Introduction: The Price Beyond Remittances

Every day, approximately 6,000 Filipinos leave the country to work abroad. In 2024, the Philippines deployed 2.6 million overseas Filipino workers (OFWs) who sent home a record $38.34 billion in remittances—representing 8.3% of the nation’s GDP. Behind these impressive economic figures lies a crisis that remains largely invisible: the devastating mental health toll on migrant workers and the families they leave behind.

This investigation examines the psychological wounds that accompany migration—from the 12 documented suicides in Hong Kong between 2023 and 2025 to the estimated 1.5 to 3 million children growing up without one or both parents. It documents the systemic failures that leave workers without adequate mental health support, the abuse that compounds their trauma, and the broken families that represent the true “social cost” of the Philippines’ labor export policy.

The findings reveal that while the Philippine government has enacted progressive mental health legislation, implementation gaps leave OFWs as one of the most underserved populations. Mental health crises among migrant workers are not individual failures but systemic outcomes of exploitation, isolation, and institutional neglect.

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Part 1: The Mental Health Emergency — Documenting the Crisis

1.1 Depression, Anxiety, and PTSD: The Research Evidence

A landmark 2022 study by Dr. Veronica Ramirez of the University of Asia and the Pacific, presented at the DOST National Brain & Mental Health Research Symposium, surveyed 884 OFWs across six Philippine regions and ten destination countries. The findings were alarming:

Key Findings:

• Depression and anxiety were prevalent across all stages of migration (pre-employment, employment, and return)
• In Macau, 25% of OFWs exhibited symptoms of Post-Traumatic Stress Disorder (PTSD)
• Similar PTSD prevalence was documented among workers in Qatar, Indonesia, Nepal, and China
• Mental disorders ranged from mild anxiety to “disruptive and assaultive behavior” and “full blown episodes”
• A few suicide cases were documented in the study population

A 2024 mixed-methods study by Jamal Magantor examined 50 OFW parents in Dubai and 50 of their children (ages 8-18) in the Philippines:

MeasureOFW ParentsChildren Left BehindMean Depression Score (DASS-21)16.3 (SD = 5.4)14.4 (SD = 4.2)Mean Anxiety Score18.1 (SD = 6.2)18.6 (SD = 5.7)Average Separation Length3.5 years—

The study found a positive correlation (p < 0.01) between length of separation and psychological distress, with parents reporting regret over missing family milestones and children expressing feelings of abandonment.

1.2 The Hong Kong Suicide Crisis: 2023-2025

The Department of Migrant Workers (DMW) has documented 12 OFW suicides in Hong Kong from 2023 to 2025:

• 2023: 6 suicides
• 2024: 4-5 suicides
• 2025: 1 suicide (as of April)

The most recent case involved a 44-year-old Filipina domestic helper found dead in Discovery Bay on April 16, 2025. Initial investigations indicated financial struggles as the primary factor.

DMW Secretary Hans Leo Cacdac identified key drivers:

• Unpaid debts and loan shark harassment with interest rates reaching 48% (legal in Hong Kong)
• Money laundering scams where OFWs surrender ATM cards in exchange for cash, only to face arrest when accounts are used for illegal activities
• Romantic relationship problems exacerbated by long-distance separation

OWWA Administrator Arnell Ignacio noted that “love life” problems constitute a significant driver of mental distress among Hong Kong-based workers, with infidelity by partners left behind adding to financial and workplace stress.

1.3 The “Forgotten” Workers: Barriers to Help-Seeking

A 2021 first-person account published in Rappler by an OFW in Thailand documented the isolation:

“I wanted to talk to a Filipino. I want someone who could understand the context. I want someone who spoke my language… I tried to check mental health crisis hotlines for OFWs. There were none.”

The writer described a panic attack in November 2020 during the pandemic, with labored breathing, racing heartbeat, and cold sweats. When calling a hospital for psychiatric consultation, he was told his health card was not accepted. Unable to afford private consultation, he resorted to daily alcohol consumption and eventually contacted Alcoholics Anonymous for support.

This account illustrates systemic barriers identified in research:

• Language barriers preventing access to local mental health services
• Cost of private mental health care beyond reach of workers sending remittances home
• Absence of Filipino-language crisis hotlines for OFWs abroad
• Cultural stigma preventing help-seeking (“strong Igorot blood… trying to deny my state”)
• “Money is more important than my depression” — prioritizing family remittances over personal wellbeing

1.4 Stressors Across the Migration Cycle

Dr. Ramirez’s research identified distinct stressors at each migration phase:

Pre-Departure:

• Financial burden of deployment costs (80.5% of workers go into debt)
• Pressure to provide for families
• Anxiety about unknown working conditions

Employment Abroad:

• Work environment stress
• Job content and organizational conditions
• Culture shock and adaptation difficulties
• Social isolation
• Abuse and exploitation by employers
• Debt repayment consuming 20% of monthly salary

Return Stage:

• Unemployment (87% remain jobless three months after return)
• Reintegration challenges
• Family dynamics disruption
• Loss of identity built around overseas work

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Part 2: Children Left Behind — The Intergenerational Trauma

2.1 Scale of the Crisis

An estimated 1.5 to 3 million Filipino children are growing up with one or both parents working overseas. Government statistics indicate:

• 7% of Filipino households have a family member working abroad
• 56% of OFWs are now women, reversing traditional gender norms
• A quarter of under-aged Filipinos are estimated to live separated from parents due to OFW migration

2.2 Psychological Impact on Children

Research documents consistent patterns of emotional harm:

The Lancet Regional Health study (2022) found:

• Familial cohesion in Filipino households is a key indicator for children’s mental illness severity and suicide ideation
• Ruptures in family beginning in early childhood inform long-term behavioral, cognitive, and emotional outcomes
• Impact occurs “regardless of whether they are separated from one or both parents”

PMC study on Southeast Asian left-behind children found:

• Children of migrant mothers face greater risk of poor mental health due to separation from primary caregiver
• Higher levels of loneliness reported among children of Filipino migrants
• Maternal absence particularly destabilizing due to traditional gender expectations

Documented emotional outcomes include:

• Feelings of loneliness and emptiness
• Melancholy and depression
• Emotional discomfort
• Increased school dropout rates
• Drug usage
• Attachment insecurity

2.3 The “Social Cost” of Migration

A 2024 study on cultural ideologies among left-behind children surveyed 949 Filipino high school students, including 103 children of OFWs. Contrary to expectations, left-behind children showed:

• More negative outgroup action tendencies toward people from other cultures
• Weaker approach tendencies toward intercultural interaction
• No benefit from parents’ international experiences

The researchers concluded that children may be “constructing their intercultural knowledge considering some negative information about OFW’s experiences”—suggesting that children internalize parents’ stories of discrimination and exploitation rather than developing positive attitudes toward other cultures.

2.4 Interventions and Gaps

The Lancet scoping review identified 48 interventions for children left behind across the Philippines, but noted:

• Only 3 interventions were government-implemented nationwide
• 20 distinct organizations provided support, with ATIKHA being the only NGO collaborating with government
• “Similar government-institutionalized interventions remain absent in the Philippines”
• Programs were unevenly distributed across the country’s 17 regions

The OWWA OFW Children’s Circle (OCC) program aims to protect and develop children-dependents of OFWs, but reaches only a fraction of the 1.5-3 million affected children.

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Part 3: The Marriage and Family Crisis

3.1 Marital Breakdown Statistics

A retired Family Court Judge in Baguio-Benguet estimated that 75% of OFW couples in the region undergo annulment or legal separation. Judge Francis Buliyat Sr. observed:

“I have to be candid that there are more separated couples that have been annulled because you have a situation wherein the wife goes abroad… and finds out that the husband has another family.”

Judge Buliyat concluded: “While the OFW is really good for the economy of the country, I think it is not good for the families of our country.”

3.2 Infidelity and Distance

A 2009 National Commission on the Role of Filipino Women report found:

• 36% of Filipino men engaged in extramarital affairs
• 2% of Filipino women engaged in extramarital affairs
• Marital infidelity was identified as a major cause of stress among Filipino couples

The dynamics of OFW families compound these problems:

• OFWs working abroad may face temptation and engage in affairs
• Family members left behind struggle with loneliness and seek comfort elsewhere
• Distance makes it impossible to address relationship problems in real-time
• Technology (video calls, social media) cannot replace physical presence

3.3 Legal Barriers: The Philippines Without Divorce

The Philippines remains the only country in the world (aside from the Vatican) where divorce is not legal. This creates unique burdens for OFWs:

The process of ending a marriage:

• Annulment requires proving psychological incapacity
• Average cost: 8-12 months of Metro Manila median household income
• Average processing time: 3.8 years
• Success rate: approximately 82%
• Only 1.9% of Filipinos have received annulment or legal separation

Impact on OFWs:

• OFWs face “host-country legal complications when they cannot dissolve Philippine marriages”
• Many OFW women “have guilt” dealing with marriage breakdown while unable to guide children through it
• Scammers target desperate OFWs with fake “Muslim divorce” schemes costing ₱200,000

A 2024 Social Weather Stations survey found that 62% of Filipinos now support legalizing divorce (up from 43% in 2005), with the House of Representatives passing the Absolute Divorce Bill in May 2024. The bill remains pending in the Senate.

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Part 4: Workplace Abuse and Its Psychological Toll

4.1 Prevalence of Abuse

Research documents widespread abuse of Filipino domestic workers:

Hong Kong (Justice Centre, 2016):

• 18% suffered physical abuse
• 66% were victims of exploitation
• 1 in 6 were in situations of forced labor

Stanford University survey of Filipino and Indonesian workers returned from Gulf states:

• 50%+ experienced at least one type of abusive situation
• Most common abuses were economic: excessive hours, late payment, denial of days off
• 12% had limited access to food
• 7% experienced forced confinement
• 7% reported non-payment of salary
• 6% were denied medical treatment
• 4% experienced physical abuse
• 2% experienced sexual attacks

Kuwait (DMW data, 2022):

• 24,000+ violations and abuses reported
• Marked increase from 6,500 in 2016

4.2 Case Studies in Tragedy

Jullebee Ranara (2022): 35-year-old Filipino domestic worker found dead, pregnant, and burned in a Kuwaiti desert. Her employer’s 17-year-old son was convicted and sentenced to 15 years.

Joanna Daniela Demafelis (2018): Found inside a freezer in an abandoned Kuwait apartment, body in sitting position with arms crossed. Family had not heard from her in two years. Autopsy revealed broken ribs and internal bleeding. Killed by employers.

Jelyn Arguzon and Riolyn Sayson (2024): Two OFWs reported dead in Saudi Arabia within weeks of each other. Arguzon’s passport had been taken by her employer and contact with family was limited. Sayson reported being locked in her room, fed only one meal a day, and experiencing back pains and shortness of breath before death.

Irma Edloy: 35-year-old domestic worker who fell into a coma after being violently assaulted and raped by her employer. She died hours after a visit from Philippine officials.

4.3 The Kafala System

The kafala (sponsorship) system used in most Gulf states compounds vulnerability:

• Workers can only work for their sponsor employer
• If employer breaks contract, worker’s visa is cancelled and they are immediately repatriated
• This gives employers enormous power over workers
• Workers may not report abuse for fear of retaliation
• Some reforms underway: UAE (2011) and Qatar (2020) now allow job changes without employer approval

4.4 The Live-In Requirement

Hong Kong’s mandatory “live-in” policy has been condemned by human rights advocates:

• Workers must live with employers regardless of treatment
• Creates “highly restrictive, exploitative, and abusive relationships”
• Workers who quit or are fired have only 14 days to find new employment or leave
• During COVID-19, some workers reported working 24 hours on-call for 8-9 months without a day off
• A February 2025 judicial review dismissed challenges to the policy

A UN report in March 2024 called for Hong Kong to amend the “two-week” and “live-in” rules and apply statutory minimum wage to migrant domestic workers.

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Part 5: The Mental Health System — Resources and Gaps

5.1 Philippine Mental Health Act (RA 11036)

The Philippines enacted its first Mental Health Act in 2018, establishing:

• Right of all Filipinos to mental health as a basic right
• Philippine Council for Mental Health as oversight body
• Integration of mental health into education
• Workplace mental health programs
• Capacity building for mental health professionals

Implementation Progress (as of 2023):

• 362 access sites nationwide covering 27 priority mental health medicines
• 75 mental health facilities in national network
• 1,556 personnel completed WHO Quality Rights e-training
• 124,000+ service users reached

Critical Gaps:

• Only 1,530 registered mental health professionals nationwide
• Fewer than 1 mental health worker per 100,000 Filipinos
• The National Center for Mental Health requires “utmost attention and improvement”
• 60,000 schools but only 1,500 registered guidance counselors

5.2 OFW-Specific Mental Health Services

OWWA Programs:

• Psychosocial counseling services for mental health and family concerns
• Welfare Assistance Program for members in distress
• Partnership with LoveYourself Inc. (July 2025) for free mental health services and HIV testing
• Embrace Virtual Hub for online mental health support
• OWWA Seafarer’s Hub in Ermita, Manila

DMW Initiatives:

• Department Administrative Order 4 s. 2025 requires Migrant Worker Offices to ensure safety and provide care for OFWs exhibiting mental illness symptoms
• One Repatriation Command Center (ORCC) 24/7 hotline
• Coordination with Hong Kong Police to address loan shark harassment

Research Recommendations (Dr. Ramirez, 2024):

• Psychosocial evaluation tool needed to measure readiness for overseas work
• Should cover multicultural, socio-economic, emotional, and psychological attributes
• More psychiatrists and psychologists needed in major OFW regions
• Joint Manual of Operations should be revised to include mental health assistance

Telepsychiatry Initiative: A 2021 Davao Medical School Foundation study found 40% of 55 OFW participants in Kuwait experienced mental health challenges, with acute stress disorder and major depressive disorder most common. Researchers are now coordinating with DMW-OWWA to assess feasibility of a telemental health program for OFWs.

5.3 Digital Mental Health Interventions

Kumusta Kabayan App (Macao): A mobile phone-based mental health app evaluated through implementation science framework:

• 25 OFW users interviewed (80% female, 76% domestic workers)
• High acceptance and potential for integration into existing OFW support services
• Promise of being scaled to other countries through collaboration with local and overseas stakeholders

5.4 International Comparison

Hong Kong:

• Estimated suicide rate of 14.1 per 100,000 (2024), above global rate of 8.9
• Young adult male suicide rate (25-39) surged from 10.0 (2021) to 14.4 (2024)
• Financial issues identified as primary driver
• Domestic workers lack access to most public mental health services

Destination Country Barriers:

• Language difficulties in accessing care
• Adverse working conditions
• Lack of available healthcare providers
• Inadequate social protection for migrant workers
• Healthcare access largely determined by employers’ willingness

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Part 6: The Reintegration Crisis

6.1 Unemployment Upon Return

Research documents devastating unemployment rates among returned OFWs:

IOM Impact Assessment (2021):

• 87% of returnees remained unemployed three months after returning
• 96% did not receive any reintegration assistance

National Migration Survey (2018):

• 7 in 10 returning migrants reported difficulties finding work or establishing business within three months

COVID-19 Pandemic Impact:

• 83% of OFWs remained unemployed three months after pandemic return
• Philippines unemployment rate hit 10.3% in 2020 (double the 5.1% in 2019)

A 2023 study by university researchers identified reintegration as “the weakest link” in the country’s migration policies.

6.2 The Gap Between Deployment and Support

Arman Hernando of Migrante Philippines noted the disconnect:

“The latest government figures mean we are sending 6,800 Filipinos per day [abroad]. More and more Filipinos can be at risk, especially in conflict areas, if we fail to properly monitor all of them. Are we deploying more Filipinos than we can protect?”

The problem extends to returned workers:

• DMW and OWWA provide emergency cash assistance of ₱10,000-₱50,000
• Some workers encouraged to start small businesses
• But many lack the social network required for successful enterprise
• Workers who spent years abroad have limited local connections

6.3 Case Example: Syria Returnees

Lucy Ortega, trafficked into servitude for 8 years in Syria then stranded 2 years in the Philippine Embassy, received upon return:

• ₱10,000 government assistance
• No trauma counseling
• No help finding work
• No compensation for embassy ordeal
• No assistance recovering unpaid wages

She now leads a support group of 52 trafficked domestic workers repatriated from Syria. She works part-time in a lottery outlet, earning less than minimum wage, while supporting three children in school.

6.4 Government Responses

National Reintegration Center for OFWs (NRCO):

• Programs addressing economic, social, and psychological aspects of reintegration
• Mission: Enabling OFWs and families to work with entrepreneurial mindset
• Focus on awareness of saving value and planning for investment/business/local employment

House Bill 11130 (November 2024): Proposed by OFW Party-list Rep. Marissa Magsino to address:

• Economic challenges of finding employment
• Social challenges of family reunification
• Psychological challenges of adjustment

AKSYON Centers: Government considering expansion in key regions to enhance service accessibility for transitioning OFWs.

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Part 7: Systemic Reform Recommendations

7.1 For the Philippine Government

Mental Health Integration:

1. Develop OFW-specific psychosocial evaluation tool measuring readiness for overseas work
2. Establish Filipino-language mental health crisis hotlines accessible from all major destination countries
3. Revise Joint Manual of Operations (2015) between DFA, DOH, DSWD, OWWA, and DMW to include mandatory mental health assistance
4. Increase psychiatrists and psychologists in major OFW-sending regions
5. Implement telepsychiatry program for OFWs (following Kuwait feasibility study findings)

Pre-Departure Orientation:

1. Expand OWWA PDOS to include comprehensive mental health modules
2. Provide realistic expectations about psychological challenges of migration
3. Train departing OFWs in stress management and help-seeking behaviors
4. Include information about mental health resources in destination countries

Children Left Behind:

1. Scale government-institutionalized interventions nationwide (currently only 3 of 48 identified programs)
2. Expand OFW Children’s Circle program to all 17 regions
3. Mandate mental health support in schools with high OFW-family populations
4. Develop national registry of left-behind children for targeted services

Reintegration:

1. Implement comprehensive reintegration support beyond emergency cash assistance
2. Provide trauma counseling for workers returning from abuse situations
3. Develop skills recognition programs for overseas experience
4. Create job placement programs specifically for returned OFWs

7.2 For Destination Countries

Hong Kong:

1. Extend statutory minimum wage to domestic workers (currently 22% lower)
2. Reform “two-week rule” penalizing workers who change employers
3. Abolish mandatory “live-in” requirement that enables abuse
4. Implement proposed HK$5,000 loan caps and Credit Data Smart system
5. Crack down on loan shark harassment (current partnership with Philippines police)

Gulf Countries:

1. Accelerate kafala system reforms allowing job mobility
2. Strengthen enforcement of anti-abuse laws
3. Provide workers with clear information about rights in their language
4. Mandate employer provision of mental health services access

7.3 For Employers and Recruitment Agencies

1. Implement mental health awareness programs for employers hiring OFWs
2. Provide Employee Assistance Programs (EAPs) with confidential counseling
3. Ensure workers have regular communication access with families
4. Train supervisors to recognize signs of mental distress
5. Create reporting mechanisms for abuse that protect worker immigration status

7.4 For OFWs and Families

For OFWs:

1. Know your rights under RA 11036 and destination country laws
2. Maintain regular communication with family (research shows this reduces anxiety)
3. Build social support networks with fellow workers
4. Document any abuse or exploitation for potential legal action
5. Access available mental health resources before reaching crisis point

For Families Left Behind:

1. Discuss mental health openly to reduce stigma
2. Seek psychosocial support for children showing distress signs
3. Maintain regular communication schedules with OFW parent
4. Build extended family and community support networks
5. Address relationship issues promptly rather than allowing problems to fester

7.5 For International Organizations

1. Fund research on OFW mental health outcomes across destination countries
2. Support NGOs providing psychosocial services to migrant workers
3. Develop cross-border mental health service delivery models
4. Advocate for inclusion of mental health in bilateral labor agreements
5. Create international standards for migrant worker mental health protection

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Emergency Resources

ResourceContactServicesDMW Hotline (24/7)1348Distressed OFW assistance, repatriationOWWA Hotline (24/7)1348Welfare assistance, psychosocial supportNational Center for Mental Health(02) 8989-8727Crisis intervention, psychiatric servicesHOPELINE (Philippines)0917-558-4673Suicide prevention, crisis counselingPhilippine Consulate (Hong Kong)9155-4023Consular assistancePOLO-OWWA (Hong Kong)6345-9324Labor and welfare assistanceSamaritans of Thailand (English)+66 2-713-6793Crisis supportHELP for Domestic Workers (HK)—Legal assistance, shelter

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Conclusion: Beyond Economic Metrics

The Philippines’ labor export policy has generated $38 billion in remittances but produced unmeasurable psychological costs. The 12 suicides documented in Hong Kong from 2023-2025 represent only the visible tip of a mental health crisis affecting millions of OFWs and their families.

The evidence presented in this investigation reveals systemic failures across the migration cycle:

• Pre-departure: Inadequate psychological screening and preparation
• Employment: Exploitation, abuse, and isolation without accessible mental health support
• Return: Unemployment, broken families, and insufficient reintegration assistance

The Philippine Mental Health Act (RA 11036) established important frameworks, but with fewer than 1 mental health worker per 100,000 Filipinos and no dedicated OFW mental health hotline, the gap between legislation and implementation remains vast.

Children pay perhaps the highest price. The 1.5-3 million Filipino children growing up with absent parents experience documented increases in depression, anxiety, loneliness, and attachment insecurity. Government interventions reach only a fraction of those affected.

Reform requires action at multiple levels: strengthening Philippine mental health services for migrants, pressuring destination countries to protect worker rights, supporting families left behind, and ultimately questioning whether remittances justify the human cost.

For Melvin Cacho, the 27-year-old Filipino teacher in Thailand who took his own life in June 2020 after writing “So stress[ed], anxiety, paranoid, family problem, job problem, money, failed dream. I can’t do this anymore. It hurts”—and for the millions of OFWs who struggle in silence—the time for systemic change is now.

Mental health is not a luxury that OFWs can defer until they return home. It is a fundamental right that must be protected throughout the migration journey.

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About This Investigation

This article synthesizes research from:

• Dr. Veronica Ramirez, University of Asia and the Pacific (2022-2024)
• DOST-PCHRD National Brain & Mental Health Research Symposium (2024)
• The Lancet Regional Health – Western Pacific scoping review (2022)
• PMC studies on left-behind children and migrant mental health
• DMW 2024-2025 enforcement data and Senate committee hearings
• IOM Philippines reintegration assessments (2021)
• ICIJ Trafficking Inc. investigation (2023)
• Hong Kong media investigations (SCMP, HKFP, 2024-2025)
• First-person OFW accounts (Rappler, 2021)

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