COVID-19: Mass exodus of migrant workers in India, are we staring at a mental health crisis?

Every day, Indian newspapers and media are flooded with tragic stories of migrant workers who in their desperation to reach their villages are choosing every possible mode of transport including walking to cover hundreds of miles. This mass exodus started in May after the Indian government relaxed lockdown rules.

When nationwide lockdown was announced in March, these people lost their jobs overnight and were confined to their temporary living spaces over the next 40 days, surviving on their meager savings, food supplied by nongovernment organizations and Samaritans. They endured all limitations imposed by the lockdown, isolation, sudden job loss, uncertain future, and rumors/fear about the pandemic and took all that in their stride.

According to census 2011 report, there are 139 million internal migrants in India and another 9 million migrants are added every year. People travel hundreds of miles often with their spouses and kids in search of better livelihood.

Global estimates indicate that 5.2 million people are displaced annually for various reasons such as natural disasters, political conflicts, and terrorism insurgency.[1] Internally, displaced persons carry substantial physical and mental health risks that sometimes cause long lasting and enduring impacts.[2] Women and children constitute a significant portion of this migratory population.[3] The potential impact of migration/displacement on the mental health of these especially vulnerable populations is difficult to predict. The prevalence of common mental diseases such as major depression, anxieties, posttraumatic stress disorder, and substance use disorders are reported to be between 20% and 40% in different studies.[24] It is also reported that many times women migratory workers are victims of physical and sexual violence.[5]

After the initial lockdown stress and travails of travel these workers will be facing a series of challenges both physical and mental once they reach home, a 14-day quarantine period and the s stigma. With of chances getting work in the villages being limited these families are vulnerable for hunger and illness. Unemployment and food scarcity are frequently found in association with mental disorders in several studies.[6] Series of traumatic physical, mental, and social experiences since 2 months their abilities to cope with are already stretched. Among displaced persons hopelessness for the future raises risk of mental disorders and suicides.[7] With continued uncertainty and hopelessness their risk of developing serious depression, substance abuse, and suicide are high.

Mental health professionals and community mental health services play an effective role in facilitating recovery in such situations. In India, regrettably mental health infrastructure and number of mental health professionals available to help them are limited. There are about 0.75 Psychiatrists for every one lakh population in contrast to 5–6 per lakh population in the developed countries. Most of them are in urban areas and unevenly distributed. The gap between number of migrant workers who might need mental health support and professionals, infrastructure available is huge. Government and policy makers need to take an urgent call on this impending crisis by making judicious use of the available resources and technology like telepsychiatry to reach them in time.

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