By the first report published by CDC on suicide rate among the Bhutanese refugees resettled in the US the alarm bell was set. Bhutanese refugees, who came from the camps in Nepal, belonged to a conventionally homogeneous society of Bhutan. When the waves of resettlement carried them far and wide to big cities and their suburbs, ways of life changed by leaps and bounds. Coupled with cultural shocks, the US resettled Bhutanese refugees particularly felt more pressure to adjust and struggle with life than those resettled elsewhere in the west. Adjustment in a new society, though very well facilitated by the resettlement agencies, could not be so easy due to language and cultural issues as well as pace with which West moves in terms of labor and technology.
Considering the recent disturbing news of suicide cases from Harrisburg-Pennsylvania, Cincinnati, Columbus-Ohio and Louisville-Kentucky, it is obvious that Bhutanese communities in the US have a lot more to do to curb this epidemic. Despite the resources and energy spent by our community leaders on mental health first-aid training, we have not seen the results as expected, proven by the suicidal death among the leading community figures. Some serious and consistent interventions are needed that can reach to the family and individuals at risk. Indeed, the identification of individuals at risk is another challenge, since it will interfere with their privacy and discussing mental health issue is a social stigma, the very root cause of this epidemic.
A Facebook post by a medical doctor living in Australia urged the Harrisburg (PA) community to act as a watchdog for preventing further suicide. He even hopes to create such mini-scale watchdog groups if volunteers raise hands to join.
Back in 2014, approximately, 130 community volunteers and leaders from all States of resettlement gathered in a mental health first aid training in Harrisburg, PA. Many considered the conference to be a success in setting-up mechanisms to mitigate this epidemic, and they were supposed to be the gate-keepers of their local communities in terms of outreach, counseling and ultimately referring such individuals to mental health services available in their cities or counties. It appears that the participants learned a lot but could not apply in a real-life setting due to many challenges.
Social stigma is posing as a number one challenge in mitigating this epidemic. Most of those deceased in the recent cases were unknown to express a moment of depressive mood, nor records of their mental health need ever discussed with their respective primary care doctors. They were learned to have very active social and family life prior to their premature tragedies. The nature of stigma in our society is such that when one ends his/her life, not even the family members open-up on the incident for fear of further stigma. The guilt nudges the closest family circle for not sharing about the mental health situation of the victim. For most cases, the blame is put on the deceased, and people tend to act surprised once the life is lost.
The flipside of this scenario is- “who cares to listen to me even if I express my feeling?”
There is a cultural disengagement on the issue: people tend to avoid talking of someone showing depressive mood or suicidal thoughts or simply throw a light sarcasm. Now, these deaths are simply becoming sources of data for mental health brokers, themselves engaging in securing credits without the real endorsement of the families who faced it.
During the Harrisburg training on mental health, the energy exhibited by some of the community leaders had given a sign of hope and they stood as ‘Gatekeepers’ on preventing suicide. Either, we read the situation wrongly or overheard during the training. Today, the mental health situation in the community is worsening in folds.
The situation around us asks; where are the gatekeepers? Why even the family members do not get a clue about the depressive mood of the suicidal person and he/she looking for a chance to destroy?
Even if one is trained to be a mental health first aid worker or a certified QPR, he/she doesn’t feel encouraged to reach out to these individuals and their families due to push back from the families themselves. Therefore, reaching out to those affected families and individuals is often not without blame. We tend to assume that consistent outreach to affected families and individuals could save a life but doing that in the first place is a formidable challenge.
With social stigma getting in on the way of the community volunteers and mental health professionals, it has become extremely hard to gauge who is living with suicidal ideation. We normally don’t bother a person with probing questions who is showing signs of depression or anxiety. Some individuals don’t even exhibit any signs of depression or anxiety, as in most of the suicidal cases so far, and there are no tell-tale signs to connect the dots. We leave it to the ‘fate’, roll our eyes, whisper with one another but don’t really open up.
It’s not so much the inaction itself as much as the lack of right approach and tactical methods of getting around the problem or subjects. The community leaders, volunteers, and religious figures should be equally concerned about this issue and start discussions around their special events they organize or in their families and not leave everything to ‘fate’. The social stigma about mental health must be busted with gradual acceptance. We need a community-wide recognition that suicide is not fateful and mental health and its treatment is as important as a cut or burn. And, somebody undergoing severe depression has to be bold enough to say ‘I am suicidal and I need help’.
‘HELP’ is ‘AVAILABLE, OF COURSE’!!