Running head: MENTAL HEALTH NEEDS OF HUMAN TRAFFICKING VICTIMS

Mental Health Needs of Human Trafficking Victims

MENTAL HEALTH NEEDS OF HUMAN TRAFFICKING VICTIMS Human trafficking is the violation of humans basic rights and is a major public health problem that occurs around the world (Hossain et al., 2011; Dovydaitis, 2010). Although the

exact number of victims trafficked is difficult to know, is estimated that there are 800,000 people trafficked annually across international borders (Dovydaitis, 2010). According to Yakushko (2009) 80% of trafficked victims are women and 75% are 25 old years or younger. Dovydaitis (2010) claims that an estimated 50,000 people are trafficked in to the US each year and domestically involves the trafficking of 400,000 minors. The United Nations definition of human trafficking is The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery (Yakushko, 2009). Within the US the most common type of human trafficking is sex trafficking of women and girls (Sabella, 2011; Hossain et al., 2010). Human traffickers pray on the vulnerability of the victims. Although many victims are kidnapped and forced into being trafficked, some are lured into by promises of paying jobs (Yakushko, 2009). Anywhere there is poverty, lack of employment opportunities, mistreatment of women and children, existence of societies where women and girls are perceived as economic burdens, political unrest, or natural disaster, people are vulnerable to being trafficked (Sabella 2011; Yakushko, 2009). Common psychological problems of trafficking victims include depression, anxiety, suicidal ideation, posttraumatic stress disorder (PTSD), and dissociative personality (Sabella,2011). The factors that place the victims of human trafficking at risk for mental health problems is the cumulative effect of being subject to horrific ordeals before being trafficked and their vulnerability to being trafficked (Hossain et al., 2010; Yakushko, 2009; Tsutsumi, 2008).

MENTAL HEALTH NEEDS OF HUMAN TRAFFICKING VICTIMS During their transit and after their arrival to destination, individuals typically are stripped of

their documents, required to pay considerable fees for transport, frightened, tortured, humiliated, threatened and abused (Yakushko, 2009). Women and girls trafficked for sexual exploitation are sexually tortured, raped, starved, confined and forced to have unprotected sex with multiple sexual partners. Many are forcibly made to use drugs to keep them submissive. (Yakushko, 2009). One European study of women trafficked into sex work found that 95% had experienced physical or sexual violence in relation to that type of work (Sbella, 2011). Victims of sexual exploitation, especially trafficked woman have also experienced violence before being trafficked. Prior exposure to violence and vulnerability associated with being trafficked places women at a greater risk for mental health problems than other victims of trafficking (Hossain et al., 2010). A study on mental health that was carried out with women found that sexually exploited women reported higher levels of anxiety, depression, alterations in consciousness (dissociation) and PTSD than did women exploited for other purposes (Hossain et al., 2010; Tsutsumi, 2008). Like torture victims, girls and women in a trafficking situation have little ability to predict the events that affect their health and safety, hence are at risk for prolonged psychological reactions to abuse (Hossain et al., 2010). Post trafficking factors such as lack of social support and additional life stress have been shown to influence severity of mental health problems (Hossain et al., 2010). More profound impacts are also associated with co-occurring behavioral health problems, like substance abuse disorders, limited social supports, lower socioeconomic status, and stigma associated with trafficking (Yakushko, 2009; Dovydaitis, 2010). They seek help only when the health issue can no longer be ignored. Delay in treatment of preexisting mental health problems has serious consequences later in life.

MENTAL HEALTH NEEDS OF HUMAN TRAFFICKING VICTIMS One of the obstacles in obtaining mental health services is that health care

providers have difficulty recognizing victims of human trafficking. Many trafficking victims do not speak English and are unfamiliar with the American culture; hence they do not know who and how to ask for help (Sabella, 2011). Some victims have experienced trauma by someone they once trusted, moreover they are threatened with physical or sexual violence especially women and girls if they fail to comply with the demands of their traffickers and try to escape or seek help (Sabella, 2011). Their families are threatened if they disobey their traffickers. As a result they are afraid and they are vary of strangers and have difficulty forming trusting relationships with health care providers and law enforcement who may be in position to help them. Shame is another major obstacle for not seeking help. Some believe that they will bring shame to their families or communities back home, especially female victims of sexual trafficking (Hossain et al., 2010). Stigma associated with mental illness is another obstacle for seeking mental health related services for foreign-born and male victims (Yakushko, 2009). Many need an array of services by trained professional, which may or may not be available locally. Because the only time a nurse might encounter a trafficking victim is when she or he presents with a health problem, its important that nurses be knowledgeable and prepared to offer appropriate help. (Sabella, 2011). First health care provider should care for immediate needs to restore health and safety (Dovydaitis, 2010). Although no one sign can demonstrate with certainty that someone is being trafficked, there are several indicators that nurses and other clinicians should be aware of. Signs of abuse among trafficked women and girls may present as intimate partner violence (Yakushko, 2009; Sabella, 2011). It is important to make the victims feel safe first (Yakushko, 2009). According to Sabella (2011) nurses can increase their likelihood

MENTAL HEALTH NEEDS OF HUMAN TRAFFICKING VICTIMS of identifying trafficking victims by acknowledging victims fears and providing a nonjudgmental environment during interviews. Suspected trafficking victims should be isolated from anyone accompanying them to health facilities and insist on using qualified interpreters when obtaining patient histories (Sabella, 2011). Each health provider facility should have a screening protocol similar to one for domestic violence (Patel et al., 2010). Once they are identified make a care plan with the client and it should be client-specific (Dovydaitis, 2010). Learn about the institutions policy regarding trafficked victims. Nurses can help by advocating

for more direct services for trafficking victims, offered at centralized locations where victims can have access to a full range of services (Sabella, 2011). Interdisciplinary care is important to help victims re-integrate into society. In addition to shelter and food victims will need pharmacological and psychological treatment (Williamson, 2008). Based on Williamson (2008) selective serotonin reuptake inhibitors can complement psychotherapeutic treatment of PSTD, anxiety and mood disorders. Cognitive-Behavioral and psycho-education can help with anxiety, mood disorders and fears. The intervention should be culturally appropriate. Human trafficking is the exploitation of human beings. The effects of trafficking have long lasting effect on victims of trafficking. Females are more vulnerable to the effects of trafficking due to the due to the nature of sexual trafficking and suffer from serious physical and mental health problems. Healthcare professionals play a critical role in both finding victims of human trafficking while they are still in captivity, as well as caring for their mental and physical needs upon release.

MENTAL HEALTH NEEDS OF HUMAN TRAFFICKING VICTIMS References Dovydaitis, T. (2008). Human Trafficking: The Role of the Healthcare Provider. Southern Medical Jornal, 55(5). Patel, R.et al., (2010). Human Trafficking in Emergency Department. Western Journal of American College of Nrse-Midwives,11(5). Sabella, D. (2011). The Role of the Nurse in Combating Human Trafficking. ANJ, 111( 2). Tsutsumi, A. (2008). Mental health of female survivors of human trafficking in Nepal. Social Science & Medicine, 66, 1841-1847. Williamson, E. (2010). Evidance-Based Mental Health Treatment for Victims of Human Trafficking. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/hsp/07/HumanTrafficking/. Yakushko, O. (2009). Human Trafficking: A Review for Mental Health Professionals. Intl. J. For The Advancement of Counselling, 31. Hossain, C., et al. (2010). The Relationship of Trauma to Mental Disorders Among Trafficked and Sexually Exploited Girls and Women. American Jornal of Public Health, 100(12).