Treating the Hidden Wounds: Trauma Treatment and Mental Health Recovery for Victims of Human Trafficking. Challenges in Meeting the Needs of Trafficking Victims who have Experienced Traumatic Abuse

03/15/2008

Many of the health and social needs of trafficking victims stem directly from their experience with trauma and the brutal reality of unremitting threats or actual physical and sexual violence.  Meeting these needs, in particular providing mental health treatment and trauma-informed services, is not without challenges.  Service providers report the following barriers and challenges to getting victims help in dealing with their trauma.

Limited availability and access to appropriate mental health services. Issues of affordability and access to services, as well as responsiveness of those services to the complex needs of survivors, are common issues identified by service providers.  Providers uniformly point to access to mental health services as a significant challenge for both international and domestic victims.

I felt shame and wanted to forget what had happened to me. I needed to be strong. But I could not stop the nightmares. Talking to [therapist] helped me.

Survivor of human trafficking

For most victims, shame is seen as one of the greatest barriers preventing them from seeking mental health services.  Providers note that the stigma associated with mental illness is an especially prominent challenge in engaging foreign-born and male victims in treatment.

For other victims, while providers report a willingness to seek help for physical health complaints, the underlying cause of the physical problems or symptoms  the trauma  often goes ignored and untreated.

For U.S. minor victims, barriers to accessing mental health services are linked primarily to the issues of confidentiality and concerns that someone will find out what has happened to them, lack of identification documents, lack of insurance, and system-related jurisdictional issues.  For example, as one provider notes, it is often assumed that child welfare systems will provide mental health services for minors.  Requirements to report minors to child protective services, however, do not necessarily result in access to treatment.  If the abuse is not inflicted by a parent or legal guardian, the case is often seen as outside the jurisdiction of the system.  In such cases the minors fall through the cracks and do not receive services they need.  But there are still challenges even if a youth has health insurance or is served under the child welfare system.  Most providers note that referral sources for mental health treatment or counseling are limited for youth, as well as for adults.  In one community, the wait for a psychiatric referral for youth was up to seven months.

Once access to mental health or counseling services is obtained, many providers are unable to maintain the long-term treatment that many victims require.  Providers report that insurance and/or funding restrictions often limit the number of sessions that a victim can receive.  Furthermore, traditional therapeutic services are often ill-designed to respond to the needs of transient victim populations, in particular U.S. minor victims, who sometimes find it difficult to meet expectations for weekly appointments.  Responsive mental health treatment requires considerable flexibility which may not be supported by existing systems of care.  Therefore, while getting services in response to the immediate crisis is not viewed as a problem in most cases, helping a victim with long-term trauma recovery is a significant concern.

Clients need time to feel safe enough to overcome being scared for their lives, to recognize that theyre victims, and to build relationships and open up to case managers, counselors, therapists, and others trying to help them.

Victim service provider

Difficulty establishing trusting relationships with victims.  For both law enforcement and service providers, getting victims to trust them and accept help is a huge obstacle.  They acknowledged that while building trust takes time,  time is something that often worked against both law enforcement and providers.  Many of the services available for victims are described as time limited.  For example, both domestic violence shelters and runaway and homeless youth programs, where most counseling services are offered on-site to victims, generally provide for short stays that do not allow adequate time to establish trusting relationships needed in order for a victim to open up and begin to address their trauma. The mistrust of victims often is due to their histories of betrayal from families, service systems, and in some cases, law enforcement and governments.  But in addition, a victims mistrust is often compounded by fears that connections with law enforcement and/or service providers can compromise their physical safety (e.g., the trafficker will find them, they will be deported, or they will be sent back to an abusive home).

Mandated treatment efforts may be counterproductive when working with victims.  In some communities, the only way to access mental health screening and treatment services is to be committed to a locked treatment facility.  Having already experienced the loss of control to traffickers, this can make being in locked treatment facilities or detention centers seem particularly threatening, essentially re-traumatizing victims and frustrating their recovery.

Secrecy is a trademark of the women and girls involved in sex trafficking; victims may not define their experience as abusive, or attempt to escape. A complex web of coping strategies and harsh realities make it hard for some victims to seek and receive help.  The shame and stigma of sex trafficking may lead them to conceal their involvement in prostitution, even in therapeutic relationships where success is dependent on frank disclosure and working through the trauma (Herman, 2003).  In addition, if a victim does not define her experience as abusive, no matter how dangerous, she will not likely seek help or engage in recovery (Ugarte et al., 2003).

Foreign-born trafficking victims face additional barriers related to language, culture, and isolation.  Lack of English skills for foreign-born victims limit their ability to access information about rights, services and options. Isolation due to these language barriers as well as cultural differences can be hard for any new immigrant but are particularly devastating for trafficking victims by reinforcing their captivity. (It should be noted that the isolation of domestic victims moved repeatedly throughout the country has some of the same effects.)  Forming outside supports is critical in fighting the isolation and ultimately getting victims the help they need.  Shifts in traditional Western professional treatment paradigms to more nontraditional interventions and support groups (which recognize oppression when working with people of low economic status and low power) have been noted as key to working with immigrant and refugee victims (Hotaling et al., 2003 p. 257).

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