A CHILD dies by their own hand each and every week in Australia.
It is a tragic issue that weighs on the minds of children and teenagers, their families and all those who try to help in the biggest and smallest communities of the nation.
Evidence gathered in a year-long examination of the issue by National Children's Commissioner Megan Mitchell indicates that the isolation and complex relationships in regional and rural Australia could be key factors in a suicide rate that is, in some cases, double that of capital cities.
"The first time I cut myself was around aged 10. I drank bleach and used a cutter to cut my wrist and arm," one young person told the inquiry.
Another spoke of how, since she was 14 years old, she hid the evidence of self-harm with "long sleeves and/or cosmetics".
"Even though I'm now open about the fact I have a mental illness amongst friends, only my husband and clinicians are aware of my history of self harm. It's the most shameful part of my experience with mental illness," she said.
These are just two of the more than 130 personal stories and expert submissions gathered as part of the inquiry headed by Ms Mitchell.
The inquiry findings were reported to parliament in October.
Using previously unavailable statistics and crucial data from the Kids Helpline, Ms Mitchell said the inquiry confirmed that "we know much less than we should" about youth suicide and child self harm.
Ms Mitchell said the lack of understanding is preventing the nation from providing "the right support to children and young people at the right time".
Ms Mitchell said ABS figures confirm that suicide remains the leading cause of death of young Australians, but statistics show the rate has almost plateaued in recent years with 324 deaths in 2012 of young people aged 15 to 24.
But while the rate of suicides has levelled off, the rate of self harm among young Australians has rocketed.
Ms Mitchell said data indicated a 657% rise in self harm and suicidal behaviour as children grow from being 12-13 years old to 14-15 years.
"It's definitely trending upwards," Ms Mitchell said.
"While we know of thousands of cases, there are many, many thousands of cases of self harm we don't know about," Ms Mitchell said.
Among the factors increasing the risk of self harm and suicide are known social problems including domestic violence, substance abuse within the family, mental illness, poverty, bullying and body image concerns.
Ms Mitchell said the top "co-presenting concerns" of young people who were self harming or considering suicide was emotional distress.
Children often feel "overwhelmed, angry and lonely" and do not have the skills to deal with the "intense feelings you have as an adolescent", she said.
Lismore paediatrician Chris Ingall said self harm was quite common among young people in the region.
Chair of the Lismore-based Headspace facility, Dr Ingall said children commonly presented suffering from "cutting, overdose or both".
The national inquiry was not able to get definitive data on child self harm and suicide in regional and remote areas but Ms Mitchell said numerous submissions highlighted the scope of the problem outside the capitals.
"The fact we're not making in-roads to the suicide rate and the fact that younger and younger kids are taking their lives or self harming, it's extremely worrying," she said.
Ms Mitchell called for a national research agenda to better understand the problem, declaring it must been understood before it can be addressed.
"We really need as adults to be aware of how these things can come about," she said.
Ms Mitchell also suggested staff at first-response places, like hospital emergency departments, be better trained to be able to deal with self harm.
Ms Mitchell said there were numerous services available to help those in need but said the best treatment begins at home and in the schoolyard, saying its "absolutely vital" parents, friends, teachers and coaches stay connected to the children.
"Make sure they feel respected and let them know they won't be judged," she said.
"Sometimes an adolescent shrug can be just a feature of their age but other times there might be something more going on.
"We need to see the warning signs, it's just really important to keep checking in."
Ms Mitchell said it was also important for families to remain connected during the holidays.
"It could be a tough time if you've had a death in the family, or the child is in a separated family and it's stressful anyway. Add to that the consumption of alcohol and children are often the ones caught in the middle," she said.
"Holidays are a time when you really need to be attuned to young people, there are less protective factors around and everyone should be talking to their children even more."
If you or someone you know needs help, call Kids Helpline on 1800 551 800, Lifeline on 13 11 14, Headspace on 1800 650 890, beyondblue on 1300 224 636 or Suicide Call Back Service on 1300 659 467.