HONOLULU(KHON2) — Someone dies from suicide almost every day in Hawaii. Experts said the pandemic has been especially hard on children and their mental health with one in four middle school students having suicidal thoughts.

The Starr family talks about how suicide impacted their family and an expert shares important information for parents.

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Sienna Starr was like most 12-year-olds. She loved art, gymnastics and drawing. She was energetic and fun-loving — a joy to her family.

Yet on July 1, 2019, she took her own life.

Her family was heartbroken.

Her father, Chad Starr said telling her siblings she was gone was devastating.

“That was definitely one of the most challenging times of my life,” he said as he wiped tears from his eyes. “Having to say that to them and having to accept that.”

“It’s been almost three years and we’ve replayed this in our head a thousand times and we truly saw nothing at all and that’s what so, to me, that’s what’s so scary about this,” said Starr.

Starr has made it his mission to help other families and spread awareness about suicide.

He recently completed a 131-mile walk around Oahu and is creating the Sienna Starr Foundation.

“I want to use my pain and suffering to try to make sure that no other parent has to go through that and do everything that I can to prevent that from happening,” said Chad Starr.

The Starr family is not alone.

According to the state health department, from 2016 to 2020, suicide was the fourth leading cause of fatal injury for children 15 and under.

Amanda Martinez, the training program manager at Mental Health America of Hawaii, said the pandemic made things worse, particularly for kids.

“When the pandemic first kind of hit, students went on spring break, and then they never went back to school. It was very sudden,” Martinez explained. “So there’s a huge disruption in schedules and routines in being able to interact with friends, peers, classmates, friends, or family members, right, other supportive adults.”

Martinez said the pressures of coping with uncertainty, adjusting to distance learning and ever-changing safety precautions while developing physically, mentally and emotionally are causing increases in anxiety, depression and substance abuse in kids and teens.

But she said, there are early warning signs, parents can look out for.

If kids are suddenly having difficulty at school, if they’re withdrawing from friends or stop doing activities they once enjoyed — sudden mood swings, changes in behavior or changes in sleep patterns, and substance abuse can all be early signs.

According to Martinez, there are other signs that are definite red flags that require more urgent attention.

“When we want to take immediate action is anyone who is talking about writing about, posting about death, dying, or suicide, whether it’s in verbal conversations in written form — so maybe on homework assignments or journal assignments, or even on social media.”

If you see that, she said you should contact a mental health professional as quickly as possible.

And if a child isn’t willing to open up, Martinez said, don’t force them to comply or threaten them. But don’t give up either.

“Let them know that they’re not alone. Be patient, we want to build that sense of trust, keep those lines of communication open, offer that consistent emotional support and check in every once in a while,” said Martinez.

Martinez said using “I” statements is helpful in guiding conversations:

“Just using those “I” statements like, ‘I care about you. I love you. I noticed that you haven’t really been acting like yourself recently. Is there anything that you’d like to talk about?’ Like no judgments — ‘I just want to be the listening ear for you.’ And ‘I see you and there’s help out there.’ And ‘I can help you find that help.'”

The most important thing to do is be consistent and offer them choices and options.

“Give your kids, our youth, their own sense of agency, that they can choose which path they think is going to work for them,” Martinez added.

And never give up hope.

“We think that no one cares, we think that we’re all alone,” Starr said. “So I think it’s important to tell people all the time, every day — it doesn’t cost anything to tell someone — that they’re special to you or that you love them.”

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Resources for parents and children: