The rate at which Hawaii teens and young adults are taking their own lives has more than doubled over the past five years, spurring some mental health experts to call it an emergency situation.

The number of suicides for youth ages 15 to 24 surged from 15 in 2007 to 36 in 2011, according to the most recent state Department of Health data. This makes it the leading cause of injury-related death for most age groups — all but the very young and the very old — outpacing car crashes, homicide, poisoning and drowning.

That means suicide is killing more people than anything but a serious illness. The trend has alarmed professionals in the nonprofit world and government agencies.

“Clearly, we’re not providing adequate mental health and suicide services to the youth population,” said Marya Grambs, executive director of Mental Health America-Hawaii. “It’s a failure of our entire community — whether parents, friends, mental health professionals, medical practitioners, teachers. It’s all of our responsibility to understand how serious the problem of suicide is.”

Dan Galanis, an epidemiologist who heads the state’s injury prevention program, examined hundreds of autopsy records in his effort to understand why the numbers are on the rise.

Combing through this third-hand knowledge, as he put it, illuminated some of the possible motivations — mental illness, relationship issues, family discord — but it didn’t bring him much closer to an answer.

“When you’re thinking about how to impact it, you’re trying to fix the world’s problems,” Galanis said.

The numbers are as perplexing as they are startling, Grambs said, in part because they come at a time when some bullying statistics offer signs of hope.

For more than a decade, Hawaii led the nation in the percent of high school kids who thought about suicide, made plans to do so or attempted it. But the latest data, the 2011 Youth Risk Behavior Survey, shows the state has slid in the rankings.

Hawaii continues to lead the nation in other categories, including the number of middle school students who seriously considered attempting suicide — almost one out of four — and those who made a suicide plan.

With bullying frequently cited as a contributing factor in suicides among youth, the contradictory trends gave Grambs pause.

“Some kids may be feeling better, which is wonderful, and not attempting as much. But more young people are completing suicides,” she said. “The positive trend seems to be outweighed by the tragedy of how many young people are killing themselves.”

The number of suicides among Hawaii’s youth only increases when adding in “deaths of undetermined intent,” which health experts say may often be suicides but the evidence wasn’t conclusive enough to label it such. There was anywhere from one to seven of these deaths annually from 2007 to 2011.

Compared nationally, Hawaii’s suicide rate is significantly higher among 15- to 19-year-olds but drops below the U.S. average for ages 20 to 24.

Suicide Prevention Plans

Nancy Kern, the state Department of Health suicide prevention coordinator, said there’s no easy answer to the suicide problem but she remains optimistic about the multi-pronged efforts happening throughout Hawaii.

The department recently published its latest five-year injury prevention plan, which highlights some of these efforts.

The relatively short chapter on suicide calls for bolstering ongoing prevention trainings for the so-called gatekeepers, the people who interact with others at work, in schools, at play, at home or in community settings.

The plan also calls for implementing a public awareness campaign, which MHA-Hawaii is helping to develop by gathering student feedback to find out what messages resonate with young people. Grambs called the suicide prevention campaign a good start, and is hopeful it helps.

The third recommendation in the plan involves breaking down barriers to effective and appropriate services for people at risk for suicide. For instance, there’s a shortage of culturally sensitive preventive services and treatment options for mental illness and substance abuse.

Overcoming Stigma

An enormous barrier is overcoming stigma, mental health experts said.

“People don’t want to talk about it,” Kern said. “They’re afraid other people might think, ‘Why can’t you get your life together? What’s wrong with you?'”

This leads to fewer people taking the initiative to get help, she said, adding that’s where the trainings come into play.

“We tell them, ‘You need to be your brother’s keeper,'” Kern said. “They may not be watching out for themselves. So family members, colleagues at work, we should all be on the lookout for the signs of suicide and see if an opportunity can be had to talk to that person.”

Grambs said if she had a magic wand she’d increase the awareness of suicide and reduce all the shame and embarrassment of mental illness.

“Depression is an illness. Your judgment is impaired and your mind is not working normally,” she said. “It’s not your fault. You didn’t wake up and say, ‘I think I’ll be depressed today.’ Your neurotransmitters aren’t working right.”

As with other diseases like high blood pressure, Grambs said there are treatments available that work. But people have to know these services exist and how to access them.

“We need to get people in positions of authority to kind of declare that this is an emergency — that twice as many young people are killing themselves in the past five years,” Grambs said. “So many of our young people are desperately depressed, so depressed that they kill themselves. As a society we haven’t grasped that. We have got to start paying attention.”

Change Starts With Education

Grambs, who tried to kill herself when she was 17, noted that suicide is a permanent solution to a temporary problem.

“That’s what’s so tragic,” she said. “If they can just be prevented from making that one move that ends everything, they could see that that one problem is going to end. But at the time when you’re in the depths of despair, you have no inkling that things are going to change.”

Grambs said it takes people reaching out to those in need and getting them help. She said she’d like to see every college and high school campus have suicide awareness campaigns to boost overall public education of the issue.

Jourdan Cachola compiled these resources in a brochure she made for her senior project in 2010 at Farrington High School:

Warning Signs

  • Direct statements, such as “I want to die” or “I hate my life.”
  • Indirect statements, such as “I won’t be a problem for you much longer” or “Nothing matters.”
  • Writing poems, songs or diary entries about death.
  • Withdrawal from friends.
  • Feelings of guilt, shame or rejection.
  • Loss of interest in favorite activities.
  • Substance/alcohol abuse.
  • Change in sleep patterns.
  • Drop in grades.
  • Dramatic changes in moods, hygiene or appearance.
  • Seeing no reason for living.

Getting Help

  • Talk to someone you trust, such as a friend, family member, coach, mentor, school counselor, teacher, religious leader or doctor.
  • Hotlines: ACCESS Line, 832-3100 (Oahu) or 1-800-753-6879 (Neighbor Islands toll free); Teen Line Hawaii,; National Suicide Prevention Lifeline, 1-800-273-TALK.

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