In February 2024, renowned Nepali-American blood donor Arjun Prasad Mainali tragically died by self-immolation. His body was found inside a rented car at the Latta Nature Preserve in North Carolina. Mainali, who had saved over 600 lives through extensive blood donations, had posted a message on Facebook suggesting his suicidal intent before he went missing.
In March 2023, Krishna Lamichhane, a renowned member of the Nepali community in Texas and former chairman of the Nepali Society of Texas, took his life at his residence. His untimely passing left many in the community heartbroken, as he was also associated with the Non-Resident Nepali Association (NRNA). He had been experiencing family-related stress for some time.
In June 2024, Uddhav Kumar Vishwa, a 39-year-old father of three from a Nepali-speaking Bhutanese refugee community in Summit County, Ohio, took his own life. Uddhav faced a challenging period after a stroke left his leg immobilized, requiring surgery. Despite a lengthy hospital stay of nearly four months, he had begun to walk slightly upon returning home. However, the pressure of his family’s circumstances weighed heavily on him. With his elderly mother to care for, young children to support, and his wife as the sole breadwinner, Uddhav’s worries became insurmountable, leading to the heartbreaking decision to end his life in the basement of his home.
We hear many more stories like these from time to time within the Nepali-speaking community in the USA. The number of such cases within the Nepali-speaking Bhutanese refugee community is significantly high.
Approximately one in eight people worldwide live with a mental health condition. Refugees and migrants are especially vulnerable due to the numerous stressors and challenges they face during their journeys and upon arrival, which impact their mental health and well-being. The prevalence of common mental disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) is typically higher among migrants and refugees compared to host populations. Additionally, girls and women on the move are at greater risk of experiencing depression and anxiety.
Between 2007 and 2019, the UNHCR reports the resettlement of 113,000 refugees from Nepal to countries including the USA, Australia, Canada, Denmark, Netherlands, New Zealand, Norway, and the UK. More than 96,000 of these refugees resettled in the USA alone, with the largest single community numbering over 30,000 in Columbus, Ohio. While resettlement often brings Nepali-speaking refugees closer to safety and new opportunities, they face distinct challenges related to social determinants impacting mental health (SDIMH) and overall well-being. The COVID-19 pandemic has exacerbated the negative effects of SDIMH, influencing economic stability, neighborhoods, physical environments, education, food security, community and social contexts, and the healthcare system. These challenges include acculturation stress, learning English and furthering education, navigating new transportation systems, finding safe housing, accessing healthcare and legal services, obtaining healthy foods and safe water, securing employment and income, and dealing with discrimination.
The Centers for Disease Control (CDC) found that the Nepali-speaking Bhutanese community has depression and anxiety rates of 21%, with a suicide rate nearly twice that of the general US population. Ohio Mental Health and Addiction Services reported even higher mental illness rates among the Nepali-speaking Bhutanese community in Ohio, the third largest recipient of refugees in the USA, with 30% experiencing anxiety and 26% experiencing depression. Furthermore, 21% in Ohio reported that family members had completed suicide, compared to only 5% in the national CDC study. Despite these high rates, they are likely underreported due to stigma and language barriers. Consequently, the actual number of cases could be up to three times higher than what is reported, similar to the rest of the population.
The problem highlights the need for the development of culturally appropriate community-based interventions for suicide prevention and standard procedures for monitoring and reporting suicides and suicide attempts within the Nepali-speaking population in the USA.
The WHO report has outlined five key themes to be addressed in order to improve refugee and migrants’ access to mental health care, including community support, basic needs and security, stigma, adversity and trauma, and access to services. Evidence shows that being part of a community with a shared background and attending school are associated with lower rates of mental disorders. Ensuring the fulfillment of essential needs and providing a sense of security are crucial elements that warrant attention. For instance, an insecure legal status can contribute to poor mental health. Experiences of racism and discrimination are consistently associated with adverse mental health outcomes. Prolonged periods of confinement have been shown to elevate the likelihood of developing depression and PTSD.
Often, refugees and migrants do not prioritize their mental health because they are not aware of the services available free of charge or do not accept health care due to language barriers and concerns around confidentiality.
The mental health crisis within the Nepali-speaking community in the USA underscores the urgent need for tailored interventions and support systems. Addressing social determinants of mental health, combating stigma, and ensuring access to culturally appropriate care are essential steps in mitigating this growing issue. By fostering community support and providing adequate resources, we can help alleviate the mental health burdens faced by this vulnerable population.
Dr. Rakesh Ghimire
View More PostsDr. Rakesh Ghimire, Assistant Professor and Project Lead of Nepal Poison Information Center at Tribhuvan University Teaching Hospital (TUTH), has worked closely with stakeholders in Nepal in reducing suicides, particularly suicide by pesticide ingestion, for more than 10 years.
