Editor’s note: This story contains references to suicide. If you or a loved one are in need of immediate support, help is available 24/7 at the National Suicide Prevention Lifeline: 1-800-273-8255.

As a Bhutanese refugee coming of age in Pittsburgh in the 2010s, I often heard of death. Death that happened to people, self-inflicted. I found myself on the periphery of the mental health crisis that seemed to have engulfed our community, though it was rarely talked about. Whispers of death everywhere. 

I remember hearing stories from my parents about the man who hanged himself in his three-bedroom apartment or about the funeral my mother attended for her co-worker’s spouse who had taken his life. And it was often his life. It seemed to me that they were almost always men. Most importantly, it seemed like this is just how things were, a matter of fact. 

It also seemed like a distant problem. I wasn’t particularly close to any of the victims. I was a teenager. The funerals were for people who were in their 30s or 40s. To me, 40 seemed like centuries away. I paid no mind to it; my job was to be a student. 

Until, one day, it touched a little too close to home.

On what seemed like a regular fall day, near our apartment complex in Baldwin Borough, a body was found hanging from a tree. My dad told us early in the morning. He told me first, and then he told my older brother who had been friends with the young man since we had become neighbors some five years before. They went to school together, they ate together, they traveled all over the city together. My experience was a passing one. I knew him through my brother. But I still knew him. And now he was dead. 

To a large degree, this was my first experience with the permanence of death. Some months earlier, I’d gone to the gas station where the young man had worked. My brother forced me, at the peak of my introvertedness, to make conversation as he got a pack of cigarettes for free. I listened as they talked about their plans. The young man talked about buying a house for his parents to finally move out of the apartment complex and about putting his sisters through college. And now he’s gone. 

His death was part of a wave of tragedies in Bhutanese refugee communities that cut across class and age lines, most acutely affecting men. 

The story of Bhutanese refugees

As a child, I was told frequently about the history of “our people.” Through oral history, the story goes that sometime in the 16th century the Kingdom of Bhutan sought immigrants from Nepal to work as farmers. Finding themselves settled in rural, far-flung but insulated villages, my grandparents spoke of still celebrating Dashin and Tihar, both Nepali holidays. In fact, my grandparents never learned Dzongkha, the language of Bhutan. Instead they spoke the same Nepali language the community had for centuries.  

After hearing about individual stories for years, I wondered if the source of the suicides is rooted in our collective refugee story. Now, as a 21-year-old, I wanted to understand the context behind my childhood.

However, this separate identity got them branded “lhotshampa” by the Bhutanese government, a term considered pejorative by some in the community. In the 1980s, as the “lhotshampa” asked for more political power, the government responded with a brutal crackdown. According to the stories from my parents and their parents, people disappeared from their homes at night. Bodies reappeared the following day in streams and creeks. Torture became rampant. 

I read stories contextualizing this oral history as an adult. Growing up, I remember hearing about distant uncles who had been tortured, leading to lifelong mental health problems. By the 1990s, almost all of the population had fled back to Nepal. Makeshift homes were constructed, and seven refugee camps were erected across southeast Nepal. Both sides of my family found themselves settling in the same refugee camp, the camp where I was born.  

Nepal itself was going through a political crisis, which led to an active civil war between Maoists and Monarchists. At some points, the war got so violent that I remember my mother telling me not to kick anything on the roads lest it be a makeshift bomb. In this environment, when the opportunity to resettle to become a reality, many families like mine took the chance and resettled in America. 

In Pittsburgh, the largest group of refugees by far are Bhutanese refugees of Nepali origins. In a similar pattern to older immigrant groups, my family found ourselves first taking refuge in affordable south Pittsburgh then moving into the outer boroughs along the Route 51 corridor. In these neighborhoods, one does not have to go too far to find a grocery store, restaurant or a community center catering to Bhutanese refugees. 

Depth of the problem 

After hearing about individual stories for years, I wondered if the source of the suicides is rooted in our collective refugee story. Now, as a 21-year-old, I wanted to understand the context behind my childhood. I learned that there was in fact a higher suicide rate for Bhutanese refugees, compared to the general U.S. population.

I also learned that this suicide epidemic followed the community from the refugee camps to the newly resettled homes in the United States. This led me to a 2013 report from the Centers for Disease Control and Prevention, which helped me realize the depth of the problem and the possible causes, research that was corroborated by a more recent 2019 study published by Cambridge University Press

The report detailed what I have described before: Bhutanese refugees express post-traumatic stress but aren’t getting mental health diagnoses from medical professionals. 

All the stories I’d heard made sense in the context of an alarming statistic. The suicide rate among Bhutanese refugees was almost double the rate compared to the nation as a whole, according to the CDC report from 2013. 

As with other parts of life, the pandemic has laid bare the importance of talking about mental health. In the years preceding the pandemic, the crisis slowed, but the pandemic has showcased new challenges…

After confirming that the stories I’d heard growing up seem to match statistics, I wanted to understand why the problem persisted. I considered the inequality I had seen within Asian Americans as a bloc and how persistent the income gap is for Nepali Americans (due to differences in demographic patterns of migration) or the language barrier and the challenges it presents. Or an intersection of both, combined with other factors. 

All of this I had understood implicitly but what was made more explicit by a doctoral thesis that I had stumbled upon recently were connections between economic success and the ability to speak competent English. I got lucky since the research was conducted here in Pittsburgh during the height of the crisis in late 2016 to early 2017. 

The thesis also helped answer another alarming question: Why is it disproportionately men? 

Raising families, working and acclimating to a new culture create access barriers to English language classes. These stressors would themselves make life hard but add onto this the expectation of masculinity, and I knew it was a potent mix. Having been raised as a man, I am aware of how both American and Nepali cultures value men being “the provider,” a task that is exponentially harder to do as a refugee. The burden of overcoming a language barrier as well as notions of masculinity are a tall order. 

After reflecting on the research and my own experiences, I sought out the solutions to the problem. I remembered my time volunteering with the Bhutanese Community Association of Pittsburgh [BCAP] as an interpreter from the time I was 16 to the beginning of the pandemic.

Filling the public health gap

In an effort to combat the problem, community organizations have taken to investing in mental health. BCAP, for example, has recently been working to connect Bhutanese refugees to a mental health helpline and a direct line to a BCAP staff member who can help in Nepali, bypassing the language barrier. 

Seeing the need for conversation, BCAP launched a Mental and Behavioral Health program. I talked to Madhavi Timsina, who was hired as program coordinator in 2020, about her experiences conducting home visits and talking to community members by phone. She shared how even just providing the space to talk in Nepali was valuable for community members.

“Majority of the time, they are not willing to share their thoughts,” she said. But after some time, “they start responding; they won’t stop because sharing their feelings will provide comfort in the mind.” She spoke about taking the time to simply talk to community members and to engage with them about their needs, especially with obstacles in place from the pandemic.

Simply seeing organizations like BCAP engage with the community about once-taboo subjects made me hopeful for the future. 

Even before having Madhavi at the helm, Executive Director Kara Timsina had been highlighting the need for mental wellness. He shed light on the timeline of deaths and provided some much needed optimism. He notes that there were “many cases” of suicide between 2010-2016, but that, “We have not seen such cases in Pittsburgh for some years now.” As a leader in the community, Timsina provided me with context for what I had experienced during what seems to be the worst of the mental health crisis. 

A couple of months ago, the grant funding Madhavi’s work with BCAP as the full-time staff member dedicated to mental wellness ended. With nobody focused specifically on mental health, the work will fall on BCAP’s already thinly stretched staff. As with other parts of life, the pandemic has laid bare the importance of talking about mental health. In the years preceding the pandemic, the crisis slowed, but the pandemic has showcased new challenges, making the necessity of resources for mental health more important than ever. 

Avishek Acharya is a senior at Duquesne University, majoring in political science and history. He is a Bhutanese refugee and has worked as a long-term volunteer for the Bhutanese Community Association of Pittsburgh. He can be reached on Twitter @avishekwastaken and on email: avisheka2@gmail.com.

The Jewish Healthcare Foundation has contributed funding to PublicSource’s healthcare reporting.

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