How Bengaluru counsels its stranded migrants

Shiv Kumar wasn’t the type to keep up with the news. When Narendra Modi announced the 22 March Janata curfew, Kumar first thought the Prime Minister had declared a national holiday. Two days later, however, Modi made another announcement and construction work at the office complex in Bengaluru stopped. The streets were deserted, his family in Begusarai, Bihar, told him all economic activity had ground to a halt in their village as well, and he realized something sinister was out there.

The 42-year-old mason now starts and ends his day with news clips on YouTube. Coronavirus is a “chhua-chhoot ki bimaari" (a contagious disease), he has gathered. The rich people returning from Italy, China and Japan brought it to India, the poor have to pay the price. Union home ministry guidelines this week allowing the conditional return home of workers have come as welcome news but Kumar fears the logistics may mean he has to stay where he is for another two-three weeks.

“If we survive this, there’s hantavirus waiting to come," says Kumar. “Some say there’s an asteroid that’s going to strike us in a few days. Barely 2-3% of humanity will survive."

Many workers are confronting this mix of panic and anxiety, fuelled by half-truths and fantasy. There are millions like Kumar across the country—“migrant" workers who cannot go home, whose savings are drying up. They are uncertain about their future, only a phone connects them with families thousands of kilometres away.

Over the past month, thousands of them have gathered in Delhi, Mumbai and other cities; in at least one instance, lured by rumours of the government allowing them to travel home. Countless have walked, biked and hitchhiked for days in an attempt to reach homes. Dozens are feared to have died of exhaustion or starvation en route. Such is the scale of the crisis that the UN high commissioner for human rights called it a “human tragedy unfolding before our eyes".

Kumar is a thin man with a baby face. He and I had connected over a video call four weeks into the lockdown. A staffer at the Bengaluru-based National Institute of Mental Health and Neurosciences (Nimhans) had helped; they had conducted a preliminary mental health screening exercise at Kumar’s construction site.

For nearly a month, professionals from Nimhans and the city civic body’s district mental health programme (DMHP) have been visiting shelter homes, relief camps and construction sites to counsel workers. “Mental health is a big issue right now," says Naveen Kumar, the Nimhans psychiatrist in charge of the exercise. “It is considered as another pandemic occurring in parallel to this one. It’s so dire that how much ever we do, it’s not enough."

The project Shiv Kumar was working on—a five-storey office for the Karnataka state electricity board—is half ready. Kumar and 70 others live in tin sheds by its side, three-nine people per room. Wages have stopped; most live off handouts from the contractor or borrow from the local grocer. There isn’t much to do but eat and sleep; they are missing the two pegs of alcohol in the evening. “And as the virus spread gets worse," adds Kumar, “I am starting to lose my sleep as well."

“Anxiety and depression are the commonest ailments we have seen, affecting nearly 25-30% of migrant labourers," says Vikram Arunachalam, consultant psychiatrist at the DMHP. “Some face behavioural problems, others experience feelings of delusion. These symptoms are particularly acute in those indulging in substance abuse."

Bengaluru is one of the few cities to launch a dedicated, in-person outreach to tackle the mental health issues of stranded labourers. It uses the infrastructure of the DMHP. “In the past three-and-a-half years, we have trained doctors, nurses, community health workers and primary healthcare workers," says Dr Arunachalam. “We have given them structured training in mental health. This has come very handy during this time."

Since the lockdown began, 11 teams have been visiting hospitals, shelters, schools and offices that are being used as accommodation. They start with a general address and an assessment. “We ask if there are any behavioural abnormalities, if there’s someone feeling irritable, sleepless or depressed. I have had people reporting death wishes, wanting to jump off a building. At such times, we intervene, give them medication or in case of severe illnesses (like schizophrenia), admit them to mental health facilities." The DMHP has treated nearly 3,000 people so far.

Raghava K., a psychologist, cites the case of a person with bipolar disorder . “He was alone, without friends or family. We prescribed some tablets and noted down his contact number. While he continues to stay in the shelter home, we will be following up with him." Some have to be admitted to mental health facilities.

Bengaluru is an outlier. The country has 38,000 camps for workers housing nearly 1.43 million people, according to a Union government estimate. Nobel laureate Abhijit Banerjee says India hasn’t done “anything close to enough" in providing relief to the poor. In contrast, thousands of Indians abroad were flown back and thousands of students stuck in the coaching hub of Kota, Rajasthan, have been taken home by several states.

So, care is often left to those managing individual shelters. In Kottayam, Kerala, they started cooking dal and rotis for north Indian workers. A shelter home in Reshimbaug, Nagpur, has a yoga teacher coming in every morning. At Versova, Mumbai, volunteers screen popular Hindi movies and circulate books and newspapers every day. “We are trying to get a therapist on board as well," says Shweta Sunder, a volunteer at the Mumbai camp. “Until then, some of us try to engage with the migrants ourselves." Not everyone is able express their anxieties. “But I have seen the difference it makes if you just sit and listen to them."

Media reports speak of migrant workers fleeing shelter homes for want of basic facilities—food, water, clean toilets, protection from mosquitoes. A survey of over 11,000 migrants by the Stranded Workers Action Network (SWAN), a collective of 73 academics, researchers and activists engaged in relief work, showed that 96% of workers did not get ration from the government during the lockdown and 90% did not receive wages. The findings were released last week.

On 6 April, nearly two weeks into the lockdown, the Union health ministry asked states to provide mental health support to workers. On its instructions, a 24*7 tele-counselling helpline was set up for general population through Nimhans. "The three mental health institutions i.e. Nimhans, Bengaluru, Central Institute of Psychiatry, Ranchi and Lokpriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, were separately requested to coordinate and assist state governments in providing counseling services," a spokesperson from the ministry said in an email to Lounge. "As per reports being received from states/UTs , psychosocial support services are being provided to people in shelter homes/migrant camp for workers and quarantine centres."

The spokesperson didn't give any specifics on the kind of support services provided beyond helplines. There’s little evidence of dedicated facilities for an in-person outreach, suggest mental health professionals and information available in public domain.

Take Mumbai: One of the cities worst hit by covid-19, it has one of the highest number of migrants. In the first week of April, the Maharashtra government set up a helpline in collaboration with Mpower, a mental health support group set up by Neerja and Ananya Birla, part of the family that owns the Aditya Birla Group. But a member of the MPower team said they didn’t have any data on workers calling. “It’s likely that they are so tied up with fending for daily essentials, mental health takes a back seat," the member says.

Given the scale, in-person counselling is not easy, says Ashutosh Salil, a Mumbai civic body joint commissioner. “There’s a lot of fear, so many (counsellors) aren’t willing to step out."

It’s often connection to family and certainty about the future that people miss the most," says Dr Naveen Kumar from Nimhans. “Time, giving reassurance and accurate information helps, as does promoting a sense of unity and solidarity among groups."

A sense of community at his construction site is what helps Shiv Kumar get through the day. It can happen in the smallest of ways: sharing food, watching movies on the mobile phone or sleeping next to each other—in spite of the emphasis on social distancing. It also helped to have doctors checking up on them. “I try to not talk to my family about my worries," he tells me. “But I am glad I spoke about it to you. I feel far lighter already."

LEFT IN THE LURCH

SURESH PANDIT (45)

BEGUSARAI, BIHAR

My son was going to be married this month. Not only is it cancelled, the caterers, bandwallahs and the rental car facility have pocketed the ₹4,000 advance I had paid them.

My family keeps asking me to come home. If I was in Delhi, I would have risked that. But this is nearly 3,000km. I am waiting for the lockdown to end on 3 May. But if it is extended further, I will set off on foot. Even if it takes me months.

SANDIP SAHANI (21)

GORAKHPUR, UTTAR PRADESH

In the first few weeks, the contractor would loan money for groceries. Now I have run out of supplies and the contractor isn’t picking up the phone. For a few days, I would buy from the local grocer but now I am out ofsavings and forced to borrow from him. It’s embarrassing to keep going to him, asking for more without being able to pay him on the spot. I don’t mind staying back here but at least the government must assure us daily meals.

SUMAN DEVNATH (24)

COOCH BEHAR, WEST BENGAL

I usually drink a peg or two before dinner every night. It helps me sleep better. Now that alcohol is no longer available, I find it difficult to sleep. Even if it was, I wouldn’t be able to afford it. The wages have stopped and the local grocers have doubled the prices of vegetables. I have to prioritize.