Mental Health and Psychosocial Impact of Migrant Workers during COVID19 in India

In a country like India with an exploding population of 1.3 billion people, COVID19 has been particularly brutal to the migrant workers. With a Google search of 13.60 crores, "COVID19 and Migrant Workers" has become one of the most important topics in the digital space which needs examination. Many studies showed a positive correlation between common mental disorders and adverse conditions like poverty, inequality, and financial debts and problems. The sudden declaration of the lockdown in March 2020 in a bizarre and episodic manner took a toll on the mind of these migrant workers. There was a significant deterioration of mental health among the migrant population which had even aggravated during the post lockdown period. Thus, the present exploratory research based on secondary data was done to explore the intricate details linked with the psychosocial impact of migrant workers during the COVID crisis suggesting a need of social support system for migrant workers during such events.


Introduction
"Everyone is affected by this pandemic. The stresses of confinement, job loss, stigma, and xenophobia certainly have an impact on mental health. Those most vulnerable including migrants, mobile populations, and seasonal workers, face a unique set of challenges. We must ensure everyone is included in our mental health response, especially during COVID19."

-Antonio Vitorino, International Organization for Migration (IOM) Director
Corona virus disease is "an acute infectious respiratory disease caused by a newly discovered corona virus (SARS-CoV-2)" (1). In this disease, people usually experience mild to moderate level of respiratory problem and it is severe to older people with "underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, etc." On 11 th March 2020, the World Health Organization (WHO) declared COVID19 as a pandemic. Initially the focus was particularly centered in China, however gradually the spread has shifted throughout the entire world. To navigate through this crisis, the World Health Organization (WHO) had advised countries to build a comprehensive strategy to save lives and minimize the impact (2).
In a country like India with an exploding population of 1.3 billion people, COVID19 had been particularly brutal to the migrant workers. With a Google search of 13.60 crores, "COVID19 and Migrant Workers" has become one of the most important topics in the digital space which needs examination.
The Objective of the study were 1) to examine the condition of the migrant workers in lockdown and post-lockdown situation, 2) to understand the mental healthcare needs of the migrant workers amid the pandemic, and 3) to understand the psychosocial impact of the migrant workers during the crisis.

Methodology
Exploratory research based on secondary data was done to explore the intricate details linked with the psychosocial impact of migrant workers during the COVID crisis. The secondary data was collected from research papers, newspaper articles, international journals and books for the study. The said data had played a crucial role in the research study and in covering the nuances of the study in an efficient manner.

Status of migrant laborers in India
With a collaboration of 29 states and 7 union territories, India is popular for its "unity in diversity". Each state has its vigor and uniqueness. However, current social system of India has a wide range of disparity among economical sources among states. Due to social and economic factors, rural people often move from pillar to post and hence inter-state migration takes place. According to S.K Das, Migration is "a process of movement of an individual from his place of birth to a new place of residence". According to the Inter-State Migrant Workmen Act1979, an inter-state migrant worker is referred to as "any person who is recruited by or through a contractor in any state under an agreement or other arrangement for employment in an establishment in another state, whether with or without the knowledge of the principal employer of such establishment" (3).
Again, the inter-state migrant laborers are often defined as those individuals who hail from the economically weaker section and move from their birth state to another state "in search of jobs" which provide them comparatively higher wages, better way of living among other factors. Because of their continuous movement, they are also often referred to as the floating population.
According to the 2001 census, there are about 14 crores of migrant laborers in India. The majority of these workers are involved in building construction, agriculture, street vendors, stone quarries among others. For decades, millions of laborers have moved from one place to another in search of job opportunities and better livelihood without any restriction. The main reason that compels this moving pattern is economic factors. Poverty, unemployment, lack of proper education, and poor wage payment are some of the reasons that contribute to this migration.
The tales of migrants travelling back to their native villages is witnessed in the earlier crises. The bubonic plague of 1994 has parallels to COVID19 where these migrant people departed from Surat which created an employee crunch when factories reopened. In Calcutta's jute industry in 1931 similar incident was encountered following the 1929 economic upheaval. The then British colonial Labour Commissioner R. N. Gilchrist wrote: "…workers moved back to the rural areas en masse, without signs of protest: they disappeared as 'snow for the sun". The Corona virus pandemic also witnessed a similar historical trend (4).
The problem with migration is that the availability and accessibility of health becomes a challenge to the migrant workers. In general, migrant clusters and individuals are often isolated from the accessibility of health utilization despite health being a basic right. Studies show how migrant laborers in India exclude themselves from the benefit of national health programs due to their constant mobility pattern (5).
Studies again reveal that the host state plays a huge role in determining their health and wellbeing of the migrant laborers. These individuals get easily succumbed to infectious diseases. Again, it is found out that there is more prevalence of depression among migrant workers than the general population. Many studies have shown a correlation between common mental disorders and adverse conditions like poverty, inequality, and financial debts and problems. Again, social inequalities in terms of gender, education, race, income also reciprocates with common mental illness. Thus, because of their vulnerable position, the migrant workers are often exposed to these risk factors (6).

Indian migrant laborers during COVID19
When the COVID19 pandemic hit the country, to combat the disease, the nationwide lockdown was imposed by the government from March 24 th 2020. During the existent confinement period, while most of the people somehow insulated themselves within their home, it is the migrant workers who were exposed to the extreme ends of the unforeseen events like pandemics. According to the Economic Survey Report of 2018-19, the migrant and informal workers comprised of 93% of total India's workforce (7). In a survey conducted by the Stranded Workers Action Network (SWAN) from April 8 th to April 13 th 2020, it was found out that 90% of the workers did not receive ration from the Government and close to 90% of those surveyed were not paid by their employers. It was also found out from the survey that less than Rs. 200 was left with 70% of the surveyed laborers (8). Thus, these factors contributed to the elevated risk that the vulnerable section of the society faces because of the sudden lockdown.
The government's decision to stop public transport triggered the attempt to move back to their hometown or villages via walking. The ruthless lockdown had forced the migrant workers to try walking back to their homes in order to ride out the pandemic crisis (9). With the rapid increase in the number of COVID cases in India, the government defended their stand on the extreme lockdown measures as "absolutely necessary" and asked for "forgiveness" for the difficulties imposed on the "poor countrymen".
As these workers (along with their families) started to trudge back home -they faced issues like starvation, road accidents, suicides, exhaustion, and death and their images and stories started flashing in different media channels and newspapers. Soon after their problems became the headlines of national and international media. Their desperate want to reach back their hometowns by traveling long distances had brought these migrant workers' plight to the forefront. The nations' conscience was stirred by seeing the elderly and the little children walking thousands of kilometers to reach their homes and put their lives at stake.
With a lack of proper housing, sanitation, economic stability, and uncertainty, the unskilled and illiterate daily wage owners had a significantly higher risk of mental disorders. According to the National Crimes Record Bureau report 2018, it was found out that there were 22.4% suicides among daily wage earners with the maximum number of cases being reported from Maharashtra, Tamil Nadu, West Bengal, Madhya Pradesh, and Karnataka.
The sudden outbreak of the COVID19 pandemic followed by the nationwide lockdown had caused deterioration in all the social determinants of health. Loss of jobs, unemployment, insecurities, and social isolation were on the high and resulted in further deterioration of the mental balance of these workers and it may even worsen during the post lockdown period. There were high rates of suicides considering the poor mental health utilization of services. Thus, the emphasis on mental health and wellbeing becomes an important issue to focus on.
The International Organization for Migration (IOM) necessitated a focused approach to be taken by governments so that they cater to the needs of these workers' mental health. Even the World Health Organization (WHO) highlighted the importance of mental health during the crisis with particular reference to migrant, displaced, and vulnerable groups. "Everyone is affected by this pandemic. The stresses of confinement, job loss, stigma, and xenophobia certainly have an impact on mental health.
Those most vulnerable including migrants, mobile populations, and seasonal workers, face a unique set of challenges. We must ensure everyone is included in our mental health response, especially during COVID19." -said Antonio Vitorino, IOM Director (10).

Struggle Of The Migrant Workers during COVID19 pandemic
"One bag on his back and another slung across his chest, He still had more than 600 miles to go to reach his home in the state of Bihar." The corona virus disease had triggered tremendous hardships and apathy towards the migrant workers. While several had lost their lives in tragic accidents and incidents from across the country (for instance, in a road accident in Madhya Pradesh, seven migrant workers died while the truck overturned), others started their journey with the hope to walk back to their houses far away. Monetarily being weak, their ability to survive became a challenge. Since these laborers had to cross the urban hot spot COVID19 huddles and they were not maintaining any social distancing norm, they were exposed to the threat of the COVID infections. When asked to a migrant worker, he replied by saying, "… I would rather die from the virus at home, than from starvation here" (11).
"You fear the disease, living on the streets but I fear hunger more, not corona" Migrant workers were against the lockdown from the very beginning. In Kerala, thousands of workers had assembled on the streets to voice out their problems relating to starvation. The Government being uncertain changed sides continuously and the police often being confused resorted to violence. With the sudden declaration of the lockdown, thousands of laborers were suddenly delineated to the status of homelessness with no source of income.
Even though the lockdown was a good decision, it only catered its goodness to the wealthy section of the society; the poorer people with no financial strength had to bear the brunt of it. In the absence of any clear policy, the migrant workers were left with distress calls and uncertainty. Being pushed to the edge of extreme apathy and anxiety during the extended lockdown, the migrant workers are committing suicides. Again, many individuals on their way back to their village or hometown or native places had collapsed due to extreme mental trauma about financial saturation and exhaustion.
The migrant workers who decided not to move back to their native places were not fortunate either. In order to survive, they are selling the basic amenities of life like mobile phones. Caught in the quagmire of unemployment and unsettlement, these people were thrown in front of the capitalist class as bait. Thus, in this predicament, the psychosocial impact and mental health condition of these people become important to cater to.

Mental Health: A Pre-Requisite Mental health is not just the absence of mental disorder. It is a state of well-being in which every individual realizes his or her potential, can cope with the normal stresses and work productively and fruitfully and can contribute to her or his community. -World Health Organization (WHO).
The World Health Organization (WHO), defines health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" (12). The definition holds true equally for the displaced and migrant individuals.
The nexus between staying healthy and being productive is very important for the social and economic development of this group of people. There are a plethora of conditions and factors that determine the health of these migrant people. These elements and factors are eluded as "social determinants of health" (13). Migration, among other factors, is considered as an important social determinant of health because it has the power to impact health.
The correlation between migration and health is often defined as complex and compounding. Conditions encompassing migration can both act as an enabler of health as well as exacerbate health vulnerabilities depending on the situation. The National Epidemiological Disease Surveillance system states outbreaks and diseases can affect public health deeply.
Since time immemorial, scholars and academicians are researching about the reciprocity between mental health and experience of deprivation and unemployment. Past research shows that there is a detrimental effect between unemployment and mental health and a positive correlation between employment and mental effect. Thus, mental health has a potential endogenous relationship between employments.
Unemployment, when involuntary and unanticipated demonstrates a lower level of psychological wellbeing. Unemployment often links itself with several psychological issues like anxiety, depression, violence, and even suicide. These linkages are true not only for the "surveys of those already unemployed" but also for the studies that relate to individuals with no mental issues into a "period of unemployment". (2000), mental disorder can be defined as "…a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original causes, it must currently be considered a manifestation of behavioral, psychological, or biological dysfunction in the individual."

According to American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders
With the declaration of the nationwide lockdown, thousands of migrant workers around the country witnessed sudden unemployment and financial exhaustion. Apart from unemployment and poverty, these laborers also faced other stressors like unequal access to health, lack of safety and support system, lack of proper reliable information, language comprehension among others. Those individuals who got proper information found it hard to seek help for their symptoms due to the fear of getting arrested or deported. These realities unguarded the migrant laborers even more and steered them to mental and psychosocial issues (10).
The entire process of migration itself creates extreme stress and difficulty for some migrant workers who are vulnerable to develop mental illness. They often consider themselves alien in the new surrounding while adapting to new cultures and ways of living which often takes a toll on their mental health status. Researchers cite two main reasons for the derangement of the mental health status of migrant workers. First, migration, at times, referred to as 'uprooting' is a process where an individual has to leave everything behind and adapt to a new environment; and the second reason being the excessive social unrest generated by social isolation, cultural conflict, identity crisis, low socioeconomic status among others.
While dealing with the crisis of the pandemic, these migrant workers faced more threats to psychosocial health and well-being. The decision to move along with the fear of the unknown, starvation, anger, epidemic, and a sense of impending loss took a toll on the minds of these people. Stigma and discrimination associated with these migrant workers being potential carriers of COVID also had negative reciprocity with mental health.
Around the world, mental health experts are of the opinion that people with existing mental trauma and depression are more likely to experience deeper anxiety (with particular reference to migrant workers) which they are referring to quarantine fatigue.
In Goa when a business strategy consultant with his team was volunteering for COVID19 outreach, it was found that around 51 workers came forward to talk out their frustration and issues to the counselors. The counselors visited the migrant workers in their hutments -where they lived. It was understood from the study that "nobody was happy to be getting free food, nobody was happy to be standing in line." Everyone was stressed about their economic distress. Their database also revealed that dignity played a crucial role in these individuals' lives and they were lining up for government support only because of their helplessness. Through this study, it was understood that only distributing food was not enough during this crisis, this migrant population required psychological support because of the sudden traumatic experiences they were undergoing (3).
Thus, the mental health of the migrant workers should had been considered seriously particularly during the lockdown and post lockdown period. There is a need to assess the psychosocial impact and the mental health status of these migrant populations. The above framework described how migration, in general, affected the mental health of the migrants. So, in a stressful circumstance like the COVID pandemic when the laborers were caught imbroglio of unemployment and poverty, there developed a widened importance of the psychosocial and mental health needs of these populations.

In need of psychosocial support
People with financial problems and unemployment at the same time, face a lot of stress. With the immediate proposition of the lockdown, the migrant workers were triggered with the concerns related to food, shelter, healthcare, fear of getting infected, loss of wages among others. All these factors led to fear and anxiety in the mind of these vulnerable groups which needs strong protection and psychosocial support. Mental health and psychosocial actions need to be contemplated as indispensable elements for "national response" to the Corona pandemic.
Psychology research proves that uncertainty has an association with a negativity bias. Negativity bias is the human tendency to register and dwell on negative stimuli more readily than on positive stimuli. As migrant workers faced the harsh reality during the COVID crises they needed physiological support (like safety, belonging, and esteem) along with psychological help. The instantaneous retaliation during this pandemic situation should include proper measures like assuring community shelters and kitchen, availability of relief materials, guaranteeing physical safety, ensuring the requirement of social distancing, identification of suspected infected, adherence to proper protocols in such cases among others.
There are various actions that can be adopted as a part of support even for any such pandemic such as: • Treating every migrant individual with respect, dignity, compassion, and empathy.
• Understanding their concerns and listening to their problems patiently.
• There should be no generalization and every individual should be catered to for their specified needs and requirements.
• Providing them with the hope that normal life is going to re-bounce back soon and help them acknowledging this unusual situation of uncertainty and ambivalence.
• Informing the migrant workers with reliable information and about the support being provided by the Central Government, State Government, NGOs, healthcare systems, and others.
• Making them realize the importance of staying in one position and how mass mobility can be detrimental and affect the efforts to contain the virus.
• Making them understand their self-worth and appreciating them for their contribution to society.
• Assuring them that charitable organizations and local administration will extend their support even if their employees fail them.
• Even if some individuals react in a way that is insulting, it should be understood that they are going through a harsh time and hence one should try to be patient and calm towards them.
• Seeking their support in order to win over this situation of crises together instead of reflecting mercy on them.

Limitation
The limitation of the study was that the samples used to generate the secondary data were small and hence the result cannot be accurately interpreted for a generalized population.

Conclusion
Migration itself is a phenomenon that involves a lot of complexity. An individual migrant goes through a lot of adjustments to a lot of stressors. Thus, in such a predicament like COVID19, there is a significant deterioration of mental health among the migrant population which may even aggravate in the post lockdown period. From this study, it was found that mental health and wellbeing is very important and crucial to strengthen the social support system, especially during the crisis. As India had already relaxed lockdown restrictions, the more attention should be given to these informal migrant workers so that we can protect them from long term mental trauma and depression. In the post-pandemic world, the migrant workers need to be made aware that it is not necessarily all bad news, and there are signs that it may bring about new opportunities for them and thus in this context mental and psychosocial support services should be enhanced according to the need of the people.