In just four weeks, there have been at least three reported cases of teen suicides in Singapore.
Lim En Han and Krystal Aki Mizoguchi, both 18, and Darryle Tan Guan Wei, 16, all fell to their deaths.
Lim was a bright Hwa Chong Institution student who had been facing relationship problems and difficulties with studies, while Mizoguchi was depressed after bad 'A'-Level results ruined her chances of getting into a local university.
Darryle Tan, a Sec 4 Express student, had been suspended from school for getting into trouble.
While the Institute of Mental Health (IMH) said there are no major differences in the causes for teen suicide compared to previous years, it did point out that teens nowadays are more internet-savvy and have easier access to social media.
For example, based on anecdotal experience, bullies "have become more sophisticated and have taken to cyber-bullying to taunt their victims", said Sivananda Penchaliah, principal educational psychologist at the IMH.
He also noted that most teens also give out tell-tale warning signs to family, teachers or friends ahead of time and that these need to be picked up.
In the case of Mizoguchi, she wrote on her blog about being depressed over her A-level exam results, while for Lim, she had been seeing a psychiatrist and her family had withdrawn her from school in March.
Other psychologists and counselors flag other possible risks of teen suicide and what can be done.
Lifestyle changes that see youth more pampered could be a cause, believed Sheena Jabel, founder and chief executive of NuLife Care and Counselling.
With families keeping to one or two children, parents are more likely to pamper them.
"When the child is about to fall, already the parents are there to hold him. They do not know what is failure. So when they go through grievances they are not able to cope with it," she said.
Other times, pampered teenagers threaten suicide to get their parents to accede to their demands. Jebal recounted a student threatening suicide because his parents did not want him/her to get a tattoo.
In such circumstances, it is difficult for parents to gauge the seriousness of a threat, sometimes until it is too late. Jebal suggested parents go to a counselor - a neutral party - for help.
The effects of these "lifestyle changes" are "more prevalent of late", said Jebal, who has spent 17 years in this sector. "For the past five years, it's become quite bad."
Teen Challenge's executive director Joyce Chan also said family upbringing and learning ability or culture could affect a teen's self-development and subsequently, their emotional resilience with life's pressures.
If they are not given the opportunity to develop themselves, youth will not be equipped with the essential skills to cope, thus contributing to the risk of suicide, she said.
Chan also pointed to times when the media influences teens by portraying suicides as a form of escape. She urged for the media to help destigmatise the topic by providing more information and getting people to talk more openly about it.
Excessive reporting, however, could result in "copy-cat suicides", cautioned counsellors.
Head of Fei Yue Family Service Centre Rachel Lee wondered if the three youths had heard reports of the others' suicide and if it had any impact on them.
Even if they were not influenced by local reports, people are more exposed to what's going on in the world through the Internet, she said, citing reports of group suicides.
What schools, parents, friends can do
The MOE suicide prevention approach, outlined in previous media reports, comprises of three key elements: Building protective factors in students, identifying at-risk students for early support and referring students with complex issues for intervention.
Counsellors want schools to be more open to working with external agencies. They note the effectiveness of school counsellors is limited because students are afraid their sharing will be reported to the school.
The Samaritans of Singapore (SOS) has been calling on schools to adopt a suicide prevention programme to educate students on resources available to them when they feel stressed, depressed or suicidal.
They also help students to look out for their peers and to be aware of where to seek help, said executive director Christine Wong.
"SOS believes in suicide prevention work and has been pro-actively publicizing our school talks/workshops but only a number of schools supported these talks," said Wong.
Schools and counsellors can't work in silos, stressed Jebal.
When dishing out punishments, such as a suspension, schools should work with an external agency to make sure the student still gets tuition outside of school, she added.
Fei Yue's Lee also called for school counsellors to pay more attention to students facing disciplinary action and support them through this "transition". It is also important to keep an eye out for students who don't do well in school and see what support they need, she added.
For parents, Jebal urged them to befriends with their children's good friends, whether or not they approve of the friend. "That person will know most things about your child," she said.
Lee advised parents to "understand new media" since teens may be better at expressing themselves online.
Latest available figures show that suicide rates for those age between 10 and 19 years were at a six-year high in 2009. There were 19 suicides from this age group in 2009, compared to 12 in 2008.
The Ministry of Education, however, reported no changes in suicide figures among primary, secondary and junior college/centralised institute students over the last five years, according to The New Paper.
The rate of incidence among this group has been five to eight suicide cases annually for the last five years.
If you need help, or know someone who needs help, please contact
Singapore Association for Mental Health: 1800-2837019
Sage Counselling Centre: 1800-5555555
Care Corner Mandarin Counselling: 1800-3535800