14 years ago, Pua Kaninau-Santos' youngest child, Kaniela, took his own life.
"Kani was 5 days after his 18th birthday," she said. "He was a senior in high school. Two months before his graduation."
September is Suicide Prevention Awareness Month in Hawaii, and the state Department of Health says one age group in particular is disproportionally affected: suicide is the leading cause of fatal injuries for people between 15 and 44 in Hawaii.
It's the ninth leading cause of death in Hawaii, and nearly 900 people committed suicide in Hawaii between 2012-2016.
When those deaths are averaged out, roughly one person dies by suicide every two days in our state. Despite the alarming statistics, suicide might be one of Hawaii's least-talked about public health issues.
"I think it was just a few weeks after Kani died that I said, 'What is this issue,'" said Kaninau-Santos. "Why is it that I didn't hear anything about it from school. Why didn't school send anything home? So I kept questioning the why, why, why of suicide."
Since her son's death, Kaninau-Santos has worked to bring awareness to issue, partnering with the Department of Health and forming an organization to help families scarred by suicide.
Last year, 902 people in Hawaii were treated in a hospital for trying to kill themselves. Jeanelle Sugimoto-Matsuda is a professor at the John A. Burns Medical School and the statewide chair of the "Prevent Suicide Hawaii Task Force."
"The particularly high-risk population within there are young adults who aren't going to college or universities," said Sugimoto-Matsuda. "So for whatever reason, they go straight into the work force, and maybe they're not as connected to an organization or a college that would provide supportive services."
She also says its difficult to pinpoint a single cause for suicide.
"There's always so many complex factors. Of course, mental health issues, that's a big one, but we can't just look at that," said Sugimoto-Matsuda.
She says there's also a stigma, in which people contemplating suicide don't share their feelings and are often afraid of seek help for fear of appearing weak.
"So we need to be the brave ones to actually just reach out and say, 'Hey, I noticed these things, I'm worried about you or I'm concerned," she says.
As for Kaninau-Santos, the spirit of her son lives on in her work. On Saturday at Magic Island, she's helped organize a community walk called 'Out of the Darkness' to get people talking about suicide.
More than 800 people participated in last year's event.For more information, contact Pua Kaninau-Santos at firstname.lastname@example.org or (808) 271-8582.