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Mila pressed the tip of the blade against her skin, liking the way the metal reflected the dappled sunlight. (1)
"Why did you even come out here if you weren't going to help?" Cara shook her rake emphatically to make her point. (2)
"I'm keeping you company." Keeping her back turned, Mila traced the blade along the path of her veins. How easy it would be to press down, to watch her life flowing out of her in a bright rush of blood. (3) No one but Cara would even notice she was gone.
"Cheer up. It's gorgeous out." Cara tilted her head to watch the bright fall of leaves. (4)
"I don't know how you can stand this weather," Mila said. "The cold makes me want to…" She broke off at a choked cry from her sister. Dark smoke curled from the shadows to wrap its way...

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1. I'm getting mixed messages here. To me dappled says calm, serene, Bambi in a glade somewhere in the Hundred-Acre-Wood. Knives and blades and skin don't. If you're going for the juxtaposition, congrats, you got it. If you're just scene setting, maybe you still got it. Can't really tell at this stage.

2. Triple redundancy here. If you are yelling at someone and shake a rake in their direction, it's for emphasis. If you do something emphatically, you do it for emphasis. And if you do something to make your point, you do it for emphasis. I'd lose the adverb and let the first and third do the heavy lifting.

3. Technically, I don't think of blood ad bright per se, especially venous blood. Arterial blood will have a more bright reddish color, but venous blood will be blue-purple. Again, the juxtaposition between a pretty dark character ( a little too emo for my liking) and the brightness of the blood might be juxtaposition, but it stood out to me in an awkward way.

4. I don't know what a bright fall of leaves is. I can take guesses, but I really shouldn't be guessing, should I?

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Mila pressed the tip of the blade against her skin,

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This for example. First sentence and I don't know who the 'her' is (Mila or Cara). Had to keep reading to put that together. I would also like to know where she is pressing the knife. Arm? Neck? It does make a difference for the reader. An ordinary cutter would slice into there wrist without really risking life or limb. Against the throat means that this chick is serious.

The prose is sharp but the setting is dull. You are banking your entire hook on a cutter. Not enough for me. At this point I need something else to draw me in.

Speaking of which...

I think I should get a prize for a triple redundancy.

I'd worried about starting out in such a way. Part of the story is having her find a reason to live, but come to think of it, I could probably be a little less dramatic.

And W_B... anytime you cut yourself, you bleed bright red, yes? Contact with oxygen changes the color of oxygen-starved veinous blood. Happily, I've not cut myself enough to really be certain.

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Starting in the wrong place, or wrong way. Where and why distract me too much. Do not know enough about each character to care about a suicidal Mila at the moment.

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How much do you have to know about someone to care they are suicidal?

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How much do you have to know about someone to care they are suicidal?

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A reasonable question to think about. How much character investment do we need to create in a reader before we begin to introduce the plot?

• How do we generate sympathy for our characters?
• Do suicidal thoughts generate sympathy in a reader in the absence of other character details?
• Are the character's suicidal motivations detailed sufficiently? Do these details themselves generate sympathy?
• Does the "suicidal teen girl" character type automatically generate sympathy, or apathy?
  

Maybe instead of Mila thinking about the blood and the knife constantly, what if instead she think about what life would be like without her in it. Maybe think about the leaves as if it would be her last time seeing them change color, or even give a hint about why she wants to die.

I would think the actual dieing part she might want to skim over, unless she gets off on pain, which seems weird to me. Like she might run the blade over her veins, but I don't think it would really register that she is doing it.