Many Nepalis around the world have connected with Hemanta Rana’s new single Saili. Praises for the song, which offers a melancholic portrait of a rural Nepali migrant leaving his wife behind to work as a migrant labourer in a foreign country, are making the rounds on social media. 

Saili seems to have struck the right chord not only because half of all Nepali households have either a migrant or a returnee amongst them, but also because Saili presents a more nuanced take on the theme of labour migration compared to many other fictional representations that deal with the same topic. Yes, there are stories about coffins that come back to remind us every day that migration is a matter of life and death to some. But there are also stories that exist in the periphery—for the vast majority—and of journeys that cannot be portrayed on a comparable tragic scale. Nevertheless, those stories need to be told as well. 

Migration and mental health

Despite the importance of labour migration to our flailing economy, not enough attention has been paid to the mental health of migrants and their families. And what Saili does—so beautifully at times—is that it brings an often overlooked issue about migration and mental health into the limelight. 

Leaving one’s home to study or work abroad is an inherently difficult and mentally taxing endeavour. Individuals who migrate have to adjust to new surroundings and cope in an environment that is alien in several ways. The process of migration itself can be stressful—especially for low-skilled workers who are known to suffer rough treatment at various stages during pre-departure—and can affect the mental well-being of migrating individuals and their families. 

Long separation from loved ones can worsen various forms of mental illnesses like depression and anxiety. In most instances, when these individuals suffer from mental illnesses, they do not receive proper care and treatment on a priority basis. That ends up affecting their occupational functioning initially, and can later lead to severe consequences such as suicide. 

Layered manifestations

According to the International Labour Organisation, out of 4,322 Nepali migrants who lost their lives across different destination countries between 2008 and 2015, 10.4 percent chose to end their own lives. The majority of these suicides happened in destination countries in the Gulf and in Malaysia. The number of Nepali migrants who committed suicide in the last fiscal year went up from 81 to 94, despite the number of outgoing migrants decreasing due to lower numbers departing for Malaysia last year. 

Individuals who are forced to take their own lives are cases where mental health problems manifest in the most severe and unfortunate ways. There are many others, however, who do not end up taking their lives, but still struggle with depression and anxiety in their everyday existence. For some this might mean years of working under mental suffering, and for others it might mean prematurely returning home due to lack of help and support abroad. 

Data is limited, but for many Nepali migrants who are forced to return prematurely from their jobs abroad due to mental illness, further difficulties at home could become unavoidable. Migration is an expensive investment for many low-skilled workers, who often borrow money to move abroad in the hopes and dreams of creating a better future for themselves and their families. Being forced to return prematurely due to mental disorders mean these hopes are dashed, inevitably leading to further distress as well as economic consequences. 

Overlooked issues

Similar to most other problems faced by migrant workers, mental health issues start at home. This is problematic in a country like ours where mental health is still considered a taboo for the majority of the population. Since mental health is a culturally sensitive topic, there is a tendency to overlook or hide initial symptoms of mental disorder. In addition, the medical check-up conducted before migrants depart severely lacks any formal screening mechanism to check for mental illnesses. The situation gets ridiculous when migrants are denied the right to board a plane because of small irrelevant patches on their bodies, but they can get clearance even if they have not slept well for days in a row. 

Small steps need to be taken to improve the mental health services offered to migrants. First, a comprehensive mental health screening tool should be prioritised as part of the pre-departure orientation process. Such a tool can facilitate better identification of migrants who need help before departure so that adverse consequences can be avoided in destination countries. In order to assess and improve the effectiveness of such tools, evaluations can be conducted with the help of government agencies, international donors and human rights organisations. Second, the government must make provisions for migrants with severe mental illnesses to be treated abroad before they are sent back. This can be done by offering platforms where migrants can voice their concerns through embassies and labour attachés. Special care must be taken to protect the migrants’ privacy and their right of disclosure of culturally sensitive topics. 

With small improvements in how labour migration is governed in our country, maybe a day will come where the migrant experience will be written in a way that offers hope, optimism and a chance for a better life. But, more importantly, even if identifying and offering better mental health services saves one extra life abroad, that is one less coffin that returns home, one less family that suffers the loss of a loved one, and one more child who can continue going to school. After all, no person leaves their home without firmly believing that the future will be better than the past.

- Adhikari is a consultant at the World Bank in Washington DC; Pant is a 

consultant psychiatrist at the Department of Psychiatry and Mental Health at TU Teaching Hospital