SINGAPORE – Migrant workers and migrant domestic workers in Singapore hesitate to seek formal mental health support as they fear losing their jobs, according to a recent study.
Some respondents were also unaware of mental health services or believed such services would be too expensive, said the study by the Institute of Mental Health (IMH) and the National University of Singapore’s Saw Swee Hock School of Public Health.
About six in 10 migrant workers and almost half of migrant domestic workers turned to informal sources of support – such as family and friends – for help with emotional problems.
The findings, published on Jan 30 in academic journal Archives of Public Health, were based on a survey of 1,465 migrant workers and 1,462 migrant domestic workers between 2022 and 2023.
The researchers recruited participants from locations such as dormitories and recreation centres, with support from the Ministry of Manpower, which commissioned and funded the research. Insights were also drawn from 14 focus group discussions with the participants.
The sample group included Indian, Chinese and Bangladeshi workers, and Filipino, Indonesian and Burmese domestic workers.
Using the same dataset, a second study examined depressive and anxiety symptoms among the workers using self-reported questionnaires. The findings were published on Feb 11 in Annals, the official journal of the Academy of Medicine, Singapore.
The participants were asked if they had experienced depressive symptoms such as feeling like a failure, or anxiety symptoms, such as being unable to stop worrying, over the past two weeks. They were also asked to what extent these problems affected their daily lives.
The study found that eight in every 1,000 migrant workers had moderate-to-severe symptoms of depression, compared with almost 41 in every 1,000 migrant domestic workers.
Moderate-to-severe symptoms of anxiety were found in about 13 in every 1,000 migrant workers and about 42 in every 1,000 migrant domestic workers.
Dr Mythily Subramaniam, principal investigator of the studies and assistant chairman of IMH’s medical research board, told The Straits Times that workers with the symptoms could be at higher risk of mental health conditions, but a clinical diagnosis would require a full assessment by a trained healthcare professional.
Migrant workers without days off were more likely to have anxiety symptoms, while migrant domestic workers who worked longer hours daily were more likely to have symptoms of both conditions.
The study also found that migrant workers with a higher education level were more likely to have depressive and anxiety symptoms, possibly because they are underemployed in their jobs.
The two papers mark the most extensive study to date on the mental health of migrant workers and migrant domestic workers in Singapore, Dr Mythily in an interview with ST on March 10.
“I would place (the studies) as baseline surveillance data that gives us important information on both the well-being of these workers, as well as their help-seeking patterns,” said Dr Mythily, who is also an associate professor at the Saw Swee Hock School of Public Health.
The research found that most of the workers sought help for emotional problems such as persistent stress and loneliness, primarily from informal sources such as family and friends, instead of formal support services.
A key barrier was the fear of losing their jobs. One of the focus group participants quoted in the study said: “You don’t know if (your) employer is going to kick you out when you tell your problem to them.”
Some workers were unsure if mental healthcare was covered by insurance, with researchers noting that they often “viewed healthcare expenditure as a trade-off against financial survival”.
Mental health services such as assessment and counselling are covered under the Primary Care Plan, meant for migrant workers who live in dormitories or work in the construction, marine shipyard and process sectors.
Employers pay between $108 and $138 per year to cover medical care for acute and chronic conditions for these workers under the plan, which was made mandatory from April 2022.
“Misconceptions regarding healthcare coverage for mental health issues suggest a critical need for more transparent communication,” said the researchers.
The Primary Care Plan does not cover migrant domestic workers.
Dr Mythily said some employers may not want to spend time talking about mental health, leaving it to the authorities and support organisations to address the issue with workers.
The prevalence of depression and anxiety symptoms in the second study was lower than that in previous research.
Researchers said the study was conducted after the Covid-19 pandemic, when fears related to pandemic regulations had eased and programmes were introduced to improve the workers’ well-being.
One such initiative was Project Dawn, a task force set up in 2020 to build a mental health support ecosystem for migrant workers. It comprises representatives from MOM, IMH, multiple organisations and government psychologists.
Newly arrived migrant workers and first-time migrant domestic workers attend a mandatory settling-in programme, and 24-hour helplines are available for those in distress.
Peer support leaders, such as “Care Sisters” trained under a programme started by MOM and the Alliance of Domestic Employees in 2022, support fellow migrant domestic workers in their mental well-being.
A group of researchers, who had studied migrant workers’ mental health during Covid-19 lockdown measures, penned a commentary on the second paper, where they noted the psychological resilience among the migrant worker population.
One of the commentary’s authors, Dr Jean Liu, associate professor of psychology, health and social sciences from the Singapore Institute of Technology, said such resilience was influenced by factors such as regular working hours, perceived job security and social support.
Though most adapt to stressors, migrant workers with pre-existing risk factors may develop mental health conditions, underscoring the need to strengthen screening and support, said Dr Liu.
Mr Ethan Guo, executive director of non-profit organisation Transient Workers Count Too (TWC2), said the main source of migrant workers’ mental health struggles is financial stress.
They have encountered workers who were “at their breaking point” because of unpaid salaries, and seeking mental health help would not have resolved their underlying problems, he added.
He said one way to reduce their stress is to provide job mobility – giving them sufficient time and flexibility to transfer jobs without worrying about paying more recruitment fees.
Dr Stephanie Chok, executive director of Humanitarian Organisation for Migration Economics, a migrant worker rights group, said psychological distress among migrant workers is often under-reported as they tend not to seek help for mental health concerns, unlike employment issues.
She said addressing structural barriers such as fears about job security and the lack of awareness of available services is necessary to encourage workers to seek support.
Dr Chok also emphasised the importance of ensuring workers have adequate rest, reasonable working hours and opportunities for social connection.
She added: “Preventing the conditions that cause chronic stress is just as important as providing help after problems arise.”