December 5, 2021

Covid-19 Makes India Wake Up to Its Migrant Labourers and Their Mental Health Issues

What life is this? What life is this?

a wretched life, a pathetic life, an abject life, a broken life

– Aadesh Ravi[1]

Introduction

Keeping aside the economic dejection in our country suffered by the citizens, we have to scrutinise the long-lasting uncertainty COVID-19 has caused to families of the migrant workers. Few of them were compelled to walk hundreds of kilometres to be back to their hometown. Even though India has developed in the past three to four decades, but the migration flow of labourers and related issues remain constant. And the pandemic made it worse as it opened up a hornet’s nest of problems faced by the migrant workers across the country.

This unprecedented crisis made an unpredictable dynamic shift in the country’s economy. Almost every sector of the society got affected, but daily wage labourers and migrant labourers suffered the most. Two PILs[2] were filed at the Supreme Court stating that the nation-wide lockdown infringed Article 21, i.e. Right to Life and Personal Liberty for the migrant labourers due to loss of jobs rendering them homeless and starving for days. The PILs sought for issuing directions to centre and state, to ensure paying minimum wages to poor migrant labourers whether there is work or no work.

 Mental Health Issues: Food for Thought

The introduction makes it painstakingly clear that migrant labourers have always led a difficult life, whether before or after the outbreak of COVID-19. Consequently, there would be serious repercussions of such a lifestyle on their mental health. But I hardly remember that being a topic of discussion ever in the country by the citizens or the bureaucrats.

The situation of women is much worse, as their position gets even more marginalised in case they do not have enough essentials to take care of their children or early marriages after being put out of school due to lockdown. This would lead to depression, anxiety and other psychological issues in most of the women without them even knowing about it.

The most recent survey that is available on mental health is of the year 2015-16 (which clears the doubt of importance given to this subject!), wherein it was found that one in twenty Indian suffers from depression of some kind. In addition, there are only 0.3 psychiatrists, 0.17 nurses and 0.05 psychologists per 100,000 patients in India who need help with mental disorders. Surprisingly, 85-90% of those in need of help either don’t get it because the condition isn’t recognized as threatening; the stigma associated with mental problems or unavailable qualified health providers.[3]

The Central Government has recently called upon centrally run mental health institutions to assist state governments in providing counselling to stranded migrant workers. These Mental Health Institutions opened helpline numbers to address “mental health concerns.” The website[4] of a Central Mental Health Institution reads, “Wish to share any mental health concerns during this crisis of COVID-19 pandemic? Feel free to call our helpline….” But the catch is that this measure will hardly address the grave human rights crisis that the vulnerable communities are facing. Mental health concerns are not to be resolved through counselling over the telephone or distributing pills when people are being discriminated, physically assaulted, humiliated, denied food and shelter and left to die on the highways. These are mental health issues that have to be resolved with strong and systematic political, community and societal response.[5]

Right to Mental Health as a Legal Right

“Where, after all, do universal human rights begin? In small places, close to home –so close and so small that they cannot be seen on any map of the world. (…) Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.”

– Eleanor Roosevelt[6]

The United Nations Human Rights Council (UNHRC) is an intergovernmental body within the UN framework that safeguards all human rights across the world, and recognizes physical and mental health as a human right.[7] Even the World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[8] For a holistic development of a human being, the relationship between mental health and human rights is essentially connected. For instance, the human rights violations that the internal migrants have faced while travelling back home without proper means of transport or food would have negatively affect their mental health. Thus, there has to be psycho-social advancement in the form of financial and clinical healthcare to safeguard the most basic fundamentals rights of everyone in this society.

The Mental Healthcare Act, 2017 has not yet defined depression or anxiety as mental health disorders. It is the need of the hour for the Judiciary to step up and bring classic precedents such as Parmananad Katara[9], Paschim Banga Khet Mazdoor Samiti[10] etc. even under the umbrella of Mental Healthcare System.

In a WHO report[11], it was estimated that globally, less than 5 percent of general government health expenditures are allocated to address mental health. Simply put, mental health budget does not achieve equality with physical health and this creates an implicit hierarchy in which mental health is listed below physical health. The same report, mentions that at least one in four persons suffer from a mental health issue in their lifetime, globally. Mental health does not enjoy parity with physical health around the world. And stigma is an essential determinant of quality of treatment and services that people with mental health problems have to face.

Factors that affect the Mental Health of Migrant Workers

Some of the factors that add to the vulnerability of migrant population are discussed here.

  • Inter-State Migrant Workers are particularly vulnerable to new infections because of social status, occupational hazards, malnutrition, urban unhygienic living conditions, lack of proper sanitation and pre-existing diseases. Migrant workers may function upon reverse migration as victims of infection and transmission.[12]
  • Since most male migrant workers don’t reside with family members, their isolation itself makes them vulnerable to mental problems such as depression and stress.[13]
  • Social isolation is negatively linked to migrants’ mental health. In addition to the issues generated by the pandemic, public health measures such as compulsory isolation or quarantine in the government’s temporary shelters after returning to their original places and social distancing may also contribute to suicide.[14]
  • Access to psychiatric help has become a problem due to the countrywide lockdown with limits on the public transportation systems. While online mental health services are made available, these service arrangements support only a fraction of migrant workers, who have access to internet providers and smart phones.
  • The sudden unemployment of migrant workers with minimal hopes of new jobs in the near future will have their repercussions on the mental health.
  • By granting lockdown relaxation, the government has allowed a reduced number of workers to restart the factories, and some state governments have also granted exemptions from legal provisions originally intended to protect workers in factories , industries and other establishments.[15] This has forced the available employees to work for 12 h instead of the normal 8-hour shift mainly to improve production. Even though this won’t amount to violation of Factories Act, 1948 owing to an extraordinary circumstance, such practices will take a toll on workers who have rejoined the industries by affecting their physical and mental health both.[16]

The Un-lockdown Effects on Migrant Labourers

In a recent study on 98 Migrant Labourers who returned to their hometown, about three fourth of them(73.5 %) were found to be screen positive for depression and about half of the participant (50 %) were found to be screen positive for anxiety.[17]

Today, all of us are waiting for coronavirus to go away and to return to our normal lives. Still, the economy doesn’t hold the same emotions, i.e. it will not be easy for the country’s economy to get back on track this fast. Due to social distancing norms and other constraints, it has become difficult to hire the usual number of labourers. Most of the labourers have gone back home and are living merely for survival with not that great opportunities in villages where they come from.

The primary issue of wage can be tackled in the following manner:

  • By informing the trade union leaders about the specific shortage of labourers or capital. Generally, trade unions look after labourers and trade initiatives of various states, making it easy for them to identify potential labourers wishing to resume work as well as policies to regulate the industry effectively and efficiently.
  • Offering an incentive/ advance to all labourers so that they can balance their daily lives with that wage, and eventually, the advance could be adjusted with their actual pay. This would benefit both employer and employee.
  • Companies can create ‘wage salary fund’ for helping the labourers who are facing a financial crisis, and as the situation normalises, can hire the unemployed labourers again.

These suggestions could help to elevate the mental health of migrant labourers. As it is said, there is always a silver lining at the end of the tunnel. Recent news articles reveal success stories of how migrant labourers are coping up with depression, anxiety, apprehensions, sleeplessness and suicidal thoughts by reaching out to mental healthcare help lines. As per the data collected by Bihar State Health Society (BSHS); nearly 14,000 migrant labourers who returned to their native places in Bihar from other states due to the Covid-19 lockdown have sought counselling and psychological help from mental health professionals in the last three and a half months. Bihar also started an initiative called ‘Ummeed’, a medical treatment facility for mental health problems among migrant labourers, people in health quarantine and isolation centres. [18]

Similarly, so far, nearly 37,681 migrant workers were provided psychological assistance at UP. UNICEF is working with the state government to provide rapid care, sending psychologists, therapists, and psychology-based scholars around the state. A research by a team of experts from the Indian Psychiatry Society (IPS) found that during the pandemic there was rise of nearly twenty per cent in mental health problems.[19]

But the situation is not too optimistic, as most of the counsellors lack professional training. Also, those who require medication for psychological problems and mental illness are unable to access it due to shortage or empty stocks in pharmacies because of the lockdown. Mental health issues needs to be given credit, especially in rural areas, where most of the migrant labourers have returned, as it is a social stigma and also no proper treatment is available.

All the directions and guidelines that have been issued during COVID-19 in India are highlights of “Disaster Management Act, 2005” and “Epidemic Disease Act, 1897”, which discuss do’s and don’ts for crisis management but have no mention of terms such as wage, labourers or migrants. Thus, when such important pieces of legislation have no mention of payment of wages, one cannot blame the government or any private entity for any casualties with migrant labourers including their physical and mental health.

Another legislation that might come handy is the “Inter-State Migrant Workmen (Regulation of Employment and Conditions of Service) Act, 1979” but it makes it mandatory for migrant labourers to register to its portal through Aadhar Card, making the basic necessities and essentials again an unachievable reality as many labourers don’t carry the required documents with them.

Conclusion

It is still astonishing to see the rigour and determination of every single migrant labourer in the country when they took the first step to reach back home. It must not have been easy. But what slips through the cracks is the effect on their mental health through an unprecedented crisis like this.

The undercurrents of structural economic imbalance exposed by the crisis have been due to the strained relationship between capital and labour. The crisis did not manifest in itself; instead, an actively driven dislocation reveals an underground systemic problem which is resistance. But who are they resisting? The question remains unanswered.

Seeing the issue of migrant labourers through the lens of economic force alone presents a distorted view. There is much more to it, a real discontent, real exodus, real suffering. The mainstream media portrayed with callous compassion by politicising the issue with hashtags #MeTooMigrant. The mental health issue of worker/ migrant labourer in India has always been mysterious as it has not become a part of the political action/ discussion yet.

The moment of discussion on these topics has already passed, now is the time to act, to do something for the mental health stigma prevailing in the society, and so why not start with those who need psychological care the most, our backbone, THE MIGRANT LABOURERS. It is high time to build a healthcare system which considers mental health issues at par with other illnesses not just for us, but for the future generations to come.


[1] Aadesh Ravi, “The long march of the Locked-down Migrants” Rural India Online, May 16, 2020, available at: https://ruralindiaonline.org/articles/the-long-march-of-the-locked-down-migrants/ (last visited on August 02, 2020).

[2] Alakh Alok Srivastava v. Union of India, Writ Petition No. 468/2020; Harsh Mander v. Union of India, Writ Petition with Diary No. 10801/2020.

[3] Government of India, National Mental Health Survey of India (Ministry of Health and Family Welfare, 2015-16).

[4] Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, available at: https://www.lgbrimh.gov.in/ (last visited on 05/08/2020).

[5] Sudarshan R Kottai, Migrant Workers and the Politics of Mental Health (Insight, Vol. 55, Issue No. 31, Aug 2020).

[6] Eleanor Roosevelt was an American political figure, diplomat and activist. She served as the First Lady of the United States from March 4, 1933, to April 12, 1945, during her husband President Franklin D. Roosevelt’s four terms in office, making her the longest-serving First Lady of the United States.

[7] Comfort Asanbe, PhD, Ayorkor Gaba, PsyD, and Jeea Yang, MA, Mental Health is a Human Right, Psychology International-December 2018, available at: https://www.apa.org/international/pi/2018/12/mental-health-rights (last visited on 07/08/2020).

[8] Preamble to the 1946 Constitution of the World Health Organization (WHO).

[9] Pt. Parmanand Katara v. Union Of India & Ors, 1989 AIR SC 2039.

[10] Paschim Banga Khet Mazdoor Samity v. State Of West Bengal, 1996 AIR SC 2426.

[11] The World Health Report: Mental Health-New Hope, New Understanding (2001); available at https://www.who.int/whr/2001/media_centre/press_release/en/ (last visited on 07/08/2020).

[12] Ranjana Choudhari, COVID 19 Pandemic: Mental health challenges of internal migrant workers of India, Asian Journal of Psychiatry 2020 Dec; 54: 102254. Published online 2020 Jun 18. doi: 10.1016/j.ajp.2020.102254.

[13] Zhou X., Snoswell C.L., Harding L.E., Bambling M., Edirippulige S., Bai X., Smith A.C, The role of telehealth in reducing the mental health burden from COVID-19 Telemed J. E Health. 2020;26(April (4)):377–379.

[14] Nelson V.M. 2020. Suicide Prevention India Foundation, available at: http://www.rfi.fr/en/international/20200514-mental-illness-suicides-on-the-rise-in-india-during-covid-19-lockdown (last visited on 08/08/20).

[15] Editorial, The Hindu newspaper, 9 May 2020 Contempt for Labour on Dilution of Labour Laws available at https://www.thehindu.com/opinion/editorial/contempt-for-labour-the-hindu-editorial-on-dilution-of-labour-laws/article31538103.ece. (last visited on 08/08/20).

[16] Rivera A.S., Akanbi M., O’Dwyer L.C., McHugh M, Shift work and long work hours and their association with chronic health conditions: a systematic review of systematic reviews with meta-analyse,. PLoS One. 2020;15(4) e0231037.Epub2020 Apr 2.

[17] Krishan Kumar, Aseem Mehra, Swapnajeet Sahoo, Ritu Nehra, and Sandeep Grover, The psychological impact of COVID-19 pandemic and lockdown on the migrant workers: A cross-sectional survey; published in Asian Journal of Psychiatry 2020.

[18] Reena Sopam, “In Bihar, 14,000 migrants seek counselling to overcome lockdown blues”, Hindustan Times, July 18, 2020.

[19] Namita Bajpai, “Addressing mental health issues after the exodus in Uttar Pradesh”, The New Indian Express, July 28, 2020.

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