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City of St. Paul

Saint Paul Logo
  • Headquarters

    St. Paul, MN

  • Number of Employees


  • Industry

    Public Administration

Educating City employees about mental health, offering skills to increase resiliency and partnering with an influential business group on health.

Organizational Overview

The City of Saint Paul values a workforce that reflects the diversity and talent of its community. Incorporated in 1845, the City is a place of opportunity with more than 600 job classifications and nearly 3,000 employees. Ninety-eight percent of its workforce is unionized, and decisions are made jointly by representatives of 22 unions and St. Paul management. City employees take pride in creating strong communities and addressing Saint Paul's most challenging issues.

The Workplace Mental Health and Wellness Initiative

Getting started. The Healthy Saint Paul Committee, made up of representatives from all City departments and headed by HR Benefits, was formed in 2011 to address the health and well-being of the City and its employees. The committee became concerned about suicides, with at least one occurring each year for several years in departments from Fire to Libraries. Much of the committee’s focus had been on physical health conditions and concerns like diabetes, obesity, poor nutrition and lack of exercise.

While stress was consistently near the top of the utilization chart provided by our health plan, which tracks high prevalence/cost conditions, no one had looked seriously at what “stress” might be hiding in diagnosable conditions.  Many employees experiencing depression and other serious mental health issues were being missed with the assumption that stress likely meant “my job is hard; listening to the news makes me angry; I don’t have time for my family.” It was concerns with stress, depression and suicide that created a call to action.

Choosing the right initiative. The City began by releasing an RFP to find a vendor that could provide easily accessible resilience tools and training. A key element was engagement – the City had experienced great success with Omada’s model for using the pre-diabetes prevention program and wanted to partner with an organization that could inspire employees to action in a similar way. The City chose MeQuilibrium as our partner for this work. The City launched MeQuilibrium on May 1, 2019, with executive support from St. Paul Mayor Melvin Carter.  As this case study is published, the City eagerly awaits learning about employee uptake with this tool.

The City also ramped up training for supervisors in accessing and using the EAP in a more robust fashion. HR Liaisons were invited to a Mental Health First Aid training; a half-day session designed to impart better, more useful interventions when mental health issues arise in the workplace. This course is being offered again in June through the League of Minnesota Cities.

St. Paul was the first to pilot a smart phone application called Vitals.  The police force is using the app to stay informed and prepared in responding to calls involving community members with mental health concerns. Families subscribe to the app, sharing information with the police department about mental health related issues so that when a 911 call goes out, responding officers receive key information from the app like the condition, potential behaviors or reactions, emergency contact information, and more. There are now 33 jurisdictions in Minnesota following St. Paul’s lead in using the Vitals app.

Nance Lee Mosquera, St. Paul’s Employee Benefits Manager, joined a subcommittee of the Minnesota Health Action Group, the state’s business group on health. The subcommittee is focusing on mental health access, quality and cost. As part of this work, the Minnesota Health Action Group interviewed many subject matter experts, disseminating what was learned from those interviews into an Employers Guide on mental health. The guide has been disseminated to employers, providers and consultants.  The City is finding it useful especially in analyzing the degree to which parity in mental health benefits exists or needs shoring up.

In addition, the Minnesota Health Action Group hosted a Community Dialogue, held at the Science Museum simultaneous to an interactive exhibit on mental health. The event was so popular that interested participants had to be turned away! Nance and a Benefits Manager from the private sector kicked off the event by talking about how they got interested in mental health, the needs they saw in their respective roles and issued a call to action for a collective effort to address mental health in the community. The Community Dialogue received extensive media coverage one day, two days and one week out in the Minneapolis Star Tribune and on public radio.

The team and leadership support.

Nance Lee Mosquera has led the initiative to address mental health along with HR liaisons and wellness committee members.Mayor Carter’s executive sponsorship of the launch of MeQuilibrium, our new resilience tool, marked a new high in leadership support. Visible leadership engagement greatly enhances workplace mental health initiatives.

MeQuilibrium is budgeted as part of Healthy Saint Paul incentive costs. Other initiatives are either part of the health plan vendor’s service package or funded through wellness credits that are provided in the vendor contract agreement.

Communicating the initiative internally and externally. The primary communication vehicle for sharing information about the mental health initiatives in St. Paul is the monthly Healthy Saint Paul newsletter and media coverage from the Minnesota Health Action Group’s Community Dialogue event.  As chair of the Guiding Coalition, Nance Lee is well-placed to obtain updates on broader initiatives in which the City may have an interest.

The City is pleased with the overall mental health initiative with its focus on increasing EAP use, increasing workplace resilience, the implementation of Vitals, the partnership with the Minnesota Health Action Group and looks forward to continuing this work. 

Measuring Impact

The goal of this initiative is to better understand the impact of mental health as measured through use of services and supports, the cost of delivering care and the quality of life for City employees. The City is building resilience in the workforce as a preventive measure. The City also implemented the Vitals program to improve interactions between the police department and community members experiencing mental health challenges. The City stepped up its marketing of EAP services and supports through benefits staff and HR liaisons to increase EAP usage.

This work is in an early phase so tools to measure impact have not yet been developed.   We will be looking proactively at two departments whose utilization in these areas were much higher than the norm. Additional outreach and support in using the new resilience tool and other resources will be provided to these departments.

Lessons Learned, Challenges and Recommendations

Like many organizations focusing on workplace mental health, there are challenges and lessons learned. For this initiative, one of the biggest challenges was where to start, given the broad scope of potential ways to address workplace mental health.

One strategy that seemed like an obvious place to start is looking at the co-morbidity that exists between mental health and other chronic health conditions with the idea that those already engaged with a health provider should also have their mental health addressed and checked. Research shows that high rates of co-morbidity exist with chronic health and mental health conditions so it’s an important way to connect with those in need of mental health care.

Also, the City recognized that it’s ok to spend the first year just focused on educating the workforce on mental health because many people have much to learn about it. They found that most people were not aware that resilience is a skill that can be taught but are benefitting from skill building in that area and in learning more about mental health in general.  

St. Paul is finding that despite challenges, there are big rewards in focusing greater attention on workplace mental health.

The Center appreciates the contributions of Nance Lee Mosquera, Employee Benefits Manager for the City of St. Paul to this case study.

Last updated: May 2019

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