spoke on the condition that his comments would not represent any particular tribe or tribes.

Ninham recently saw three suicidal Native American patients at Bellin Health in Green Bay. Each had seen multiple health-care providers, none of whom identified the potential for suicide.

“My biggest frustration is people (who) are trained to pick up on these warning signs and are not following through and making the referral and the assessment,” Ninham says.

Dorgan, chairman of the Senate Committee on Indian Affairs, is investigating the quality of mental health care in the Indian Health Service’s region based in Aberdeen, S.D., one of 12 administrative regions. Dorgan says the reservation’s director of mental health position has gone unfilled for over a year.

“That represents, in my judgment, incompetence. The Indian Health Service has a responsibility to fill these positions and make mental health treatment available to people,” Dorgan says. “I think Congress has some responsibility to provide more funding here.”

The Aberdeen district gets the most funding for mental health care from the IHS at $73 per person per year. By comparison, the Bemidji service area, which includes Wisconsin, Minnesota and Michigan, receives about $19 per person, the third lowest per capita spending among the 12 IHS regions.

Thomas Sweeney, a spokesperson for the Indian Health Service, insists the agency is addressing the issue.

“Currently, in partnership with tribes, (we are) developing strategic plans to address suicide and behavioral health for the Indian health system,” Sweeney writes via email.

Witnesses told Dorgan’s committee that only 60 percent of the demand for mental-health services is being met on reservations.

“There’s wide-scale health care rationing going on on Indian reservations,” Dorgan adds. “That includes rationing with respect to mental health which relates directly to the question of suicides.”

A simple wood cross marks Schuyler Webster’s grave at St. Anthony Cemetery in Neopit, Wis. on the Menominee Indian Reservation. His mother, Evora “Tinker” Fish Webster, was so angry about the 14-year-old’s suicide that she didn’t buy a permanent grave marker when he died 15 years ago. In the past three years, Webster says she finally made peace with her son -- and herself. Allie Tempus/WCIJ

‘He lived for the day’

When Schuyler began acting up at home and school, his mother, Tinker Webster, took him for help to Maehnowesekiyah, never thinking the young man who loved drumming and drawing eagles might be suicidal.

“He was 14 years old, just going through puberty, different kinds of mood swings and just a lot of fun,” Webster says of her son, who was proud of his Indian heritage. “He lived for the day. He was that kind of boy.”

A single parent of six boys, Webster worked two jobs to keep her family afloat. When Schuyler got to be too much to handle, Webster sent him to stay with her oldest son Chauncey, who lived on the reservation with his wife.

The day before he died, Schuyler was at Chauncey’s home, drinking, smoking marijuana and huffing glue with his youngest brother Bronson. The next morning, Schuyler, high on glue, argued with Bronson over who should mow the lawn.

Chauncey’s wife smelled the glue and after trying to reason with Schuyler, called the police. Schuyler hid in the closet of a locked bedroom. As officers entered the trailer, he shot himself with a hunting rifle.

According to Wilber of Maehnowesekiyah, Schuyler’s living conditions — drug and alcohol use at a young age, bouncing from home to home — are common on the Menominee Indian Reservation and in other Native American communities. Single parents are sometimes forced to work two jobs, and children are often left to their own care.

LISTEN: Too late, Tinker realizes how much her son had grown up.

“Day in and day out when a child lives like that … they start getting involved with kids that are currently doing or using drugs and alcohol,” Wilber says. “Alcohol and drugs, once they get past that euphoria, it creates that downer effect. And that brings down their whole world and makes them feel like there’s no reason for living.”

Menominee Tribal member Andrea Thundercloud, 40, in the backyard at her mother’s home in Madison, Wis. Thundercloud moved back and forth between the Menominee Indian Reservation and Madison as a child. Thundercloud, who has bipolar disorder, first contemplated suicide at age 12 and has attempted suicide 30 to 40 times. Allie Tempus/WCIJ

Andrea Thundercloud’s left wrist is marred by a thick constellation of scars from repeated suicide attempts. Thundercloud, 40, a Menominee Tribal member, first became suicidal at age 12. Allie Tempus/WCIJ

Andrea Thundercloud, now 40, spent a turbulent childhood rotating between the Menominee reservation and the “white man’s world,” leading to a lifelong struggle with suicidal tendencies. She estimates she has tried to take her own life 30 to 40 times; her left wrist is marred by a thick constellation of scars.

Thundercloud says the cycle of dysfunction among young people on the reservation is obvious.

“They’re young, they don’t know another way of life and they see their parents being abusive, so they become abusive, and then they are bored, so they drink,” Thundercloud said. “It’s beautiful land, but my tribal members make it depressing.”

Philip A. May, professor of family and community medicine at the University of New Mexico, has studied suicide among Indians since the 1960s. He says Schuyler’s story represents a “pretty routine recipe” for Native American youth suicides.

“Because people of those age groups tend to be impulsive, if you mix alcohol or other drugs, people tend to be more impulsive,” he says.

Says Webster: “Two different times, two of (Schuyler’s) friends had told me he had talked about doing that, not shooting himself but killing himself, but I didn’t really put emphasis on it because he seemed like he was okay.”

As a result of Schuyler’s death, Webster fell into a deep depression. The stress of the suicide also inflicted deep wounds on his siblings, she says. His two eldest brothers endured failures in the logging business. His two brothers in high school did not graduate. His youngest brother, now 28, is serving time in an Indiana prison.

Webster, sadly, doesn’t feel that her family’s situation is unique.

“A lot of the Native people have so many crises in their family, they go through one and they don’t heal from that one and you got another one,” Webster says. “They’re one right on top of one another.”

Opened in 1893, the Tomah Indian Industrial School in Tomah, Wis. was funded by the federal government and “intended to teach Indian children to shed their cultural background and become more like white, middle-class Americans” according to the Wisconsin Historical Society. Psychotherapists, scholars and tribal members note that a loss of culture and lack of nurturing at such schools throughout the state and country led to a breakdown of community and family within Native American populations. Wisconsin Historical Society image #38078.

Tribal trauma

For Native Americans, the term historical trauma describes the takeover of Indian lands by white settlers, relocation to reservations and loss of culture when children were forced to attend white-run boarding schools.

George Kamps, a psychotherapist who formerly worked with the Oneida tribe, says boarding schools in particular worked to undermine families, stunt emotional development and damage parenting skills.

At these schools, he says, “punishment was prominent if you didn’t behave, but the nurturing and the loving was absent.” As a result, Native Americans who attended these schools, some of which operated until the 1970s, “didn’t learn to be gentle, to be nurturing,” Kamps says. “They learned to be disciplinarians because that’s what they were taught.”

Historical trauma leads to dysfunction because it damages the ability of families, schools and the community “to buffer and protect the individual from normal challenges,” May says, “and those challenges tend to be greater in Indian communities.”

Psychotherapist Ninham says drugs and alcohol are too often blamed for problems such as suicide on reservations. He and other experts instead point to the physical, sexual and emotional abuse that they believe has its roots in historical trauma.

“Nobody wants to talk about trauma and abuse, so we talk about drugs and alcohol,” Ninham says.

Zimmer, the alcohol and drug abuse counselor, agrees: “The alcoholism is a symptom of that greater over-arching issue of the historical trauma. It’s a symptom of, it’s not the cause. But people just can’t get out from under it.”

Thundercloud says her first suicidal thoughts at age 12 stemmed from physical abuse and “not feeling loved and cared about” at home. She turned to alcohol and drugs to numb the severe mental pain that anti-depressants failed to soothe.

“This depression just makes you not want to do anything, and you just want to sleep and you feel like … you’re not hurting anybody, (but) actually I am,” Thundercloud says. “I’m hurting myself, because I’m wasting away in my room.”

LISTEN: Thundercloud examines the depths of depression.

Jonelle Pettibone, a member of the Ho-Chunk Nation, at the home of her friend Andrea Thundercloud’s mother in Madison, Wis. Pettibone traces her repeated suicide attempts to a tumultuous childhood and problems with her mother. She attributes the high suicide rate among Native Americans to “family issues.” Allie Tempus/WCIJ

Jonelle Pettibone, 34, last attempted suicide a year ago following a particularly stressful time in her life, which has been punctuated by physical and emotional abuse from those closest to her. She says her mother once told her after she landed in the hospital because of a serious accident, “You should have just died.”

‘Culture is prevention’

In February, the College of Menominee Nation in Keshena added a suicide prevention specialist, Cary Waubanascum, who runs a training program in how to question people about their suicidal thoughts, persuade them to seek help and refer them to services.

Over the next two years, the college plans to train half its faculty and 150 of its students in recognizing and preventing suicide, Wabanascum said. Darwin Dick, the tribe’s youth development and outreach director, hopes to extend the program to Menominee Indian High School students.

Dick runs another federally funded program, Native Aspirations, which reconnects youth to their culture to reduce violence, bullying and suicide.

“Culture is basically prevention in itself,” Dick says, adding that when students know who they are, “their confidence is higher, their self-esteem is higher — it creates that sense of belonging.”

Thundercloud and Pettibone, who live in Madison, have both looked to native culture for healing. Pettibone uses prayer and traditional tobacco offerings to the native creator. Thundercloud says sweat lodge ceremonies have helped relieve her pain in a way no modern medicine has done.

After a “sweat”, she says, “I felt like I was getting rid of all the evils and all the dirt inside of me. It felt like I was getting back in touch with my background, being Indian again.”

LISTEN: Thundercloud finds relief in cultural healing through traditional sweat lodge ceremonies.

Another program, Reaching Out Against Depression and Suicide, based in nearby Shawano, has brought suicide prevention educators to the Menominee Indian High School. It also hosted the 2008 prevention training session that drew more than 100 tribal members, including Summers, who left early to respond to another suicide.

On a national level, the health care reform bill signed by President Obama in March includes the Indian Health Care Improvement Act, authored by Dorgan. Among its many provisions, the bill directs the IHS to establish comprehensive behavioral health, prevention and treatment programs for Indians.

Now Congress must decide how much of the bill it is willing to fund. “If we can get these funded,” says Dorgan, who’s retiring in January, “I think we will see almost immediate improvement.”

Back in Neopit, Tinker Webster makes a monthly pilgrimage to her son’s grave, a small plot in a shady corner of St. Anthony Cemetery marked by a simple wooden cross.

When Schuyler took his life, Webster was so angry, she didn’t buy a permanent grave marker. In early visits to the cemetery, she would curse and kick at the small rocks lining his grave.

Webster says it’s only in the past three years that she finally forgave Schuyler and herself for his death. In 2008, she mustered the courage to speak publicly during the suicide-prevention event held on the reservation.

And recently, she started looking for a headstone.

The nonprofit Wisconsin Center for Investigative Journalism (www.WisconsinWatch.org) collaborates with its partners — Wisconsin Public Television, Wisconsin Public Radio and the UW-Madison School of Journalism & Mass Communication — and other news media. Allie Tempus may be reached at atempus@wisconsinwatch.org.

By Sara Jerving

Wisconsin Center for Investigative Journalism

Not again.

That was the dread that hit 18-year-old Bianca Lewis when she learned she was pregnant with her second child, less than a year after her daughter was born.

The depression that had troubled the single mother during her first pregnancy intensified after the birth of her second child.

Lewis, of Sun Prairie, frequently cried.

She fell into fits of screaming rage.

She abused alcohol.

She even broke ceramic plates over the head of the father of her children.

More than 65 percent of depressed mothers don’t get adequate treatment for depression, according to a nationwide study released this fall by the UW-Madison School of Medicine and Public Health. The study of 2,130 women found that black, Hispanic and other minority mothers were among the least likely to be helped. Women with health insurance were more than three times as likely to receive adequate care compared to uninsured mothers, the study found.

“Expanding health insurance coverage to mothers with depression is a critical step in

helping them get the care they need,” said lead author Whitney Witt, assistant professor of population health sciences at UW-Madison.

Nationally, depression that develops during the pregnancy and up to a year after giving birth afflicts up to 15 percent of women, a condition that can cause long-lasting problems in children. Although women of all income levels and backgrounds can suffer from perinatal depression, for women living in poverty, it’s twice as likely to strike, according to the Wisconsin Association for Perinatal Care.

Solutions to the problem of perinatal depression in Wisconsin remain elusive.

Consider that:

• Few health care professionals specialize in perinatal depression, meaning not many women are screened for it, physicians may overlook depressive symptoms and there are few places for treatment if they’re diagnosed.

• Women living in poverty are especially vulnerable because they are often already under excessive stress.

• Some women may avoid treatment because of the stigma of feeling depressed at a time that’s supposed to be among the most joyful in their lives.

• Some who qualify for state-sponsored health insurance while pregnant may lose the coverage after the baby is born because of more-restrictive income requirements for women who aren’t pregnant.

Some symptoms of perinatal depression include feelings that persist for two or more weeks — being overwhelmed, a lack of energy, sleep disturbances, difficulty attaching to the child, loss of concentration and, in severe cases, a desire to hurt themselves or their baby. Postpartum depression can make a woman unable to pick up her child when it needs her or respond appropriately to other cues.

“The attachment that can very quickly rupture when a mother has postpartum depression is potentially devastating,” said Jenny Grether, program coordinator of the Early Childhood Initiative of Dane County, a local home visitation and employment program.

The majority of women suffering from perinatal depression will suffer in silence, and the harm to their children can be profound, experts say, including delays in the child’s cognitive and language development, behavioral problems or other psychological issues.

Mothers and children can also be at physical risk. The most extreme form of perinatal depression, perinatal psychosis, may cause a mother to hate her unborn baby or infant, have thoughts of suicide or of harming the child. While this type of perinatal depression is extremely rare, several cases have made national headlines. In 2008, Alisa Lorraine Evans of Milwaukee was found not guilty by reason of mental disease after she killed one of her twin infant sons and injured another after she was diagnosed with perinatal psychosis.

Insurance limits are tight

On top of the natural stress of being a new mother, poor women struggle, often alone, with how to feed their children, a lack of adequate transportation, child care, employment and health insurance.

The Early Childhood Initiative works in the low-income neighborhoods of Allied Drive, Russet Road and Wexford in Madison, as well as the town of Sun Prairie. Women who are pregnant or have a child under 1 year old can participate in the program.

While its main mission is help children and create self-sufficient families, the program has become one of the primary screening tools for perinatal depression in low-income areas of Dane County. The program finds that just over half of the new mothers and pregnant women screened in low-income areas of Dane County had depressive symptoms at levels warranting further evaluation.

For many low-income women, a lack of adequate health insurance remains a significant roadblock to getting help. For those who do have state-sponsored insurance, finding therapists who charge on a sliding scale, or who accept patients receiving Medicaid, is difficult, said Birdie Meyer, president of Postpartum Support International.

BadgerCare Plus, the state’s health insurance program for low-income residents, has a special eligibility standard for pregnant women, offering state-subsidized coverage, for example, to a family of four making up to $66,144 a year.

Following the birth, the mother will still be covered for at least 60 days and the child is still eligible for BadgerCare Plus, but the income eligibility for his or her mother tightens to $44,100 a year to qualify for BadgerCare Plus.

Sixty days after the birth, women who don’t meet the income-level requirements are dropped, according to the Wisconsin Department of Health Services. Some cases of postpartum depression don’t show up in the first two months, meaning a woman could be dropped from coverage before the condition is identified or treated.

“I am stable now”

For Bianca Lewis, the path toward wellness has been rough.

Lewis moved from Houston to Dane County to live with her baby’s father in 2006. But things didn’t work out, Lewis said, because he was involved with two other women, and he’d already fathered two children with one of the women. A few months after the birth of her first child, Lewis found herself alone with her baby daughter at a homeless shelter.

She’d just had her gall bladder removed and was preparing her seven-month-old daughter for surgery to repair a congenital defect when she found out she was pregnant again.

She felt miserable, overwhelmed — and depressed.

“So here I go all over again,” Lewis said. “Not knowing if he’s going to be there or not. And I’m going to be sitting here with two kids … “

Lewis got help from the Early Childhood Initiative, where she was referred by her landlord after her first child was born. She’s been seeing a therapist, has been on and off medication and has developed a support network to help her through episodes of depression. Throughout her apartment are handwritten reminders to “Take your meds!”

Since she qualified for state-subsidized health insurance and was connected to treatment by the Early Childhood Initiative, Lewis didn’t have to worry about access to care. Even without this stress, however, Lewis felt burdened with other problems that make it hard to cope with depression.

“Mentally, I am stable now, but I still have three bodies to worry about,” Lewis said. “I have to make sure that we have enough food at the house and that everyone gets to their doctors’ appointments … I just want everything to be like the classic normal family — have a perfect home, the kids can have a father-figure, a picket fence house, all of that.”

Access improves, yet stigma persists

Access to treatment for women in Wisconsin suffering from perinatal depression has improved over the past 10 years, said Ann Conway, executive director of the Wisconsin Association for Perinatal Care. Women and health care providers are more aware of the problem, which has boosted the number of women getting screened for perinatal depression. And a growing amount of research has focused on the effects maternal depression on infants, children and families, she said.

Still, many women with perinatal depression aren’t getting help, Conway said.

“Some of the things that have remained the same include the stigma associated with a mental illness; the fear of prescribing selected antidepressant medications for pregnant and breastfeeding women; and a lack of mental health providers, ” Conway said.

Jennifer Doering, assistant professor of nursing at the University of Wisconsin-Milwaukee, agreed a stigma persists.

“In society, there is the idea that you can’t be a good mom and have a mental disorder,” she said. ” The two, for whatever reason, wrongly seem to be on the opposite ends of the spectrum.”

The depression itself can be a significant barrier to getting help, Doering said.

“Simply making the phone call when you are depressed to seek help is, for many women, a severe and almost insurmountable burden, ” she said.

Should screening be required?

Rebecca Cohen, a mental health program analyst for the state Department of Health Services, believes all pregnant women and new mothers should be screened for depression. She said identifying women suffering from perinatal depression would help knock down some of the barriers to getting help. The Wisconsin Association for Perinatal Care recommends women be checked for depression twice during pregnancy and twice after the child is born, once at six weeks after birth and another time before the child is 1 year old.

Some states have passed legislation dealing with perinatal depression, including New Jersey, which requires health care providers to screen all new mothers for the condition. Earlier this year, a bill was introduced in the U.S. House of Representatives that would ensure new mothers are screened and treated for postpartum depression. The bill also calls for increased funding for research on postpartum depression.

Still, most women like Lewis who do find treatment do so by accident, said Lisa Hebgen, Wisconsin state co-coordinator of Postpartum Support International. She said there are few support groups in Wisconsin aimed at women with perinatal depression, who may feel alienated in regular new-mother groups.

Hebgen, who suffered from postpartum depression after the birth of her son, found Dane County had few health care providers versed in the problem. Nowhere in her birthing classes or doctor visits did she hear about perinatal depression. Hebgen said when she began experiencing symptoms of depression, her concerns were ignored.

Said Conway of the Wisconsin Association for Perinatal Care: “The most common lament we hear … is the lack of services for mental illness, especially for pregnant women with mental illness.”

The nonprofit Wisconsin Center for Investigative Journalism (www.WisconsinWatch.org) collaborates with its partners — Wisconsin Public Radio, Wisconsin Public Television and the UW-Madison School of Journalism & Mass Communication — and other news media. This report is part of All Together Now, a community-wide collaborative journalism project, with all coverage available at www.ATNMadison.org.

What is perinatal depression?

A majority of new mothers may experience the ‘baby blues’ where they feel tired, have no energy and are overwhelmed by both joyful and depressive emotions. The postpartum blues may last up to 10 days and normally go away naturally.

But symptoms of perinatal depression, which afflicts pregnant women or new mothers, are more serious and last longer than the ‘baby blues.’ Some of the symptoms include depressed mood, lack of interest in activities, an inability to sleep, decreased concentration, a lack of energy to respond to the baby’s needs, emotional detachment from the child, feelings of guilt about that detachment and thoughts of harming oneself or the child.

Researchers have long thought that perinatal depression is caused by hormonal imbalances. However, many recent studies have found that other risk factors may have a stronger impact on perinatal depression. Those include recent stressful events like a job loss, financial difficulty, relationship problems or divorce or a general lack of social support.

The Centers for Disease Control and Prevention has found that reports of postpartum depression are high among teenage mothers, victims of physical abuse, low-income patients, smokers and mothers with less than 12 years of education.

The most serious and rare form of perinatal depression is perinatal psychosis. Women with this disorder can have delusions, paranoia and hallucinations, including hearing voices and having thoughts of harming their babies or themselves. Women with these symptoms should seek medical help immediately.

Women with perinatal depression can experience anxiety disorders such as panic disorder or obsessive-compulsive disorder in addition to their depression. Postpartum obsessive-compulsive disorder can cause a mother to have persistent thoughts about harm to her baby, causing her to excessively protect her child.

Perinatal depression can last several months to a year or longer if left untreated. Extended maternal depression can damage a mother’s relationship with her child but also result in delays in the child’s cognitive and language development, behavioral problems and other psychological issues. Some of the treatment options include therapy and medication.

Key facts about perinatal depression

If you need help

• UW-Madison Postpartum Depression Treatment Program, 608-263-5000
• Postpartum Support International, Lisa Hebgen, Wisconsin state co-coordinator, 608-929-7629, http://postpartum.net/
• Maternal and Child Health Hotline in Wisconsin, 800-722-2295, www.mch-hotlines.org