Suicide and Suicide-related Behavior among Bhutanese Refugees Resettled in the United States.

Suicidal behavior and death by suicide are significant and pressing problems in the Bhutanese refugee community. Currently, Bhutanese refugees are dying by suicide at a rate nearly two times that of the general U.S. population. Proper identification of risk factors for suicide saves lives; however, if risk is underestimated due to culturally inflexible risk assessments, preventable deaths may continue to occur. In this review, we examine specific cultural factors related to psychopathology and suicide among Bhutanese refugees. To contextualize the current suicide crisis among Bhutanese refugees, we propose an integration of the interpersonal psychological theory of suicide (Joiner, 2005) and the cultural model of suicide (Chu, Goldblum, Floyd, & Bongar, 2010). We provide recommendations for preventing suicide from a systems framework and discuss practical lessons from a preliminary study designed to test a culturally-responsive model of suicide in Bhutanese refugees.

Connecting Cultures: A training model promoting evidence-based psychological services for refugees.

Training clinical psychology graduate students in providing effective psychological services to refugees can be extremely complex. The training approach requires a culturally sensitive framework, potential modification of empirically validated techniques, and flexibility on the part of trainees and supervisors. Connecting Cultures is a program that creates a culturally sensitive context from which trainees can learn to effectively work with refugees within a social justice framework and the ecological model of human development. Connecting Cultures graduate students provide both community-based outreach and direct clinical services to meet the mental health needs of refugees in the Northeast region of the United States. The primary aim of this manuscript is to provide an overview of Connecting Cultures' training and supervision model, highlight the importance of working with cultural consultants, interpreters, and community elders, and discuss the impact this work has on clinical psychology graduate students. A secondary aim is to describe our method for evidence-based psychological assessment and to present preliminary outcome data from our graduate students. Strengths of the Connecting Cultures program include its clinical and research efforts with refugees from over 20 countries, and its ability to flexibly incorporate alternative therapeutic frameworks such as Acceptance and Commitment Therapy. Finally, the manuscript concludes by providing the implications of our work in attempting to meet the mental health needs of refugees after resettlement.