A new national analysis of data collected from people seeking help with their mental health during the COVID-19 pandemic ranks Hawaii as having the highest percentage of survey participants who reported thinking about or planning suicide.

Hawaii also had the fifth-highest proportion who reported thinking about suicide or self-harm at least four days a week, according to a report by Mental Health America.

The findings are based on data collected from nearly three-quarters of a million people who volunteered to take an online depression screening aimed at discovering mental health hotspots across the country.

The data represents only a portion of people at risk for suicide, according to the report. That’s because for every person who opted to take the mental health screen online, there are others who are struggling but did not participate.

“As the nation strives to mitigate the public health crisis introduced by COVID-19,” the report reads, “there is even more responsibility to ensure a fast and coordinated response to address these mental health concerns, so we are not left with a mental health crisis long after the virus itself is under control.”

Bryan Talisayan, executive director of Mental Health America of Hawaii, said the large percentage of people in Hawaii who reported feeling suicidal is a clear indicator that the state needs to double down on suicide prevention efforts.

“Given the year that we’ve had, absolutely we’ve been noticing an increase in people feeling helpless or hopeless, an increase in people feeling anxiety and depression — people of all ages,” Talisayan said.

All told, 71% of participants in the depression screening said they were female. More than 40% were ages 11 to 17. And while half of the respondents identified as white, people who took the depression screening were more diverse than the general U.S. population.

Consistent with early findings of increased mental health concerns among Asians in 2020, 19% of people who took the depression screening identified as Asian or Pacific Islander, whereas those groups together represent only 6% of the U.S. population. 

“One thing that’s important to be aware of is these people who took the health screening are people who are reaching out and looking for help,” Talisayan said. “So they may be more likely to have depression or thoughts (about suicide) than the general population.”

Last March, the pandemic forced Mental Health America of Hawaii to temporarily halt its youth suicide prevention training for middle school and high school students.

After a seven-month hiatus, it launched a virtual version of the youth suicide prevention training in mid-October.

One benefit of adapting the suicide prevention curriculum to the internet is that some people are more comfortable opening up about their feelings from behind a computer screen, according to Talisayan.

But, overall, he said students have been less engaged online.

Due to pandemic disruptions, 2,093 students and teachers in Hawaii participated in the youth suicide prevention training in 2020, down from an annual average of about 5,000.

Talisayan said the nonprofit wants to go back to in-person trainings but is waiting for guidance on classroom visitors from the Hawaii Department of Education.

Data Shows There Was No Pandemic-Related Suicide Spike In Hawaii

Although mental health experts in Hawaii have raised alarm about the impact of coronavirus-related shutdowns, a report published by the Hawaii Department of Health in February found that none of these alarming trends translated to an increase in suicide deaths in 2020.

There were 124 documented suicides in Hawaii during the pandemic period of April to December 2020, according to preliminary mortality data.

That compares to an average of 150 suicides in the same nine-month period from 2015 to 2019 and an average of 138 suicides in the comparable period from 2010 to 2014, state officials said.

The data, however, is likely incomplete because it’s not always clear when a death is a suicide. About one of every nine suicides in Hawaii is ruled to be of “undetermined intent.”

The report also does not take into account attempted suicides. For every suicide in Hawaii, there are four or five attempts, according to data from state health regulators.

Talisayan said he is surprised by the slight decrease in documented suicides in Hawaii during a year of not only coronavirus lockdowns, but also so much social and political unrest.

The state’s lower suicide count, he said, might reflect the increased availability of mental health resources through telehealth and a growing acceptance of candid conversations about mental health.

But he said stigma and shame are still pervasive barriers for many people to get the help they need.

“It’s never been like this where you have the governor or the lieutenant governor at a press conference saying, ‘Take care of your mental health,’” Talisyan said. “I think the key is to keep that conversation going.”

“I think it’s a little bit harder in Hawaii because shame and stigma a lot of times is rooted in culture and we have a lot of cultures in Hawaii where mental health is seen as a little bit taboo to discuss.”