A cluster of four suicides in seven days on Kauai is raising concerns that the coronavirus pandemic and the collapse of the economy may be having devastating mental health consequences, especially for people with a history of psychiatric symptoms or addiction.

The four deaths were all young men in their 20s or 30s, according to Kauai Police Chief Todd Raybuck. 

The suicides took place between May 2 and May 8. There is no known connection between them.

All four men died by hanging, police said. Three were residents of Kapaa and the fourth man lived on the west side.

“The biggest message for people who are struggling today is that you are not alone,” Raybuck said.

“We are all experiencing some level of challenge as a result of (the coronavirus pandemic), and clearly some of us are suffering more than others, but the most important thing to know is that there are resources and people who care,” he said. “As traumatic as this is, (the pandemic) is a temporary problem that we can get through.”

The spate of deaths cannot necessarily be attributed to the coronavirus, although Raybuck said the stress and fear roused by the virus and its economic impacts may have played a role. 

Some of the suicides, he said, had other precipitating factors, such as drug use, addiction, depression, relationship conflicts or financial failures.

“I don’t think that COVID-19 was the reason why these people decided to take their lives,” said Kauai County Councilman Mason Chock, who is involved in suicide prevention initiatives on the island. “But it certainly could have been the breaking point for them.”

Suicides Increased During Last Decade

In Hawaii, one person dies by suicide every two days. That translates to an average of 190 suicides among Hawaii residents each year. Another nine non-residents die from suicide in the islands annually.

Over the past decade the number of suicides in the state has increased, following a national trend.

This does not take into account attempted suicides, which are also on the rise. For every suicide in Hawaii there is an average of four or five non-fatal attempts, according to data from the Hawaii Department of Health.

Hawaii had the highest attempted suicide rate in the country in 2017 for youth ages 10 to 24.

All told, 843 people are treated in Hawaii hospitals on average each year after making a non-fatal suicide attempt, according to state data. This number is conservative since it does not include people with a preexisting mental health or addiction diagnosis associated with inflicting self-harm.

On Kauai, there is an average of one suicide every 30 days. The recent spike in cases during a single week is highly unusual.

“To have four (suicides) in seven days there is extraordinary,” said Daniel Galanis, an epidemiologist at the state health department.

But Galanis also cautioned about making any assumptions about the cause behind the rash of deaths.

“We’ve seen ‘spikes’ that as time goes by appear to have been nothing more than rare, unassociated events that happened to be in quick succession,” he said in an email. “In other words, what is essentially random can sometimes appear to be a trend.”

Elsewhere in the state, suicides do not appear to be on the rise. But real-time data on suicide is difficult to ascertain in part because it can take up to three months to determine a cause of death when a toxicology report is required.

It’s also not always clear when a death is a suicide.

For every 10 suicides on Kauai, Galanis said there is approximately one death that’s ruled to be of “undetermined intent.”

With an average of 16 suicide deaths per year, Kauai has the highest suicide rate per capita among the state’s counties, although Galanis said all neighbor island residents have a comparable risk of dying by suicide.

The suicide rate is lower on Oahu. This is consistent with higher suicide rates in more rural populations in other states.

Kauai’s annual suicide count has varied over the last five years from 11 suicides in 2019 to 25 suicides in 2017.

Raybuck said it’s not known why there was such a striking rise in suicides on the island in 2017.

So far this year there have been five suicides on Kauai, which has a population of 72,000, with one occurring in February before the May cluster.

Virus Complicates Crisis Prevention

The loss of four young men on Kauai is bringing to light some painful facts.

One in 11 youths between the ages of 15 to 24 attempt suicide every year on Kauai, according to the 2018 Kauai Youth Report. 

The survey also found that 28% of high school students reported feeling sad and worthless for at least two weeks at a time.

This disturbing data galvanized community leaders in early 2019 to form the Kauai Resilience Project to bolster the ability of the island’s young people to overcome adversity and build positive, purposeful lives.

Chock is leading the initiative’s charge, which includes suicide prevention and promoting financial literacy, career development, coping skills, social-emotional tools and mental health awareness. 

The project is trying to establish more safe and fun places for youth to gather on evenings and weekends. It’s also working to remove barriers, such as tuition, fees and transportation, that prevent kids from participating in after-school programs, sports and other extra-curricular activities.

A scarcity of psychiatric resources on the island is a problem, Chock said. But so is the reality that many people who are struggling with suicidal thoughts and other mental health issues do not reach out for help and are, in fact, resistant to it.

So the project’s community action plan has set out to grow authentic support systems for youth within their existing networks.

“We’re trying to get inside people’s living rooms,” Chock said.

The group has a campaign that asks families to turn off the TV, put down the phones and share more meals together. And it calls on participation from school principals and counselors, faith leaders and local business owners.

“We know that this is somewhat of a cultural issue,” Chock said. “There’s shame to ask for help, especially for young men who are already affected by the realities of the economy and the high cost of living and not being able to provide for their family or their kids.” 

“It’s a constant battle for most people,” Chock added. “So how do we get people to say hello to each other, to support each other, to be a little bit more of a shining light for each other on a more consistent basis?”

Adjusting Psychiatric Practices

The task is further complicated by social distancing.

Belgica Heredia, cofounder of the grassroots Kauai Mental Health Advocates, said her organization is trying to reprogram itself as a hub for virtual outreach and resources. It’s a big shift for a suicide prevention group known for hosting frank community discussions and healing arts events.

“This is really bad and I fear it’s going to get worse,” said Heredia, who is a nurse. “It’s like you’re watching it happen and you feel like your hands are tied because you can’t physically reach out to folks.

“Nothing beats one-on-one, face-to-face interaction. But we are trying to get wise to Zoom and some of these other tools that will have to be our new lifeblood now.”

Psychiatrists and psychologists across Hawaii have also adjusted their practices during the pandemic, adopting telemedicine to accommodate the growing needs of patients.

Medicare and Medicaid have temporarily relaxed the rules around telehealth coverage to allow patients and health care providers to connect remotely from their homes. This means that even new patients can virtually meet with a mental health professional using a computer, phone or tablet.

Numerous mental health professionals in Hawaii have reported that they are increasing prescription drug doses or seeing patients more often due to the enormous stress, anxiety and depression people are feeling over pandemic-related financial grief or isolation.

“This is something that I think, when the pandemic first surfaced here, was anticipated by the mental health community,” said Franci Davila, a social worker and cofounder of Kauai Mental Health Advocates.

Breaking The Silence

Five years ago Aaron Hoff founded the Keala Foundation, a nonprofit that provides hundreds of Kauai youth with free programs, including workouts, competitive athletic events, meals and mentorship. 

Now the organization is moving online to reach people who are sequestered at home and feeling desperate. 

Hoff has a new, free online class where kids can get sports coaching and life skills development from professional athletes and local role models. He also has a podcast called Coconut Wireless that blends stories of fitness and mental wellness. The newest episode addresses Kauai’s recent suicide cluster.

A Kauai native who said he has been sober for more than two decades, Hoff attempted suicide years ago. When he figured out how to cope with his anxiety and depression, he started sharing what he’d learned with his friends who were facing similar internal battles.

“How do we get people to say hello to each other, to support each other, to be a little bit more of a shining light for each other?” — Kauai Councilman Mason Chock

“I kind of became the guy that people call,” said Hoff, who has used his home as an unofficial halfway house for years.  

Hoff said one of his friends who attempted suicide during the pandemic is now staying with him and getting help.

“I still struggle with depression,” Hoff said. “But I have an army of people around me and friends I can call to talk about it and then it doesn’t gain any momentum.”

“The thing is, strength comes with being able to communicate,” he added. 

Kauai’s police chief urged residents to stay vigilant for signs of crisis in loved ones. 

“Do everything you can to intervene,” Raybuck said. “If that means calling the police and getting them on a mental hold, if that means calling a pastor or a friend, if that means trying to remove anything that they could potentially get their hands on to hurt themselves, then do whatever it takes.”

He also encouraged family and friends of the young men who died to seek help as they grieve.