More youth in Hawaii die from suicide than from traffic accidents or cancer.

Many others feel so down that they consider ending their own lives. But the subject of suicide tends to be hidden — like those desperate thoughts.

Mental Health America of Hawaii is working to intervene early, before people get to the point of despair. The nonprofit is offering free youth suicide and bullying prevention training in public and private schools across Oahu, courtesy of a grant from the City and County of Honolulu.

September is Suicide Prevention Month, and now that the academic year is underway, MHA Hawaii is seeking more sites where it can offer the two-hour program.

Also in the works is a cellphone app called Kokua Life, designed to help youth and adults take better care of themselves, reach out for help and cope with challenges. The app should be available later this year.

“It’s not just for emergencies, it’s not just for when you’re not doing well,” said Mara J. Pike, community outreach manager for MHA. “It’s for when you are OK. It’s about self-care and stress management. Just to be able to get people connected to local agencies, to know that there is information and help out there, is really a big blessing.”

Across the state, nearly 25 percent of middle school students said they had had suicidal thoughts at some point in their lives, and 12.5 percent said they had made a suicide attempt, according to the 2015 Youth Risk Behavior Survey. In high schools 10.5 percent of students reported making a suicide attempt in the last 12 months. The national survey is administered every other year.

“The numbers are high,” said Amanda Martinez, training program coordinator for MHA Hawaii. “Suicidal thoughts are common among youth in Hawaii. With our training, we really want to help youth identify risk factors and warning signs and also to be able to identify ways to cope and ways to help others.

“If they do encounter a situation where a friend comes to them who might be having suicidal thoughts, they know who they can go to for help.”

The training is usually offered over two class periods, one on bullying prevention and the other on suicide prevention. The evidence-based curriculum, created by MHA Hawaii, incorporates the experiences and perspectives of local youth.

“This is specifically for middle and high school-age students,” Pike said. “We do a pre- and post-test. With the feedback we get, we know they appreciate being able to have these conversations and they appreciate having the information.”

She said it’s important to help youth open up about what’s going on in their lives and let them know where to get help.

“It’s OK to speak up if you’re not OK,” Pike said. “There is a lot of pressure, we hear from youth themselves, that they are supposed to be able to figure things out on their own.”

Suicide is the leading cause of death among youth ages 10 to 19 in Hawaii, according to Daniel Galanis, epidemiologist for the Department of Health’s Emergency Medical Services and Injury Prevention System Branch. From 2012 through 2016 there were 47 suicides, 46 traffic deaths, 25 cancer deaths and 11 drownings for that age group.

Hawaii’s youth suicide rate is slightly below the national average and ranks 29th highest among the states, although suicidal thoughts are more frequent here, Galanis said.

For every death by suicide in Hawaii, another six youth were hospitalized and 19 others were treated in emergency rooms for nonfatal self-inflicted injuries each year, he said.

Miki Nishizawa, a University of Hawaii-Manoa student, helps advise the Youth for Safety Club at her alma mater, Waipahu High School, and also serves on the state’s Youth Leadership Council on Suicide Prevention.

“When you think of suicide prevention, it seems pretty straightforward,” Nishizawa said. “But when it comes to actually putting it into practice, into action, it’s very hard.”

She added, “School is supposed to prepare you for real life and real situations. We should have some kind of preparation or training for the dangers or risks that we might be open to. I hope more early education will be implemented in school.”