This “parent night,” on a recent quiet Thursday evening at Mililani High School, appeared unremarkable at first glance, with dozens of parents and educators gathering at dusk in the school library for an informational presentation.

But the topic was as unusual, and uncomfortable for some, as it was crucial: “Suicide Prevention 101: Promoting Hope, Help, and Healing for Our Families.”

Mililani’s schools, like many schools across the U.S., are working to stem an alarming nationwide rise in mental health difficulties among students since at least 2009, made worse by the tension and isolation of the COVID-19 pandemic.

The seven-campus Mili­lani school complex is one of the first in Hawaii to offer suicide prevention education complexwide not only as required to educators, but also to both parents and older students, following a 2019 legislative initiative to address factors that could lead to suicide among Hawaii’s youth.

“There has definitely been increased need and concerns with youth mental health overall for the state,” said Jeanelle Sugimoto- Matsuda, a University of Hawaii associate professor in public health and a steering committee member and immediate past chair of the Prevent Suicide Hawai‘i Statewide Taskforce.

While Hawaii deaths by suicide during the pandemic have not spiked the way they have in other states, Sugimoto-Matsuda said, the prevalence of anxiety and depression here has increased. “We have heard this anecdotally as well, such as from our mental health provider partners, who say they’re busier than ever,” she said.

For the Mililani schools a major reason for the extra education efforts is that “there’s been a lot of loss,” said Korene Horibata, a school renewal specialist and suicide prevention trainer for the Mililani complex.

Horibata said she did not have specific numbers for the Mililani community on youth suicides or other mental health issues, but said the wave is unprecedented. “It’s definitely unique, this increase now in youth reporting increases in anxiety and depression types of symptoms. It’s been much higher than it has been … and so we thought it might be good to start giving our families more information so they they immediately know (what to do) in those crisis moments.”

Started before COVID-19

Mental health experts nationwide have been sounding the alarm on worsening youth mental health from well before the COVID-19 pandemic began.

The CDC’s “Youth Risk Behavior Surveillance Data Summary & Trends Report: 2009-2019” found that more than 1 in every 3 high school students had experienced persistent feelings of sadness or hopelessness in 2019 — a 40% increase since 2009. In 2019 approximately 1 in 6 youth reported making a suicide plan in the past year, a 44% increase since 2009.

Then came the pandemic, with its disruptions to schooling and relationships, stresses on and within the family, and societal tensions and conflict.

The CDC’s first nationally representative survey of high school students during the pandemic, released in March, found that in 2021, 37% of high school students reported they experienced poor mental health during the pandemic, and the percentage of those reporting persistent feelings of sadness or hopelessness in the past year ramped up to 44%.

In addition, 55% reported they experienced emotional abuse by a parent or other adult in the home, 11% experienced physical abuse by a parent or other adult in the home and 29% reported a parent or other adult in their home lost a job.

The American Academy of Pediatrics in 2021 declared a state of emergency regarding child and adolescent mental health. In December 2021, U.S. Surgeon General Dr. Vivek H. Murthy also warned of a mental health crisis among youth, and he has made youth mental health one of his five priority areas.

Horibata thinks young people’s increased reliance on cellphones and computers for socializing, schooling and entertainment, especially during the pandemic, has made things even worse. Contrary to popular belief, hours of screen time ultimately can leave people feeling less connected, she said.

“Even if you’re chatting online with people, you’re not in the same space as people, and it’s very different,” she said. “That’s not real connecting, that’s not growing, that’s not reading people’s emotional responses, as when you’re having a conversation (in person). And so that kind of lack of practice and lack of exposure can be very isolating.”

Leading cause of death

Suicide is the leading cause of death for Hawaii youth between the ages of 15 and 24, and the fourth- leading cause of death for children between the ages of 10 and 14, says a 2022 Hawaii legislative report.

In Hawaii there were 46 suicides between 2017 and 2021 among Hawaii residents 10 to 19 years old, according to state Department of Health data. That far surpassed traffic crashes (24 deaths), cancer (23) and unintentional drug poisonings (12) for that period.

One person of any age dies by suicide in Hawaii every 2 days, and for every person who dies by suicide, 30 others make an attempt, according to a 2018 legislative report by the Prevent Suicide Hawai‘i Statewide Taskforce.

“Every suicide attempt and death affects countless other individuals, having a profound impact on families and communities across the State of Hawai‘i,” the report said. “And yet, suicide continues to be met with silence and shame.”

Hawaii Act 270, enacted by the state Legislature in 2019, requires the state Department of Education to work with the Department of Health to develop a mandatory youth suicide awareness and prevention training program for certain school leaders, and a model risk referral protocol for schools. The act specifies that teachers, teacher assistants, administrators and counselors be trained in suicide awareness and prevention.

Requests to the state Department of Education for an interview were not granted. However, DOE Communications Director Nanea Kalani said in an email that “supporting students who are experiencing trauma and dealing with crises is a high priority for the department.”

The state DOE has a dedicated crisis prevention educational specialist who assists complex areas and schools with safety care training, suicide prevention training and bullying prevention, Kalani said. Each of the 15 complex areas also has a liaison to coordinate such issues as training, safe messaging and protocols.

Sugimoto-Matsuda hopes student lessons also will be mandated eventually. “But our law is definitely a good start,” she said. “We are one of the few states in the U.S. that have such legislation, and we occasionally get inquires from other states asking how we are implementing things.”

Normalize seeking help

In the Mililani complex’s employee trainings, parent meetings and student lessons, Horibata said, the goal has been to “normalize help-seeking” and fight the “I got this” mindset of going it alone when it comes to mental health.

The Mililani complex of schools — Mililani High and Mililani Middle; and Mililani Ike, Mililani Mauka, Mililani Uka, Mililani Waena and Kipapa elementary schools — has held two complexwide parent nights on suicide prevention, Horibata said.

A brief student lesson on suicide prevention and mental health resources was given to Mililani High School seniors in November. Similar lessons will come in the third quarter for Mililani juniors, then in the fourth quarter, sophomores and freshmen. Families may choose for their students to opt out, but few do.

The Mililani schools also are finding other ways to support overall mental and emotional health, through positive messages, programs and activities. The Leilehua-Mililani-Waialua complex area also has launched LMW Cares, a mental health support program, labeled with an acronym for the school names.

One reason the Mililani complex has been able go beyond the law’s basic requirements is the synergy of having Horibata and her husband, Jarrett Horibata, a clinical psychologist in private practice who also is a DOE employee, working together to facilitate content and training.

During the Mililani parent night in November, the two presented an audience of about 40 parents and educators with a video slide presentation covering suicide warning signs, do’s and don’ts when talking with someone who may be in crisis or suicidal, and supportive community resources (see accompanying information list).

Some of the key messages in the slide presentation for parents:

>> Most people who die by suicide communicate their plans in advance and/or show warning signs. Take immediate action if a person threatens, or talks or writes about, suicide.

>> Causes for concern also include major changes in behavior, such as difficulty at work or school, neglect of self-care and grooming, withdrawal from activities, mood swings and substance use.

>> “Connect and ask.” Gently asking questions like “Are you thinking about killing yourself?” does not cause someone to become suicidal, Horibata said; it opens the door for discussion and help.

>> Do listen, take the person’s feelings seriously, stay calm and offer a message of hope, such as “I can help you to get support.” Don’t overreact. Also don’t minimize the feelings of a person at risk. “Now is not the time to solve all their problems. Now is the time to keep them safe,” the presentation said.

>> “Suicide is a complex problem, but we can do something about it.”

Mililani seniors got an abbreviated version of similar information.

Horibata said she hopes the community can “come to a place where it is very normal and comfortable, where we openly talk about mental health needs” with the same openness that people discuss physical health needs.

“We’re so open to talk about, ‘I need to exercise,’ or ‘Don’t eat your chips near me — I just diagnosed with diabetes,’” Horibata said. “We won’t say, ‘Hey, I’m struggling with something. I’m really having a tough time. Would you mind sitting with me for a little bit?’ … We won’t talk about suicide, mental illness and needing that kind of support. If that’s something that we could get to as a community, that would be a really, really good start.”

HOW TO GET HELP

If you or someone you know needs support for mental health issues, suicidal thoughts, substance abuse or other crises, many people and organizations want to help. They include the resources listed below, which are free and available 24 hours a day, seven days a week:

NATIONAL SUICIDE & CRISIS LIFELINE

>> Call, text or chat 988.

>> Online: National network of local crisis centers providing free and confidential emotional support to people in suicidal crisis or emotional distress; 988lifeline.org

HAWAI‘I CARES

>> Oahu: 808-832-3100

>> Neighbor islands: 800-753-6879

>> Online: Local team of professionals available for mental health and substance use support; a partnership between the state Department of Health and community-based mental health and substance abuse serv­ice providers statewide; hicares.hawaii.gov

CRISIS TEXT LINE

>> Text ALOHA to 741-741

>> Text-based mental health support and crisis intervention provided by a community of trained volunteers; crisistextline.org