Project Bhalakushari

Project Bhalakushari is a community-based participatory research (CBPR) programme studying the mental health and psychosocial well-being of ageing Bhutanese refugees resettled in North America. Led by principal investigator Dr Rochelle Frounfelker, assistant professor at Lehigh University's College of Health, and funded by the National Institute on Aging (NIA grant 1R01AG089038-01), the project takes its name from the Nepali term bhalakushari, meaning a casual conversation. Built on a decade-long partnership between researchers and Bhutanese community organisations, the study examines how forced displacement continues to shape mental health outcomes among older refugees decades after resettlement.^[1]

Background

Tens of thousands of ethnic Nepali Lhotshampa were expelled from Bhutan during the Bhutanese refugee crisis of the early 1990s and spent up to two decades in refugee camps in Nepal. Beginning in 2007, more than 100,000 were resettled to third countries, predominantly the United States and Canada. As this population ages, a growing cohort of older adults — many of whom experienced violence, dispossession, and prolonged displacement — face compounding health challenges. Cultural concepts such as dukha (sadness), manaasik bhoj (mental burden), and tanab (tension) shape how this community understands and expresses psychological distress, often in ways that do not align with Western diagnostic categories.^[2]

Research Phases

Pilot Phase (2017)

Project Bhalakushari originated in 2017 with a pilot study in Springfield, Massachusetts, involving 190 older Bhutanese adults aged 50 and above, along with 10 healthcare providers. This initial phase established the community-based participatory approach that would define the project, with Bhutanese community members involved as co-researchers rather than merely subjects. The pilot generated foundational data on prevalence of depression, anxiety, and post-traumatic stress among older Bhutanese refugees.^[3]

Current Phase (2024–2029)

The current NIA-funded phase, which began in 2024 and will continue through 2029, is based at Lehigh University in partnership with the Bhutanese Community in Harrisburg (BCH), an organisation that advocates for an estimated 40,000 ethnic Nepali Bhutanese in the central Pennsylvania region. The study pursues three primary objectives: documenting stories of social support among residents aged 50 and older; tracking over three years how pre-migration and post-migration experiences have shaped mental health; and examining how caregiving responsibilities affect both caregivers and care recipients within this demographic.^[4]

The current phase includes exploratory qualitative interviews with 50 individuals, followed by a longitudinal study enrolling dyads of 200 older Bhutanese adults and 200 identified caregivers. Academic partners include researchers at Harvard T.H. Chan School of Public Health, McGill University, and Boston College's Research Programme on Children and Adversity.^[5]

Methodology

Project Bhalakushari follows a mixed-methods design combining quantitative surveys with qualitative interviews. A defining feature is its CBPR framework, in which Bhutanese community members participate in research design, data collection, and interpretation. The project name itself reflects this approach: bhalakushari — casual, unhurried conversation — signals to participants that the research process values their narrative experience rather than extracting clinical data. Multiple Bhutanese communities have collaborated, including groups in Springfield, Massachusetts; Ottawa, Ontario; and central Pennsylvania.^[6]

Key Findings

Research published from the project's earlier phases has identified distinct mental health profiles among older Bhutanese refugees using latent class analysis, documented the prevalence of multimorbidity (co-occurring chronic conditions), and explored how socioeconomic status intersects with refugee experience to produce diminished cognitive health returns. The research has also examined help-seeking behaviour, healthcare navigation challenges, and the role of social capital in long-term integration.^[7]

Significance

Project Bhalakushari represents one of the few longitudinal studies focused specifically on ageing refugees, a population largely absent from both gerontological and refugee health research. By centring culturally grounded concepts of well-being and involving community members as research partners, the project aims to produce findings that can inform downstream interventions designed with, rather than merely for, the communities they serve.

See Also

• Bhutanese Refugee Crisis
• Bhutanese Refugee Suicide Crisis
• Bhutanese Diaspora in the United States
• Lhotshampa

References

1. Frounfelker, R. et al. "Using a Community-Based Participatory Research Approach to Study the Mental Health of Older Adults with a Refugee Life Experience." International Journal of Environmental Research and Public Health 22, no. 8 (2025): 1303. https://www.mdpi.com/1660-4601/22/8/1303
2. Frounfelker, R. et al. "Past trauma, resettlement stress, and mental health of older Bhutanese with a refugee life experience." PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9386683/
3. Frounfelker, R. et al. "Mental Health Among Older Bhutanese with a Refugee Life Experience: A Mixed Methods Latent Class Analysis Study." PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10330824/
4. Bhutanese Community in Harrisburg. "Project Bhalakushari." https://www.mybccpa.org/our-work/project-bhalakushari
5. Frounfelker, R. et al. "Using a Community-Based Participatory Research Approach." IJERPH (2025). https://www.mdpi.com/1660-4601/22/8/1303
6. Frounfelker, R. et al. "Using a Community-Based Participatory Research Approach." IJERPH (2025). https://www.mdpi.com/1660-4601/22/8/1303
7. Frounfelker, R. et al. "Mental Health Among Older Bhutanese: Mixed Methods Latent Class Analysis." PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10330824/