Coming from a broken family in Indonesia, Sandersan Onie said he had occasionally experienced negative thoughts, but it only got worse when he moved to Australia in 2015 to study.
"For months I never felt happy at all," said Mr Onie, who is now completing a PhD in psychology at UNSW.
"I could be full of laughter when catching up with mates, but suddenly I would feel so horrible without any reason at all.
"Then there was a moment, when I sat in a church and I thought 'I think I want to end my life'."
Key points:
Pressure to succeed and financial burdens had led many students toward suicide
Data crucial to identifying where the problems are is not being collected
Cultural, financial and language barriers often prevent international students seeking help
Mr Onie eventually found the help he needed, but amid isolation, financial pressures and cultural taboos, other international students suffer mental health issues in silence.
And for some, those thoughts can be fatal.
On World Suicide Prevention Day, students and community leaders are urging the Australian Government to implement more effective mental health services for international students studying in Australia.
"It is a national tragedy that we lose so many people to suicide," said Suicide Prevention Australia CEO Nieves Murray.
"We can all make a difference in the lives of those who might be struggling by having regular, meaningful conversations about life's ups and downs."
But while Ms Murray said state and national authorities were making "suicide prevention a priority", foreign students can often fall through the cracks.
'We don't know where else this is happening'
In 2016, Chinese student Zhikai Liu took his own life.
His sister said he had been struggling with English and had difficulty understanding his classes at the University of Melbourne, which led to depression and insomnia.
Victoria's Coroners Court ordered an investigation into other student deaths and a subsequent study of 27 suicide cases among international students in Victoria was carried out.
The report, released by the Coroners Prevention Unit (CPU) in January this year, said: "The CPU was unable to locate any studies — either Australian or international — addressing suicide among international students."
The report included three recommendations for the Federal Department of Education, two of which addressed the need for the collection of data to "inform interventions to reduce suicide among international students".
"The Government accepted the recommendations of the Victorian Coroner in 2019 and is working with the sector to address them," Federal Education Minister Dan Tehan told the ABC.
However, Mr Tehan said in a letter to the Coroners Court that the possible violation of privacy laws could be an obstacle to the collection of such data.
The ABC contacted the Department of Education, Victoria's Coroners Court, Universities Australia and student associations, but found that to date, no-one had compiled data on suicide rates among international students in Australia.
Suresh Rajan of the Western Australia Ethnic Communities Council has dealt with 12 suicides deaths among the Indian community of WA in the last 10 years.
While he has given voice to the issues he has identified among students in his own community, he said a lack of data made determining mental health needs within other states and other ethnic groups challenging.
"No data is collected on suicide rates by ethnicity so we don't know where else this is happening," he said.
"We need that data so we can keep a track of where suicides are occurring so we can identify the communities most impacted."
Mr Rajan has the grim task of sending home the bodies of young Indian students after they have taken their own lives.
He said the weight of cultural expectation, both academic and financial, is "enormous" and often leads to an "abject sense of failure".
The CPU report found an inability to pay tuition fees was evident in five of the 27 deaths in Victoria, and gambling losses were key factors in two other deaths.
Mr Rajan said often entire family savings would go towards sending a student to study abroad with the expectation they would excel and become breadwinners for the whole family.
One young Sikh man — the eldest and only male of five siblings — came to Australia on a student visa on the expectation that he would not only earn enough to cover his own living expenses, but also send money home to pay for the weddings of his five sisters.
Under great financial pressure, he recently blew his entire savings from working as a taxi driver at the local casino.
He is currently on "suicide watch", Mr Rajan told the ABC.
In another case, a young couple took their lives a few days after being denied permanent residency at the end of their study visas.
"They would have had to go home as failures," Mr Rajan explained.
"Their fees to study here had been collected by the whole village — so there was that expectation from the community that these people will go and become a success and then help to get [the village] out of the poverty they are in."
Others accumulate massive student debts.
Student visas restrict the holder to 20 hours of work per week — or about $400 a week at minimum wage — out of which they must pay rent, living expenses and tuition fees.
Mr Rajan said relationship issues, including the "unacceptability of same-sex relationships in cultures like mine", also contributed to suicidal thoughts in some cases.
He described many cases of not only Indian but also Malay and Singaporean students who were able for the first time to openly pursue a same-sex relationship while living in Australia, but they were not able to disclose this to their families.
In many cases, marriages were arranged back home by the family that they felt unable to refuse.
"After being accepted as openly gay here, they now — at the end of their student visa — had to contemplate going back home," he said.
Misdiagnosis leads to thoughts of suicide
The coroner's report compared the international students cases with local students and found a "lower engagement with mental health services", and the rate of diagnosed mental illness among the Australian-born students was four times higher than international students.
The report suggested this may reflect cultural, financial and linguistic hurdles inhibiting international students from accessing mental health treatment.
Anya Niu, now 27, was misdiagnosed when she was studying in Australia in 2017 due to what she described as a combination of cultural misunderstanding, language barriers and limited mental health resources at her campus.
She was diagnosed with major depression and prescribed medication that left her incapable of feeling any emotion at all, and led to suicidal thoughts, she said.
Her condition became so bad she decided to return to China without completing her studies.
"I was sitting on the stairs, crying and desperate because of my life in Australia … I decided to go back home," Ms Niu told the ABC.
Back in China she was diagnosed with bipolar disorder and improved immediately with the right medication.
"It's hard to accept that those two years of suffering were preventable," she said, describing mental health issues among international students as "a hidden killer".
Janice Ip, a researcher for the Centre for Holistic Health, said due to cultural barriers, students often felt misunderstood and many said they "felt even worse after seeing the counsellor".
"Sometimes, they need to see several counsellors and repeat their stories many times."
Cultural taboos stop students seeking help
In their report on 27 cases, the CPU found failing grades to be a factor in 10 of the suicides.
For five of these students, their main fear appeared to be disclosing the failure to their parents, while three others feared their student visas would not be renewed.
"Chinese students believe 'no pain, no gain'," Ms Ip told the ABC.
"When they are facing high levels of stress, they may tend to think they are not working hard enough rather than looking for ways to manage the stress."
Sandersan Onie said immense academic pressures and perceived failure had contributed to his suicidal thoughts, driving him to a point where he had "not had a single happy thought in months".
When these pressures build, cultural taboos hold many foreign students back from seeking help.
We come from a culture where we're told that speaking openly about our feeling is going to bring us harm," Mr Onie said, adding that fear of being judged due to "cultural miscommunication" adds to the reluctance to talk about personal wellbeing.
Psychologist Queenie Wu, who treats many international students, said she was one of a small number of Chinese-speaking clinical psychologists in Australia.
She said while universities do provide mental health services in English, many students "often feel intimidated and self-conscious" and have difficulty expressing their feelings in a foreign language.
"I came to Australia more than a decade ago as an international student," Ms Wu told the ABC.
"I understand from my personal experience the loneliness and the pain that most international students experience and struggle with on a daily basis."
She said many students were coming from a culture with a strong "shame-based" stigma surrounding mental health issues.
"[Many] believe that mental health conditions are caused by lack of willpower, strength or self-discipline," she said, adding that those who seek counselling can face discrimination.
"Most Asian cultures value high academic performance, but do not value personal health, especially mental health."
'Building them up to fail spectacularly'
There are currently 630,247 international students studying in Australia according to the latest figures from the Federal Department of Education.
Often students find themselves completing degrees which cost in excess of $100,000 that rarely lead to professional employment after graduation.
In some of Australia's largest universities, international students make up nearly 50 per cent of the student body, while their tuition fees contribute an increasingly disproportionate amount of revenue — in some instances, over a third of total revenue, dwarfing domestic student fees and rivalling, or even exceeding, government funding.
Federal Education Minister Dan Tehan said universities were required to provide mental health support, and that the Government had also provided funding for English language teachers to receive mental health training "to ensure they can support international students".
"Every Australian university has qualified counselling services available," said Universities Australia chief executive Catriona Jackson.
"I would strongly urge students to reach out to these services if they need help or if they are feeling distressed."
But in Ms Niu's case, she said the university was more concerned with payment than her wellbeing.
"The school didn't care about my condition, but it was absurd when it sent multiple emails for tuition fee payment for the next semester."
She said part of the problem was having to wait one or two months between appointments due to high demands and limited services, while she also experienced a lack of cultural awareness during sessions.
Ms Wu said universities should be taking on the role of carer for international students who are leaving behind their homes and families to study on their campuses.
"I think universities are trying, but they can do more, systematically," she said.
Despite language barriers, she said cultural training can go a long way for health care workers as many of the students "just want to be heard" and emotionally understood.
Mr Rajan said, at least in WA, he believed there was no transcultural mental health networks or adequate support provided by universities.
"We give them no induction, no acculturation process, no pastural care while they are here," he said.
"I don't believe that governments should go out and recruit students to come here until such time as they have attended to these issues.
"Because all they are doing is building these students up to fail spectacularly."
Finding help
Mr Tehan told the ABC the Government has provided the Council for International Students Australia with $100,000 "to progress mental health support for international students".
They can also "access free mental health support offered to all Australians", he said.
There are also 24-hour helplines available in English including Lifeline, Suicide Call Back Service and Beyond Blue, with a translation service also available by first calling the Translating and Interpreting Service.
A Monash University spokesperson told the ABC students and staff have "the option of seeing a campus-based counsellor, GP or psychiatrist proficient in a number of languages", as well as attending a Mental Health First Aid training workshop.
The University of Melbourne said in addition to counsellors, psychologists, doctors, mental health nurses and psychiatrists, staff also undergo mental health training.
"The University has and will continue to use Chinese social media platforms like Weibo and WeChat to make Chinese students aware of the various support services available to them," a spokesperson said.
Melbourne student Chang Liu, 23 — who has been researching student mental health services — said while many resources are available, students often do not understand how to access them.
Information about self-identifying mental health needs and choosing the right service is poorly delivered, she said.
The Australian medical system can be confusing for international students, and paying hundreds of dollars in fees per session before being able to claim it back is also an obstacle, as well as the limited number of sessions funded.
"International students are not provided with a simple and affordable service when they were experiencing life-threatening situations," Ms Liu said.
"Instead of asking if international students are ready to study and live here, we should have asked whether Australia is ready to provide a learning and living environment that meets international students' needs."
Mr Onie said he escaped his suicidal thoughts after finding the right person to talk to.
"I have a best friend and I spoke to him that I was having suicidal thoughts and he started crying," Mr Onie told the ABC.
"I felt his expression of love and care."
He realised how critical it was to have a "support system" and has this week launched a bilingual online platform called What I Wish They Knew where young people, particularly from Indonesia, could share their problems anonymously.
The aim is to gather information that will help develop a mental health first aid program for students.
"There's no harm in asking people about their suicidal thoughts, in fact it will reduce the risk," he said.
https://amp.abc.net.au/article/11476938
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