There’s a lot more bound up in the "Merry Christmas!" greeting we toss off than many people know, says Marya Grambs, executive director of Mental Health America of Hawaii.

For some, she noted last week, it’s a reminder of how little their own life resembles that Norman Rockwell kind of image of the holidays.

"We idealize them," she said. "We all do, and then we think, ‘Oh, no, my family’s kind of small … ‘ and it can never live up to those idealized expectations."

Grambs knows that her agency’s mission is tough year-round. A recent study showed how much: Nearly 18 percent of high school youths have at least made a plan for suicide.

Her agency, formerly known as Mental Health Association in Hawaii, recently received a challenge grant from the Omidyar Ohana Fund of the Hawaii Community Foundation aimed at helping it expand its outreach program to deter youth suicide and bullying.

On an ongoing basis, she likes to keep putting the word out about the state’s mental health Access Program hotline (832-3100, or toll-free for the neighbor islands at 1-800-753-6879).

Grambs has run the agency for seven years, after many more years in previous positions working to prevent family violence. But at 66, Grambs is convinced that her own tough beginnings — more than her resume — gives her street cred with the clients the agency tries to help.

Growing up in a household torn by domestic violence, with a father struggling with alcoholism and mental illness, formed the backdrop to her own acute depression and two suicide attempts: one at age 17, one later when she was newly divorced with a young son.

People need to see that you can come out of such dark places, she said.

"I think mental illness is the most stigmatized illness there is," Grambs said. "And that’s why I think it’s important for any of us who have any issues around mental illness to speak out, to say, ‘Here I am. I’m an ex-mental patient. And I’m doing OK, I survived. I still struggle, but I’m doing OK.’"

QUESTION: What’s your take on why the holidays are so hard on mental health? Or is that a myth?

ANSWER: No, I don’t think it’s a myth.

I think several things happen during the holidays. One is, images are all around us. Big, happy families; big groups of friends, laughing, having wonderful meals.

And what if you’re not like that? What if you’re single? What if you have a tiny family? What if you’ve just moved and don’t know anybody? What if your spouse or your sibling has died?

So you can be surrounded by all this joyfulness and all these joyful images, and you’re not experiencing it and you’re feeling really isolated. It can really trigger a lot of sadness and a lot of depression.

Q: So, the holidays are idealized?

A: Yes … because we idealize them; we all do … I also think some of us may come from really dysfunctional families and in families like that, the holidays are really hard. There’s alcoholism — things get worse during the holidays. So for some of us, the holidays trigger those bad memories. …

Q: Can the holidays sometimes

paper over family problems?

A: Or they can’t. They might cover everything up and tamp it down, or sometimes they can’t and things just explode, because everybody gets so nervous and stressed.

And the third thing is the darkness, the days are shorter and shorter, and that affects a lot of people’s moods.

Q: We don’t have that problem here, right?

A: We do. We have short days. At 6 o’clock in the morning, it’s dark black, and it’s not that way the rest of the year. …

Q: Moving to the issue of teen suicide: How would you characterize Hawaii’s problem?

A: It’s teens who plan suicide or attempt suicide or think seriously of suicide. … You take 18 percent, that’s four in every classroom.

Q: Has anyone tried to analyze why?

A: There’s no factual reason, but we have anecdotal. And one thing is that kids kind of feel there’s no place to go, they can’t escape, because we’re an island, so they’re really hemmed in.

Another thing, interestingly, is we have a lot of ohana, a lot of big families, and sometimes that means if kids tell an auntie something, it just goes everywhere. So there’s not much confidentiality. So that can be hard.

We also have military families, and these are kids moving around all the time, and they’re also kids where parents may be gone, or may be coming back and having a hard time. …

You know, I just saw an interesting study and it hasn’t been replicated. But it said, you know there’s this happiness index? And it rates states on how happy they are, and Hawaii is No. 1, right? Well, what they showed is the states with the highest happiness rates also tend to have very high suicide rates. And the states with the lowest happiness rates have some of the lowest suicide rates.

Q: What does that tell you?

A: Well, the theory — nobody knows — is it’s really hard to be unhappy in a really happy place, where everybody’s supposed to be happy. It’s kind of like that holiday thing. Isn’t that something? Like, New York and New Jersey are the lowest-rated (on the) happiness scale, the most unhappy states, and they’re very, very, very low, at the bottom of suicide rates, too.

So it may be that being sad, to be unhappy, is more acceptable in a place where maybe there are more people who are unhappy.

Q: So you feel more of a norm?

A: More supported, maybe, yeah. Less isolated.

And I think also here there may be cultural reasons that people don’t talk about these things. There’s a lot of "don’t shame the family" we do to

ourselves, and that can be why people don’t talk about when they’re feeling really bad. And if you don’t talk about it, it tends to isolate you more.

Q: What’s this training program Mental Health America of Hawaii is doing as suicide prevention?

A: We’ve trained 10,000 adults and youth in suicide and bullying prevention. … There’s a lot of risk factors.

Risk factors are being in rural communities, being Native Hawaiian, being in a military family, being a foster kid, being an adjudicated kid, but also being LGBT — being a gay kid. Higher rates of bullying, and higher rates of feeling suicidal. …

We train kids, we talk to them about if they see a friend of theirs, here are the signs and symptoms of suicide, and that they can learn to ask their friends, "Are you feeling suicidal?" That it’s really important to ask the question.

And we talk about bullying, the different definitions of bullying, whether it’s physical or emotional or cyber, and what you can do, how you can handle it, can you intervene? And also raise awareness about lesbian and gay kids.

And so we’ve been doing that to kids, and also to teachers, parents,

foster parents, after-school programs, anybody who works with kids, small groups of 30 or 40 kids or adults.

But now it seems that you can’t be the only one who goes around the state doing that. So we’re starting a "train the trainers" program. What we’re going to do is train people so then they can become trainers. We’re going to do it in different communities, so every community will have somebody who knows that community and can train the parents, train the teachers, train the kids, train the counselors, train the probation officers in their community. So it will just multiply.

Q: Does this suggest that we have a shortage of people who can help with this problem?

A: I think suicide is the most tragic public health problem we have in this community, in any community, in our society. Because it’s so much more prevalent than anybody knows.

We have 160 suicides a year in Hawaii. That means every other day, somebody kills themself. And that’s three times more than die in car crashes, and it’s eight times more often than homicides. Nobody knows that. … You would never imagine that.

And it’s because it’s not on the front pages. It’s not on any page. There’s two reasons for that. One is families don’t want it to be in the newspaper; they don’t want it public, they feel ashamed of it. And the other reason is, and it’s a good reason it’s not in there, is that there are such things as copycat suicides. … But we have to do something about this, because we’re in the midst of this horrendous cause of people dying, and nobody knows it. Nobody knows it.

Q: Do you want to talk about your own episode? How long ago was that?

A: Well, there were two. Once when I was 17. I had gone away to college and I had a breakdown. I came back and was hospitalized for a year, in a psychiatric hospital.

Q: What was the diagnosis? Depression?

A: Major depression. And I felt like a failure, because I couldn’t be in college. I felt my life was over. I felt totally hopeless. Totally, excruciatingly hopeless. So the only answer was to die. So I tried to kill myself. And that was the days before there was medication. It took me a year to kind of climb out of that hole, and I had lots and lots of therapy, and lots of help.

Then when I was in my early 30s, a relationship ended, and it plunged me into that same thing. But everybody’s depression is different, and everybody’s suicidal situation is different. What I can tell you about mine was that being alive, it became anguishing. I was just in mental agony. I couldn’t stand to be alive another minute. … I say it was like my brain torturing me. And I was filled with hopelessness, I felt like I would never be any different. I was sure that I would never be any different.

Q: Obviously you got through school because you have a masters degree in clinical psychology. What happened?

A: It took me a long time because I worked and I went to school and I worked and I went to school.

Q: Why did you choose that field?

A: I chose clinical psych because I wanted to understand people’s psyche, and I wanted to help people.