"I always imagine what if you were going into the school cafeteria, and you don't know which kids have seen these horrible pictures of you," said Marya Grambs, executive director of Mental Health America of Hawaii.
She helps us understand the horrific chain of events in the life of California teenager Audrey Pott.
Three of her Saratoga High School classmates, have been arrested for allegedly raping her, then texting and posting pictures online.
"She had no idea what occurred until the following morning, until she saw some drawings on her body in some private areas," said Potts family attorney Lauren Cerri.
Days later Pott killed herself.
Then there is the story of Rehtaeh Parsons.
She was raped by teenage classmates, who then spread pictures of the assault. It was too much for the teen to take.
"I just opened the door and said 'Rehtaeh' and then I had to cut her down. She was hung. She was hanging," said her mother Leah Parsons.
"We've trained 11,000 youth," began Grambs.
She leads the Stop Youth Suicide & Bullying Program.
She said in the past four years, suicide rates in Hawaii's youth have doubled.
And Hawaii's middle school students are the highest in the nation in making a suicide plan.
In Hawaii, in a period of just a one month, two students in every class said they missed a day of school because they were fearful or felt unsafe.
"It tells us that Hawaii is not a paradise for a lot of kids. That we have a lot of desperate kids and kids who are being harmed by bullying and cyber bullying," said Grambs.
Last year, 16-year-old Hawaii-native Brandon Elizares succumbed to the pressures of being a gay teen.
His mother said he committed suicide after three years of bullying.
"It's just really horrific. The type of bullying is more vicious," said Grambs.
Grambs emphasizes bullying itself does not lead to suicide, but does lead to the depression, abuse, and trauma often associated with it.
"Everybody needs to understand it's an issue," she said.