Bhutanese Refugees Face a High Suicide Rate



At a conference held in Pittsburgh last fall, several dozen men from around the United States discussed a disturbing trend in their community: the high suicide rate and prevalence of depression among Bhutanese-Nepali refugees.

"People are looking for resources where they can go to curb this mental health issue," said Buddha Mani Dhakal, editor of the Bhutan News Service.

The men gathered were volunteer reporters. They were seeing high numbers of suicides, from New Hampshire to Georgia to Arizona to Pennsylvania. It worried them so much that they came together to talk about how they could use their reporting to find solutions to the problem.

The U.S. Office of Refugee Resettlement has been worried about the problem, too. In 2012, the agency asked the Centers for Disease Control and Prevention and the Refugee Health Technical Assistance Center of the Massachusetts Public Health Department to study the suicide rates among the Bhutanese over the previous three years.

The global suicide rate per 100,000 people is 16. The U.S. rate for the general population is 12.4. The study found the Bhutanese rate is higher — 20.3 among refugees resettled in the U.S. and 20.7 among those in the refugee camps in Nepal.

“Most suicide decedents were generally unemployed men who were not providers of their family; the most common post-migration difficulties faced by the victims were language barriers, worries about family back home, and difficulty maintaining cultural and religious traditions,” the authors of the report wrote.

While there were suicide deaths reported among other refugee groups during that time, the numbers were not as high.

The rate of depression among the Bhutanese was also high at 21 percent, which is nearly three times the rate of the general U.S. population.

"You can only imagine the stress and strains of folks coming here," said Ken Thompson, a psychiatrist who works at the Squirrel Hill Health Center, a clinic where many of the refugees in Pittsburgh get their health care. "They get very little support for a brief period of time, and then they are left to find their way in the world. They have to get jobs, language skills, the pressures on the families are intense, and they’ve already been highly traumatized and dealt with all kinds of circumstances."

More than 60,000 Bhutanese refugees have been resettled in the United States since 2008. A few thousand of those refugees are in Pittsburgh. Those who are here are ethnically Nepalese. For generations they had lived in Bhutan.

About 20 years ago, Bhutan’s king instituted an ethnic cleansing. More than 100,000 people with Nepali ethnicity were driven out of Bhutan and into refugee camps in Nepal.

Kishor Pradhan, who lived through this before seeking asylum in the United States and moving to Pittsburgh, said life in the camps was difficult on every level for everyone.

"There was health care there, but you look at the people with a huge range of issues, some of the people were tortured, they were forced to leave the country,” Pradhan said. “Those that weren’t willing to leave were arrested and tortured until they signed a form saying they were willingly leaving the country. …They had mental trauma."

Pradhan is president of the Bhutanese Community Association of Pittsburgh. He said addressing suicide and depression, between which there is a strong connection, is a concern for the association, particularly because emotional self-expression isn’t part of their culture.

"We really don’t talk, we really don’t express ourselves too much in terms of trauma,” Pradhan said. “I feel sometimes depressed but I cannot express it.” 

This attitude helps explain why so few Bhutanese reach out for help before committing suicide. The CDC study found that “only 2% of respondents reported they would use a suicide hotline when in crisis. While this may represent a preference, it might also indicate lack of awareness of and access to language-appropriate services.”

 The report also made a few key recommendations:

  • Enhanced mental health screenings and services for refugees to identify and treat anxiety, depression, and post-traumatic stress disorder.
  • Strengthened community programs for refugees to address post-resettlement isolation.
  • Expanded mental health interventions that are relevant to the Bhutanese culture.

New community-based suicide prevention training and interventions.

Thompson said the concern isn’t just in working through trauma and depression with people, it’s also in finding something that will engage them in their new lives here.

"If you treat them, what are you treating them towards?" he said. "If you treat them to sit in a chair all day and do nothing, what’s the treatment?"