Fighting Mental Health and Stigma in Disguise

Resettled Bhutanese in the US have various mental health problems but the people in the community, in fact, do not understand the illnesses as disease.

It was an alarming situation when numerous resettled Bhutanese (refugees) dying by suicides in the US. Every month, there were suicides taking place in among the people in the country after resettlement. November of 2013 was the worst month for Bhutanese in the US because the number of suicide went up to seven in the month in approximately 65,000 people. Bhutanese in Pittsburgh was also adding the number to the list. When Pittsburgh was counting the fourth one within three years in among the population of approx.4500, no Bhutanese had any idea how to prevent it. There was no option other than keep watching.

The factors that did not allow others (friends, relatives, and neighbors) to prevent such mishaps were the lack of knowledge on Mental Health and the Stigmatizing attitude. Knowledge of Mental Health is limited in Bhutanese (in the US at the present context) because it is hard to find high school graduates (or equivalent) in among them who are over the age of 50 years. Mental Illness thus is often considered as a taboo subject and people are stigmatized talking about it openly” within the community. If an individual has psychosis, bipolar disorder or schizophrenia then only s/he is considered as having mental health disorder. Unfortunately, the patients barely express the illness even if s/he understands because of the fear of sensitizing it. Thus, it becomes a big barrier to receiving any sort of treatment support.

Understanding the situation, it was the volunteers from the same community to find an alternative to fighting the disease. Sometimes people expressed their desire to hurt themselves. This sort of information would be very useful for the volunteers if the families were in trouble due to mental illness. The volunteers’ plan was to sort out mental health related issues in the community and help families in troubles. But identifying any person having mental health issue needed careful attention to avoid sensitization. The volunteers then created a network of like-minded friends to collect information from families with conflict but without their notice. The group collected information on only the behaviors and symptoms of the individual. This was a small group of ten people to work in anonymousness from different locations started in November 2013. The community was spread in sixteen different locations in Pittsburgh and having the representative from the different locations was thought to be effective. The group knew, at least, few people in the community who were aware of their neighbors with unusual conducts from over drinking to quarreling. The collected data also included information from the people who are gloomy and acting unusual. They were continuously monitored in disguise; visiting them and talking about how they were doing was one of the main strategies. Working this way was much easier to study the family and the targeted individual than asking directly how the individual behave. However, volunteers were not equipped with any standard knowledge of mental health aids. The knowledge of community perspectives on mental health and the information about crises services provided by the resettlement agencies in Pittsburgh were advantageous. Few among the volunteers were at school, which was an added advantage to understand the mental health symptoms, at least. But this group was seeking professional help, which is possible only if the volunteers have knowledge about the individual and can give some information to the crises services to get support from them. Resolve Crises is one of such agencies the volunteers dealt with.

This group has come across with several cases that are associated with mental illness but working with them was always challenging due to stigma issue. Many individuals were hospitalized with support from crises services for many days and all of them have done very well until date.

On 28 and 29 of June 2014, Pittsburgh, Philadelphia, and Harrisburg Bhutanese Communities jointly organized a conference on Community Initiative for Mental Health for

Bhutanese with supports from PA State Health Department and Office of Refugee Resettlement (ORR). On the second day, there was a Mental Health First Aid training (MFHA) provided to the participants by the instructors from National Council for Behavioral Health. Ten of those team members from Pittsburgh participated in the training. This group then started using tools of MHFA for identifying and helping their folks in Pittsburgh. The mental health risk assessment and surveillance is still blinded to the general people in the community.

A case Scenario:

One day this group got information that there was a conflict going on in a family. Two of their team visited. Children were playing in the living room; they opened the door for the visitors.  They inquired their parents’ whereabouts. One of the parents was out and the other came from their bedroom. One of the visitors (volunteers) started to talk to the parent while the other went to the bathroom. Realizing that there was a strange situation, he (visitor) went to a bathroom and tried to scan around. Taking the advantage of a bathroom and the bedroom are adjacent to each other, he was able to scan into their bedroom as well.  Not to a surprise, he found a suicide note on a bed that was half completed when they enter. They talked to the person and called crises service after getting consent from the individual. The individual is doing perfectly fine until date. Over a dozen of such cases have been dealt operating for about two years. Unfortunately, the community lost one individual even after the operation of this group, who the group could never figure out.

So, having MHFA training in Harrisburg, ten Pittsburgh Bhutanese felt that it is the very great tool to work with people in such situation. Philadelphia and Pittsburgh Bhutanese organization requested the State Health Department to support MHFA training to all the cities. The State Health Department supported for the training and was provided to Pittsburgh, Erie, and Lancaster to over 150 Bhutanese individuals.

In Pittsburgh:

  • There were ten people who started in the beginning. Around 55 of them were trained on February 28, 2015. Many have joined the group of volunteers after the MHFA training.
  • The members of the group actively monitor the neighbors in different locations.
  • When there are some social gatherings, the group remains attentive to gossips.
  • This group does not take any specific personal information other than their activities, if unusual.
  • When the group perceives there is the risk, assessment is done for the risk of harm.
  • One or two of the volunteers in the group talk to the individual when they see symptoms and give reassurances.
  • The group encourages professional help and self-support techniques like yoga, meditation, outdoor exposure, and socialization.
  • The group asks for the individual’s consent to call for crises services and call for support depending upon the severity of the case.

This model seems to be very effective in Pittsburgh Bhutanese, which is mostly accompanied by professional help. The group believes that this initiative has been able to help many members of the community in trouble.

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