BRAINERD, Minn.-It could be said no one wants to live more than a victim of suicide.

Paradoxical? Maybe. But, subtle distinction as it may be, it's a misconception suicidal people just want to end their own biological existences, said Jack Hinrichs, a licensed therapist based in New Brighton and the director of training and development at Nystrom & Associates LTD.

At a fundamental level, suicide is about relieving psychological pain, he noted, and relief can be found in other ways. When given the right support and care, more often than not, people choose life.

However, teenagers still take their own lives-some despite having a supportive home and seemingly every resource provided to them, Brainerd High School Principal Andrea Rusk said. It is these cases that highlight the complexity of mental health and the urgent conversations needed regarding it-whether among school administrators, at the dinner table between family members or within the community at large.

"Our great challenge is to figure out how to help kids develop strategies to deal with the mental health issues," Rusk said. "They can go to a doctor and some of them receive medication and that may help, some of them go to therapy and that may help, but in general how do we help them develop the strategies to deal with mental health issues?"

The predicament of youth

Teenagers are particularly vulnerable. Reports of mental illnesses commonly associated with suicidal ideation, such as clinical depression and anxiety disorders, increased by 33 percent nationwide among teenagers between 2010-15, according to a study published by Clinical Psychology Science in November.

Within the Brainerd School District, caretakers and teachers are seeing more and more of these mental health issues among students, Director of Special Education Heidi Hahn said, and these conditions are manifesting at younger ages, among middle school and even primary-level children.

As a result, suicide ranks as the second leading cause of death among 13-18 year olds, or typical high school ages-and the phenomenon, in line with the mental illnesses that catalyze it, is worsening among adolescents. Between 2010-15, the number of suicide attempts by teenagers rose by 31 percent.

This can stem from a number of causes, Hinrichs said, many of them unique and endemic to people between the ages of 13-18:

• A common myth is teenagers display suicidal behaviors or attempt to end their own lives because they're looking for attention, Hinrichs said, which can lead people to delegitimize their struggles and pass it off as petty or self-serving. To the contrary, self-destructive behaviors-such as self-harming, self-sabotaging actions or suicidal gestures-point to a host of overwhelming psychological issues and deep emotional distress.

• Teenagers often lack the experiences necessary to anchor their emotions during periods of upheaval or emotional distress. As Brainerd High School Resource Officer Troy Schreifels noted in a separate interview, "For these kids, they haven't gone through some of these life experiences and forever isn't forever yet."

• As a result of physical development, teenagers are prone to hormonal and emotional swings-this, Hinrich said, is tied in with impulsivity as well. Suicide, at its core, is an impulsive act. The vast majority of people who survive attempts or receive proper counseling do not return to extreme self-destructive behaviors.

• Likewise, as a result of early development in the frontal lobe of the brain-which controls executive functions-teenagers may lack the judgment skills to properly address their own life circumstances, or their own mental health and the factors that undermine it.

Young people are likely to deal in absolutes, even with with their own mental health, Hinrichs said. This rigid mindset doesn't always cope well with the tumultuous changes of adolescence.

"A lot of kids and adolescents are black or white in their thinking," Hinrichs said during a phone interview. "All or nothing. Some of them are just more rigid than others in their thinking. And that's some of the things we cue into as therapists and have to work with, especially when it comes to suicide."

This rigid mindset and absolutes often manifest as certain phrases, Hinrichs added-"I am damaged goods," "My family would be better off without me," or "Nobody cares about me," phrases that can sometimes seem casual in nature, but are indicative of critical psychological distress.

In keeping with their delicate stage of development, Hinrichs said he always advises teenagers to avoid mind-altering substances, such as alcohol or cannabis, that can adversely affect short-term behavior or damage long-term cognitive growth.

While the stereotype of an at-risk child is one who's bullied, socially isolated and/or living in a dysfunctional home, individuals struggling with these issues commonly come from another group: perfectionists. The ever-driving pursuit of perfection can be rarely fulfilling and the difficult standards these people hold themselves to can be unforgiving. Often, Hinrichs said, it's the illusion of a well-adjusted, put-together life that masks complexes as crippling as a traumatic past.

Males, females

While it's difficult to say whether males or females suffer from depression and suicidal ideation more, statistically teenage boys are three to four times more likely to take their own lives than girls-largely a result of traditional values of masculinity, which place a hollowed status on self-sufficiency, stoicism and toughness, often to the detriment of the boys themselves, Hinrichs said.

Rusk echoed this sentiment, noting suicides among freshman and sophomore boys are more common than other high school groups, per her observation.

However, there are shifting social mores on what's acceptable, said Hinrichs, a 26-year veteran of mental health care, who noted more than 50 percent of his clients are now male.

At the same time, teenage girls made three times the attempts of teenage boys, even though they're less likely to succeed than boys. Teenage girls are more likely to pursue "suicide gestures," Hinrichs said, or reckless acts of self-harm that aren't intended to go all the way, but serve as a cry for help.

Sparking the conversation

Multiple students at Brainerd High School said none of the counselors from outside sources are pervasively known within the student body and there isn't a face to pin on the mental health services available to them.

"If my friends were feeling that way, I would want them to open up to me, so I would want to be educated so I can help them," said Emma Peterson, a junior and the vice president of student council. She added extending education on mental health issues beyond brief forays into the subject during freshman year would help mitigate the problem.

Noah Sundberg, a junior at Brainerd High School, said the issue of suicide and mental health care flares up after a suicide, but subsequently dies down without real progress being made because the overarching conversation is shallow and uninformed.

"It's a subject that we don't know a lot about. It's talked about for about a week and a half, two weeks after-like everything that happens, it works for a little bit, we talk about it and we get our feelings out there," Sundberg said. "But after that three- to four-week mark it dies down as a heavy conversation and there's definitely a long-term stigma."

As a result of this stigma, it's difficult to speak candidly about issues of mental illness, depression or suicide-whether it's between students on a face-to-face basis, or the discourse by the community at large. Direct, sincere conversations are what's lacking most in the community's response, Sundberg said. By coming together and being open and sincere, solutions will start to present themselves.

"People overthink what the right thing to say is. I think there's a lack of education piece to it," Sundberg said. "We don't have meetings in the cafeteria or the gym where we have adults tell us about the warning signs and what to do and ways that kids with depression ask for help."

When discussing strategies for therapy, Hinrichs noted direct questions and forthright conversations specifying mental health are often the best way to get through to people in difficult straits-even some who try to shield others from their struggles by being withdrawn and uncommunicative.

Mind over matter

Hinrichs said the interconnected issues of depression, anxiety and suicide, all key aspects of the larger conversation of mental health, are starting to come into the light and progress is being made-though, he noted, rural areas in greater Minnesota are lagging behind. More than a lack of resources or access, the stigma of mental health poses as a pressing concern.

Ultimately, the most significant issue barring progress for mental health in many areas is, itself, a mindset, Hinrichs said, and until people take it seriously, these issues only look to get worse before they get better.

"My guess is that it's going to get worse until we focus on it enough and put enough practical things in place, pay enough attention to it, in order to curb the tide and start bringing it around the other way," Hinrichs said. "It's certainly doable. I'm pretty optimistic that it will happen. But, there's still a lot of work to be done for that to happen."

In the meantime, students are reaching out and making an effort to engage each other in a meaningful way, direct way. With recent events still fresh and painful to remember, students at Brainerd High School are considering the needs of everyone-even those who may seem the brightest and happiest among their peers, senior Tim Whiteman said.

"You have to think of everyone as a whole, not just the people you'd stereotypically think, 'That's the person who might be suffering, having a hard time,'" Whiteman said. "You gotta ask everybody. You have to pay attention to who's struggling. You gotta talk to your friends. You gotta really ask them-like 'How are you doing?'-and care."

Get help

If in a crisis or in need of help-or know of someone who is-call the Crisis Line and Referral Services at 218-828-HELP (4357) or 800-462-5525. The Crisis Line is answered by local, trained volunteers 24 hours a day. It is a free, anonymous and confidential service.

Help is also available through texting. People who text MN to 741741 will be connected with a trained counselor who will help defuse the crisis and connect the texter to local resources. The service helps people contemplating suicide and facing mental health issues.