New research at the University of Minnesota shows many of the refugees coming to the Twin Cities aren't getting the mental health services they need, and university researchers are searching for a way to solve that problem just as a new group of refugees arrives.
The twelve-member Kharel family - grandfather, grandmother, three sons, their children, aunts and cousins - gather eagerly around a table when visitors arrive.
They've rarely had a chance to speak with someone outside the family since coming here from Nepal as refugees. Now they talk over each other.
"They came about two months ago; they were feeling OK, [but a] few days ago everyone started getting sick," said Mangala Sharma, translating for the family. "They really became hopeless and worried because there was nobody to help they don't have transportation; they don't know which hospital to go to."
Sharma, now the refugee resource manager at CAPI USA, a social service organization, was one of the first 50 Bhutanese to arrive in the United States a decade ago. She and thousands of other ethnic Nepalese were expelled from Bhutan in the early 1990s.
Since 2008, more than 200 Bhutanese have taken refuge in Minnesota. Now, Sharma helps the newest arrivals as much as she can.
"I haven't been here for the last 20 days now; we come only once in a while," she said. "With my new job I didn't have time to visit them. They're kind of feeling that 'we're alone, nobody comes to visit us, and we're isolated.'"
That's because for the first time, Minnesota is accepting so-called "free cases" -- Bhutanese refugees like the Kharels who aren't related to people already living here.
Government aid will pay the Kharel's bills for several months. That covers the basics, which is more than they had for 18 years in a refugee camp.
There, they had no privacy and no freedom of speech; here they have both but are too isolated to use them. The family doesn't know how to find services or jobs.
The grandfather of the Kharel family, Balaram Kharel, simplifies the confusing emotions by saying only that they'd appreciate a friend.
"We want a trusted friend - a trusted friend, culturally appropriate community person where we can talk and discuss and feel better," he said.
What Balaram Kharel calls "a friend," advocates here call "mental health care" -- services that would help refugees deal with what they're feeling and navigate their new environment.
University of Minnesota assistant professor Patricia Shannon led a study showing refugees want mental health care but can't get it.
"We interviewed over 50 social service providers, primary care providers and cultural leaders in the community to try and assess the strengths and needs of the incoming refugee populations to Minnesota," Shannon said. "One glaring area everyone talked about was the unmet mental health needs of refugees coming to the state."
Shannon said without such services, refugees have a harder time learning English, getting a job, and generally building a new life. That means they may spend more time on social support services, including welfare.
State officials say Minnesota, like many other states, doesn't have the money to address mental health issues. And there's the language barrier: only so many people speak Bhutanese.
Shannon's researchers are surveying other states to see how they deal with the problem. They're working with Twin Cities-based Center for Victims of Torture to create a sort of transferrable therapy program that refugee community leaders can use to discuss mental health issues within their own groups.
Mangala Sharma hopes to use the program to teach older members of her community to help new arrivals.
"We would like to train people who have come one year ago so they are ready to receive new group," she said. "And then those who come, maybe they will be able to receive another group. So those of us - the old ones - may be able to retire one day."
The Kharel family would be grateful to serve that role for someone else one day, but first they say they have to find a way to pay rent.