Funeral home workers worry about youths' mental health as repatriations to India increase

WARNING: This story contains distressing details

A funeral home in Toronto is drawing attention to mental health issues facing international students as it increasingly repatriates the remains of young men and women to India.

Funeral workers at Lotus Funeral and Cremation Centre in Etobicoke, Ont., say they believe some of these deaths are a result of suicides. Students and advocates say they are similarly worried about international student mental health and suicide rates, especially as the international student population from India grows, and say the issue demands action.

The numbers are murky. One student activist says it's problematic that federal statistics don't track deaths among international students because, otherwise, there will be no way to find a solution. 

Lotus has, for years, been repatriating the remains of Indian citizens from throughout Canada at the request of the Consulate General of India and other members of the diaspora.

It used to repatriate no more than two a month — some of them students and some who had moved on to work permits. But since last year, that number has more than doubled, the funeral home says.

"We're about four to five [repatriations] a month right now," said president and owner Kamal Bhardwaj. Some months, as many as seven. Funeral workers have travelled as far as P.E.I, New Brunswick, Nova Scotia, Manitoba and Quebec to gather bodies. 

Here's the breakdown of those repatriations, which the funeral home says have been mostly of young people:

• 2018: 8 remains.
• 2019: 16 remains.
• 2020: 12 remains.
• 2021: 11 remains.
• 2022: 33 remains. 

Funeral home workers say they are troubled by some of the signs they're seeing on bodies.

"It's more of a visual. When they come in, how we see it and sometimes there's ligature marks on the neck," Bhardwaj said. "So that would be something that we think that's a suicide." 

While ligature marks can be caused by other incidents, funeral workers say, in other cases, staff see signs of drowning or drug overdoses, which could also indicate suicide.

Funeral workers could not provide specific causes of death due to privacy concerns, but they did tell CBC News that natural causes are usually associated with only one or two deaths per month among student and other young Indians. 

The rest include accidents, suicides, accidental drug overdoses, or other causes. In some cases, determining the cause of death takes time, as coroners' investigations can take weeks or months to confirm, according to funeral home workers. 

Funeral director Harminder Hansi says the home is on its way to outpace even last year's repatriation numbers.

"I'm burnt out," he said. "As a parent, when I see how they died, the cause of death, that makes me upset. Why [did] this happen, why we … as a community, why [can't we] stop this?"

Last year also saw far more students come to Canada from India — 319,000, up from 216,500 in 2021 — according to Immigration, Refugees and Citizenship Canada (IRCC). But that 47 per cent rise was far outstripped by the rise in bodies handled by Lotus. 

According to IRCC data, the number of Indian students with valid study permits has been trending upward: 

• 2018: 171,505.
• 2019: 218,540.
• 2020: 179,510.
• 2021: 216,500.
• 2022: 319,000. 

IRCC said it does not track the remains of foreign nationals sent back to their home countries. Statistics Canada says while it does collect information on deaths, there is not enough information to determine whether the deceased was a foreign student.

The Consulate General of India (CGI) in Toronto — which predominantly deals with students in Ontario — says, in 2021, 22 of those who were registered with the consulate died out of the 173,935 in the province who had a valid study permits. Four of those were suicides.

Both the consulate's student and suicide numbers also rose in 2022 — when 25 out of 236,565 died and seven were confirmed as suicides — though as a percentage of the student population the change seems proportional. 

The consulate could not provide CBC News with segregated data before 2021. 

So far this year, consulate officials say another eight students had died by March. Two of those were confirmed as suicides.

Jaspreet Singh, founder of the International Sikh Students Association and a former international student himself, says if governments aren't tracking the deaths of international students, it makes it hard for officials to see the crisis that he and others in the community see on a daily basis.

"In Canada, everything is pretty much systematic," he said. "We work with numbers, we always try to analyze the number, we always try to project the numbers for the future. In the case of [international students], nothing is happening."  

"They are getting neglected and only the students are suffering."

Singh says pressures bubble up for international students over time — from applying for study permit extensions, to paying fees, to working while keeping grades up and waiting for immigration pathways.

When those students can't keep up with the "expectations of their families and friends … from a South Asian perspective, it's a matter of life and death when they feel they have failed." said Singh.

Homesickness is "a lot" of the problem, said Amanjit Kahlon, manager of community development at Punjabi Community Health Services (PCHS), which helps members of the South Asian community access mental health supports. Over the years, he's seen more people needing to access these supports. 

"A lot of these folks come from large families where somebody's checking in on them, asking them how their day was. When they come here, a lot of them are alone. They're in a new space, but they don't have that connection or that social support."

Kahlon says the organization has had to intervene in the past to support the mental health of students, even going so far as sending some back to India through the Rapid Response, Saving Lives program. It helped send nine students home before their mental health got worse, at the request of the students and their families.

"We've followed up with the majority of them once they've gotten back and the families are very thankful they were able to understand what their child was going through," Kahlon said. 

The organization no longer gets provincial funding for the Rapid Response Saving Lives program. Kahlon says case managers at PCHS can have up to 100 cases at a time.  

"If we're seeing an increase in the international student population size, then there needs to be an increase in funding for programs that support them as well," he said. 

Josh Sankarlal, a board member with the Ontario Undergraduate Student Alliance (OUSA), says institutions have historically struggled to address student mental health, but international students' mental health is especially nuanced. 

"I think the culture that a student comes from can really impact how comfortable they feel with accessing mental health services," he said. 

OUSA has recommended that institutions and governments take a community approach. This includes working with service providers so students can access mental health support in places of cultural significance.

Recently, Colleges Ontario also came out with a new international standard of practice, which comes into full effect by June 2024 for its 23 signatory colleges. 

One of the standards includes "supports and services to promote student well-being and safety." Specifically, colleges will have to provide information to students about how to access medical and mental health services through the college or through community and public services. This will include culturally responsive services when available. 

"One student death by suicide is already too many." Sankarlal said. "What students really want is for their mental health to be treated just as urgently as their physical health."

If you or someone you know is struggling, here's where to get help:

• Talk Suicide Canada: 1-833-456-4566 (phone) | 45645 (text between 4 p.m. and midnight ET).

• Kids Help Phone: 1-800-668-6868 (phone), live chat counselling on the website.

• Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.

• This guide from the Centre for Addiction and Mental Health outlines how to talk about suicide with someone you're worried about.