Last year, the Ministry of Health and Population sent a team of doctors, including psychiatric consultants, to South Korea at the request of the Ministry of Labour, Employment and Social Security to look into the deaths of Nepali workers in foreign land.

The government move was prompted by a sharp rise in the number of deaths of Nepali migrants workers—821 in 2017 from 755 in 2016.

Dr Mohan Raj Shrestha, a senior psychiatric consultant, led the team to South Korea, which conducted health screenings of the Nepalis working there.

“We found shocking mental health conditions among some Nepali youths there,” Shrestha told the Post. “Most of them were overwhelmed by loneliness and homesickness. There were many who were found to have suicidal thoughts. Some complained of excessive fear for no apparent reasons.”

According to Shrestha, some people, who were already suffering from mental health problems, were found to have discontinued their medication, largely due to communication problems. Some migrant workers did not know they were suffering from mental health issues even though they complained of insomnia and anxiety. Most of the workers were found to have refrained from seeking treatment because of costs.

“Doctors do not easily prescribe medicines due to which Nepali youths are compelled to live with the ailment,” he added.

At least 77 Nepali migrant workers died in South Korea between 2008 and 2017, according to the third Labour Migration for Employment: A Status Report for Nepal report made public in May last year. The highest number (2,154) of deaths was reported in Malaysia. The total number of deaths from 2008-09 to 2016-17 stood at 5,892.,

While the major cause of deaths (1,152) was cardiac arrest, according to the report, 650 (543 males and 7 females) had committed suicide.

Gulf countries, Malaysia and South Korea are the most favoured destinations for Nepali workers. According to the national report, the highest number of deaths was reported in the fiscal year 2014-15.

Though country-wise data on suicides was not available, the government had sent the team to South Korea to study the pattern of health problems, including mental ailments, migrant workers were living with.

Upon return, the Shrestha-led team had prepared a report, and one of the recommendations was mental health screening of workers applying to work abroad.

However, no action has been initiated as per the recommendations.

Doctors say mental health is a serious issue and it has a profound impact on an individual’s well-being and that there is a rise in the number of migrant workers suffering from mental problems abroad.

While pre-employment medical check-up is mandatory for all youths seeking jobs in foreign countries, in which physical fitness and infection of contagious diseases are examined, mental health issues have been ignored.

The stigma attached to mental health issues also makes people uncomfortable talking about their problems even if they have any, say doctors.

“Some people commit suicide and others end up on the roads and behind bars,” Dr Ananta Prasad Adhikari, a consultant psychiatric at Nepal Mental Hospital, told the Post. “While the number of such patients has seen a rise in the country, we have also seen many migrant workers visiting us for mental health issues.”

According to hospital officials, some migrant workers head to the hospital directly from the airport seeking help and medicines.

Professor Saroj Ojha, head of the Department of Psychiatry and Mental Health at Tribhuvan University Teaching Hospital, said the maximum number of youths, who go abroad for employment, suffer from anxiety and depression.

“Depression leads to suicide. Many migrant workers are found to be suffering from depression and this could be the reason behind the suicide cases going up,” said Ojha. “On an average, 40 youths returning from abroad visit my clinic for mental health issues every month.”

Most of the foreign returnees are found to have complained of insomnia, anxiety and lethargy as well as alcohol abuse, among the major symptoms of mental illness.

Some foreign companies, which hire Nepalis, send workers back after they are diagnosed with psychotic disorders. But some companies just expel them, leaving them on the streets. Left without an option—job or money—some commit crimes and land in jail.

Doctors say one of the ways to address this challenging problem could be making mental health screening mandatory for migrant workers. Clinical psychologists and psychiatrists can easily diagnose mental health problems.

Ojha suggested sending psychologists and psychiatrists to countries where the concentration of Nepali workers is high to conduct check-ups and to discuss mental health issues with them.

Since the money remitted by migrant workers keeps the country’s economy afloat, experts say the government needs to pay equal attention to their well-being. In the decade from 2008 to 2018, the country received Rs 4.48 trillion in remittances, but at the cost of 6,000 lives of its citizens.

They say migrant workers’ health and well-being can have a far-reaching impact not only on their families but on their communities and society as a whole.

“A healthy migrant worker—without any physical or mental illnesses—can contribute with more work and earn better and save more,” said Adhikari. “And the savings can hugely uplift the living standards of his/her family, which can contribute to the society’s well-being.”