This story was corrected to reflect Dr. Brenda Butler's proper job title.

While Massachusetts has among the lowest rates of suicide deaths in the United States, their frequency has been increasing in recent years, prompting health and community groups to search for new strategies for prevention and education.

Dr. Brenda Butler, medical director of child and adolescent psychiatry at Berkshire Health Systems and The Brien Center, said there has been "two decades of efforts but minimal effects on reducing rates. Youth in particular have been on the rise."

In 2015, according to the state Department of Public Health, there were 631 confirmed suicides in Massachusetts — more than twice the number of motor vehicle traffic-related deaths and four times higher than homicides. Even greater were the number of self-injuries, with 11,147 hospital discharges and emergency department visits reported for nonfatal self-inflicted injuries that year.

The 2015 data were publicly released in fall 2017, and it should be noted that suicide statistics often are considered estimates. Many attempts go unreported, and some deaths cannot always be clearly determined to be suicides.

According to the 2015 Massachusetts Youth Risk Behavior Survey of self-reported behaviors of 9,185 students across grades six through 12, 15 percent of students seriously considered suicide during the previous year, with 12 percent making a plan and 7 percent attempting suicide. Students who said they felt unsafe at school, who were bullied, threatened or injured with a weapon, or who had experienced dating violence or sexual assault, were found to be more likely to attempt suicide or self-harm.

A total of 401 Massachusetts youths ages 10 to 24 were lost to suicide from 2011 to 2015.

In response, some staff members at Berkshire Medical Center and Heywood Hospital in Gardner are involved in their third year of research and programming developed under their award of a five-year Garrett Lee Smith Youth Suicide Prevention Grant funded by the federal Substance Abuse and Mental Health Services Administration and state Department of Public Health. The goal is to put into practice what's known as the Zero Suicide model of education, prevention, screening and treatment.

It starts by training hospital staff to look for warning signs of suicide risk and to ask follow-up questions to see if patients might need more care. Berkshire Medical Center started by training its emergency department staff to conduct screenings, since the statistics show an increasing number of youths arriving there with self-harm and suicide-attempt injuries.

Christine Decker, who manages the local program, said the screening notes are entered into a person's electronic medical records as a way to inform other health care providers about a patient's possible risk for suicide.

Berkshires Health Systems also has since begun a Pittsfield support group for people and families affected by suicide and will soon be starting another group at its Northern Berkshire Campus.

Rebecca Phelps-Smith, division director of acute service at The Brien Center, said that agencies countywide are working together with the Berkshire Coalition for Suicide Prevention, the National Alliance on Mental Illness Berkshire County, schools and other youth centers to help encourage the message and practice of asking for help.

"People are afraid and think that if I go see crisis, everyone will know something is wrong with me ... but it's not something out of the ordinary to ask for help," she said.

At Saturday's Out of the Darkness Walk in Great Barrington, a local parent and survivor, Jessica Bourassa, called for schools to take a greater role in suicide-prevention efforts.

"Teachers need to talk more about this and become trauma-informed," she said. "They need to talk to the kids and keep checking on them, because depression can happen to the students you least expect."

Local students agreed that these kinds of conversations matter, and say mental health education is lacking in schools.

Miranda Hastings, a junior at Berkshire Waldorf High School, said that message needs to be "consistent" because "not everyone understands what someone with mental illness goes through."

"I do think it starts in schools. A lot of students are struggling silently," said Eliza Keenan, a junior at Monument Mountain Regional High School. "We shouldn't have to wait for suicide to happen to be a walk-up call."