Psychosocial intervention model for migrant workers during extended lockdown: The Chandigarh model.

BACKGROUND: Human suffering and future uncertainty due to extended lockdown is enormous and this is much more among migrant workers. AIM: The aim of this study was to design and utilize a model for psychosocial intervention for migrant workers during the extended lockdown.
MATERIALS AND METHODS: In Chandigarh, due to lockdown, 61 migrant workers from various states were lodged in a shelter home at village Maloya, located in the outskirt of Chandigarh. Since no specific model was available to handle the psychosocial issues of this specific population, hence, an attempt was made to prepare a model for psychosocial intervention using Maslow's hierarchy of needs.
RESULTS: Changes in infrastructure and facilities provided to migrant workers due to implementation of this model for psychosocial intervention helped the participants seeing beyond their problems.
CONCLUSION: Psychosocial intervention model based on Maslow's theory was found suitable for migrant workers in shelter home in Chandigarh. Copyright:

INTRODUCTION

Migrant population have many psychological issues related to their basic needs and mental well-being. Firdaus has previously analyzed the social environmental issues for mental health needs of migrants in the urban center of India.[1] In recent time, a sudden national lockdown was declared in India, starting on March 25 in the first phase and extended thrice up to 68 days.[2] The sudden imposition of lockdown resulted in enormous hardship for migrant workers.[3] More than 21,600 shelter/relief camps were set up in the country for migrant workers.[4] In an era of increased globalization, population migration is becoming frequent. As per the latest census, the level of urbanization in India has increased from 27.81% in 2001 to 31.16% in 2011.[5-7]

Previously, the work carried out has reported on the socioeconomic and environmental problems faced by the migrants. However, there is no work reported in the literature to study their psychosocial support services, either during pandemic or extended lockdown. Hence, the present study was planned with the objectives of: (a) To determine the sociodemographic characteristics of the migrant population residing in a shelter home (b) To design and utilize a model for psychosocial intervention to handle the psychosocial support services for migrant workers residing in a shelter home.

MATERIALS AND METHODS

In Chandigarh, due to lockdown, 61 migrant workers from various states were lodged in a shelter home at village, Maloya, Chandigarh. The Department of psychiatry of Government Medical College and Hospital, Chandigarh, was asked by the Ministry of Health and Family Welfare, Government of India, to provide psychosocial intervention to the residents housed in the shelter home. The mental health team (MHT) from the Department of Psychiatry initially followed NIMHANS guidelines[7] to address the physical and emotional needs of this vulnerable population which was found to be not sufficient, thus the MHT decided to design a model for psychosocial intervention for migrant workers. A concise, yet comprehensive, 12-step model was prepared keeping its feasibility for community psychosocial intervention for migrant workers in the shelter home [Table 1]. Maslow's model has been used to provide a framework to link the determinants of psychosocial needs to components of the intervention.[89]

Table 1

List of components of intervention

Problem area	Components of intervention
Lack of basic needs	Regular supply of food, water, comfortable place to sleep was ensured
Lack of privacy	Ensured privacy by making small partition as they may not be known to each other
Lack of security	Arranged security, particularly of ladies and small children
Lack of medical needs	Attended to medical needs and ensure medical needs on SOS basis
No safe place for valuables	Since they were returning home and must be carrying cash and valuable articles, arranged lockers
Lack of trust	Since they have come from different places, encouraged interaction so that they recognize and trust each other
No contact with families	Made arrangements for them to contact their families
Safety of their family and society	Tried to convince that the decision to lockdown has been taken for their safety and safety of their family and society at large
Self-esteem	Made them feel that the efforts will not be effective without their support and they have an important role to play
Support from government agencies	Reiterated that the government is trying to reach out to them and various other agencies are there to support them
Support for decision	Re-assured that situation is temporary and very soon they will be able to reach their native place
Voice of group	Among the group, asked them to select their representative who can talk on their behalf
	Work with that person closely and make him feel proud that he has larger responsibility to fulfill

SOS - Saviour drug or medicine

The research protocol was approved by the competent authorities and institutional research committee and ethics committee. The inclusion criteria were (a) new participants residing in shelter home (b) at least 2 weeks stay in shelter home (c) any gender. Exclusion criteria were refusal to participate and language/communication problems. No participant refused to participate in the project or had language problems. The participants who gave informed consent were administered sociodemographic sheet, details of job work profile clinical evaluation for the screening of psychiatric disorders, and substance abuse. Assent from those 7–14 years with parents' consent was obtained.

RESULTS

A total of 61 residents of the shelter home utilized the psychosocial services during their stay in the shelter home during the lockdown. Out of 61 residents, seven were children and adolescents. The age distribution details revealed that majority of participants were in the age group 21–30 years (44%), followed by the age group 11–20 years (32.78%). The mean age of the residents who participated in the project was 25.83 years (standard deviation 10.30). Male (77%) outnumbered female (23%) in the gender distribution of the participants, majority were single (60.6%) and illiterate (42.62%). In job profile status, 27.86% of the respondents were daily wagers, 14.75% were cloth vendors, 11.47% were factory workers, 9.83% were granite workers, and 9.83% were housemaid/cook/working in a restaurant. About 63.76% of workers were from Uttar Pradesh, followed by West Bengal (14.75%), Rajasthan (13.12%), Madhya Pradesh (1.63%), and Karnataka (1.64%), Bihar (1.64%), and Punjab (1.64%). Table 1 depicts the components of intervention based on the 12-step model of psychosocial intervention. These components of the intervention were provided in a stepwise manner after removing the problematic areas.

DISCUSSION

This is the first project from North India to obtain direct information regarding psychosocial problems faced by the migrant workers and designing a model for psychosocial intervention for migrant workers during the extended lockdown. This Chandigarh model for psychosocial intervention was different from already available disaster models in many ways. The Chandigarh model for psychosocial intervention was based on Maslow's theory of hierarchy needs. In disaster models documented in the literature, handling the severe life-threatening stressful situations of the victims was prioritized.[1011] During a disaster event like earthquake, flood, and tsunami, one of the most common and effective informal health community interventions reported in the disaster manual is called psychological first aid. Psychological first-order intervention after a crisis, an emergency or a disaster is designed to reduce the distress caused by exposure to a traumatic event, and to enhance the knowledge of the protective factors that helped the person to survive the event.[12131415]

In the NIMHANS model, psychosocial issues of the migrant population were taken which were theoretical. In the present model, it is more realistic and practical based on the ground-level situation in a shelter home. In this model emphasis first was on the fulfillment of basic needs prior to commencement of group sessions with migrant workers. NIMHANS model has not taken into consideration the five levels of needs as proposed in Maslow's hierarchy of needs.[5] Maslow's model was chosen as people are motivated to achieve certain needs and that some needs take precedence over others. Application of Maslow's Hierarchy model-based psychosocial intervention would help propel mental health-care professionals toward comprehensive care of the whole person, not merely for survival, but toward the restoration of all important functions of mind and body. For this purpose in the Chandigarh model and looking at shelter home psychosocial intervention, once the most basic and physiological needs are met, migrant workers could proceed to concerns regarding psychological and higher order needs. Physical survivorship was no longer the goal, but rather emotional and psychological functions, happiness, and physical abilities of the participant should all be considered important needs that can be immediately addressed and incorporated into psychosocial intervention.

The strength of this project was that it was a unique attempt; there was no such project from North India that has proposed the model for psychosocial intervention among migrant workers during the extended lockdown. However, certain factors may affect the implementation of this model in other centers. There was smaller number of migrants in Chandigarh, the administration was providing unstinting support, and there was only one migrant shelter home where this model was implemented. The authors recognize that the model was preliminary and our study population was selective.

Despite the limitations, this study identified psychosocial issues in migrant workers. Thus, this study represents another meaningful step toward understanding how a project designed for psychosocial intervention could be useful in providing support services to the migrant workers during the lockdown. There is limited knowledge about psychosocial intervention for migrant workers during the lockdown. The present study reduces this knowledge gap, especially as it attempts to design a model for psychosocial intervention for migrant workers during the extended lockdown. Additional research could focus on how it may be utilized to promote psychosocial intervention strategies in the lives of migrant workers.

CONCLUSION

The model for psychosocial intervention to handle the psychosocial support services based on Maslow's hierarchy of needs designed in Chandigarh was useful in resolving multiple psychosocial issues of the migrant workers. Application of Maslow's hierarchy model-based psychosocial intervention would help propel mental health-care professionals toward comprehensive care of the whole person, not merely for survival, but toward the restoration of all prepandemic era function of mind and body. This Chandigarh model for psychosocial intervention for migrant workers could be helpful in future training and research and could be replicated at shelter home of other states of India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.