Does statelessness affect mental health?

In Part V of this series on statelessness and mental health, we look at the possible connection between the two major issues and if there is help for the stateless.

A STUDY titled ‘Statelessness, Trauma and Mental Well-being: Implication for Practice, Research and Advocacy’ (Ajwang Warria and Victor Chikadzi, published January 2023) stated that statelessness creates psychosocial challenges for the affected individuals and their families as their lives are put on hold.

In Malaysia, there are several news reports published in recent years that explicitly suggest a connection between statelessness and its impact on mental health.

The Malay Mail, on June 17 last year, reported on a three-generation stateless family in Perak who filed a lawsuit against the government at the High Court in Taiping.

The family filed the lawsuit to demand recognition as Malaysians.

It was mentioned in court by one of the family members, Kamaladevi Kanniappan, that her two elder sons had taken their own lives.

She told the court that the family believed her sons’ deaths were contributed by the devastating consequences and burden of being stateless, which included being denied educational opportunities and equal job opportunities, as well as the hardship and difficulties from their lack of citizenship.

On May 21 this year, Malay Mail reported that the High Court in Taiping ruled in favour of the family and ordered the National Registration Department (NRD) to recognise them as Malaysians.

Malaysiakini, another online news organisation, reported on the devastating story of a stateless young mother of the indigenous Bajau Laut tribe in Lahad Datu, Sabah, who committed suicide with her five-month-old child on Feb 1, 2020.

From the article, it was learned that the young mother’s baby had been hospitalised for 11 days for a bacterial infection and the hospital bill came to RM3,000.

It was understood that she was charged a non-citizen rate because she did not have documentation.

With the exorbitant bill, which neither she nor her husband could afford to pay, and the fear of being arrested by the authorities due to her stateless status, the young mother resorted to ending her life and that of her baby.

Serious cause for concern

In recent years, mental health has become a pressing issue in Malaysia. A report by the National Health and Morbidity Survey (NHMS) revealed that almost one third (29.2 per cent) of Malaysians aged 16 and above had mental problems in 2015.

It also revealed an increase in the prevalence of suicide attempts among the Malaysian population.

Another survey by NHMS in 2019 showed that half a million Malaysians suffered from depression.

To address this, Malaysia introduced The National Mental Health Strategic Plan 2020-2025, with the vision to have ‘a resilient and mentally healthy community where mental health is valued without stigma and ensuring access to comprehensive, affordable mental health care and services in a timely manner to promote recovery’.

While there is a concrete plan to address the issue of mental health among the general Malaysian population, there is, however, no data to show the prevalence of mental health problems among the stateless populations in the country, let alone policy or strategies to address it.

This is most likely due to the fact that the government does not acknowledge the existence of stateless populations in the country.

In a news article published on March 7 this year, Bernama reported that the government does not have data on ‘genuinely’ stateless people in Malaysia — that is, those without citizenship or ties to other countries, and born and bred in Malaysia.

It said that the NRD categorised stateless individuals under the same category as non-citizens.

Dr Francesca Brady, a senior clinical tutor at University College London and a clinical psychologist at the Central and North West London NHS Foundation Trust, said statelessness has a significant impact on mental health.

Unfortunately, she said that stateless people often discover their mental health issues too late.

In an interview with The Borneo Post, she pointed out that stateless people struggle to access treatment for their mental health difficulties due to lack of documentation, thus leading to worsening conditions over time.

“They end up with chronic mental health problems because they had not been able to get the support earlier on. One of the reasons they delay treatment or refuse to come forward to check their mental health is often the fact that they feel very stuck because of their immigration status and documentation,” she said.

Drawing from her experience working with asylum seekers and refugees, Dr Brady said these groups face trauma, mainly related to persecution, arduous journeys, and ill treatment during migration.

In contrast, she said stateless individuals, although they may not always have direct trauma, struggle with identity crises and a sense of not belonging, especially when rejected by the country they thought was their home.

“There is a huge impact of legal status on mental well-being, including feelings of hopelessness, depression, anxiety, and even suicidal thoughts.

“There is also an intergenerational aspect of statelessness, where children inherit the struggles and trauma of their stateless parents. The waiting times for resolution can be decades, leading to a sense of being stuck and a lack of hope for the future, which can contribute to mental health challenges and even suicide,” she said.

Physical manifestations

When asked on who has a higher risk of developing mental health among stateless men or women, Dr Brady said the area is still very much under research.

Mental health, she said, manifests differently for different categories, depending on where in the world they are living, what the community is like, and what is considered taboo in their society.

“We see that in many communities where mental health isn’t really spoken about, people are constantly presented with, like, stomach pain or headaches because their stress is manifesting in a different way.

“And often it is seen as more socially acceptable to have a physical health difficulty than it is to have a mental health difficulty. Then of course, it perpetuates the fact that the mental health difficulties are never spoken about, the stigma persists, people start to feel more ashamed, their mental distress becomes more serious.”

Typically, she argued, men have a higher rate of suicide in the general population, not just in asylum seekers or stateless people, because men do not talk about their mental health.

Often, she said, some people find themselves in a ‘pressure cooker’ situation where they cannot talk about their state of mental health, and at the same time, cannot access healthcare due to various barriers.

She pointed out that this could lead to distress and may trigger suicidal thoughts.

Nevertheless, she noted that this area, which shows the suicidality rate among certain communities, is still very much under researched.

“There is a lack of data collected on the status of people who die by suicide or how many stateless people died by suicide.”

Dr Brady called for more research to shed light on the neglected topic of mental health for stateless individuals and communities, as it is often overlooked despite it being vital aspect of the broader challenges faced by those without citizenship or nationality.

Meanwhile, Miri Hospital mental health expert Dr Ravivarma Rao Panirselvam concurred that the lack of legal identity and documentation can affect the mental wellbeing of stateless individuals.

He said stateless individuals could experience a variety of mental health issues, but most cases involve anxiety and depressive disorders along with trauma-related symptoms.

“Stateless individuals are often denied opportunities for education, occupation and home, which are the prominent psychosocial stressors. If they are homeless as well, substance misuse is common.

“One has to consider intergenerational trauma within statelessness where there is a generation of people at risk for mental disorders. This increases the risk of developing severe mental illnesses and suicidal behaviour,” he said.

Impact on children

Statelessness also has long-term psychological impact on children.

Dr Ravivarma said that when children are denied education opportunities or have difficult times in school due to their status, the risk of dropping out is higher, which can lead to the development of oppositional defiant disorder or conduct disorder.

Eventually, he said, this will increase the risk of substance abuse.

“These stateless children are vulnerable to abuse and fall through the gaps in the social care system.”

He revealed that stateless people do not seek mental healthcare unless they are in a very desperate situation, and attributed this to the barriers that this group faces in accessing healthcare.

“The part when they seek healthcare is when things are so emergent, such as they become aggressive or have a suicidal attempt,” he said.

Dr Ravivarma added that stigma and discrimination also play a role in deterring stateless individuals from getting support or treatment for their mental health struggles.

He explained that this is because the status of being stateless often overlaps with other stigmatised identities such as poverty, unemployment, and minority status.

This combination of marginalised identities, he said, leads to self-stigma within individuals as well as stigma from others in society, thus making it very difficult for stateless people to access opportunities in life and get the help they need.

Tomorrow: Lack of research, funding on mental wellbeing of the stateless

* Jenifer Laeng is a recipient of the Khazanah-Wolfson Press Fellowship 2024 at University of Cambridge in the United Kingdom.