Importance of Mental Healthcare to Rehabilitate and Empower Survivors of Human Trafficking 

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Pompi Banerjee

In 2014, Bringing It All Back Home, a study on how survivors of human trafficking are accessing rehabilitation services after returning to their home communities showed that barely three per cent of the returned survivors were accessing government support services for their rehabilitation. The study also shed light on a possible reason – the debilitating impact of trauma on their mental health. 87.3 per cent of the survivors who were rescued from trafficked situations, and were returned to their homes home reported symptoms of dysthymia (persistent depressive disorder), and 13 per cent experienced major depression. This is very high, especially when compared with the fact that about 1.8 per cent of India’s women experience depression and dysthymia. 

India, at present does not have a comprehensive rehabilitation policy for survivors of human trafficking. We also do not have a definition of what would rehabilitation mean for the thousands of trafficked survivors rescued every year. The Immoral Trafficking Prevention Act provides for shelter homes for post-rescue safety, protection, and rehabilitation support. However, it does not provide for continued rehabilitation support after the survivors leave the shelter home.

Depression and dysthymia, when seen in combination with other symptoms reported by survivors (flashbacks, anxiety, aggression, impulsivity, sleeplessness), is part of the trauma response that survivors go through. Sadly, after the rescue, their mental healthcare needs go largely unnoticed, and unaddressed, even when the survivors are in shelter homes for their rehabilitation. This results in the survivors further isolating themselves, drawing even more stigma and criticism. Their family members often try to rescue the survivors from social stigma by getting them married off quickly, without disclosing the possible mental health issues – eventually making the survivor more vulnerable to domestic violence and/or abuse. 

India, at present does not have a comprehensive rehabilitation policy for survivors of human trafficking. We also do not have a definition of what would rehabilitation mean for the thousands of trafficked survivors rescued every year. The Immoral Trafficking Prevention Act provides for shelter homes for post-rescue safety, protection, and rehabilitation support. However, it does not provide for continued rehabilitation support after the survivors leave the shelter home. Survivors of human trafficking, especially collectives like Utthan, Bijoyini, Bandhanmukti have been demanding that State and Central governments bring in comprehensive community-based rehabilitation policy, that is trauma-informed in its approach, and has survivors’ mental healthcare support as one of the key components. Survivors from West Bengal have even filed a PIL in the Calcutta High Court seeking the intervention of the State Government in bringing about such a policy at the State level.

Survivors are generally kept in shelter homes for two to three years on court order where their symptoms remain unrecognised, hidden, and untreated. Additionally, when confined to shelter homes, the PTSD felt by the survivors is compounded. This is because they feel as though they have no control, no information, and are kept in the dark about the trajectory of their lives. 

In the PIL lodged in Calcutta High Court in 2017, the petitioners argue that at the time of rescue, victims are not offered with any psychological or psychiatric evaluation. They are only tested for physical tests including HIV and pregnancy to determine whether and how much they had been sexually active, keeping the psychological aspect latent. Shelter home management often reports survivors exhibiting episodes of rage, depression, impulsivity, lack of concentration, lack of motivation etc. Some shelter homes which can mobilise the resources employ counsellors as part of the post-rescue care team. However, survivors have reported that the counsellors often do not have the bandwidth to provide trauma-informed or trauma-focused mental healthcare services to a large number of residents in any shelter home. 

Survivors are generally kept in shelter homes for two to three years on court order where their symptoms remain unrecognised, hidden, and untreated. Additionally, when confined to shelter homes, the PTSD felt by the survivors is compounded. This is because they feel as though they have no control, no information, and are kept in the dark about the trajectory of their lives. 

Once the survivors return home to their villages and communities, there is often limited resources to get professional help to address and overcome mental health issues. Their mental health further deteriorates because of the stigma and ostracisation they face from their communities. Added to this is the burden that their traffickers live in close quarters and keep threatening and intimidating them (post-rescue), further adding to the trauma they face.

It was in this context that the Shakti campaign by Sanjog, in collaboration with other community-based organisations, piloted a model of community-based rehabilitation in North and South 24 Parganas of West Bengal. Working in close collaboration with survivors and social workers, the model ensured that survivors were at the centre of their rehabilitation roadmap and that the approach was trauma-informed, focused on ensuring survivors’ access to their rights through government services. Since 2014, they have consistently prioritised mental healthcare services to survivors as one of the top three rehabilitation needs. In 2018, a re-assessment of the survivors’ mental health was done that showed a steady increase in the survivors’ mental health and wellbeing. In the reassessment, 62 per cent of the survivors reported experiencing severe clinical symptoms of depression, anxiety and/or post-traumatic stress disorder. The grassroots workers ensured that for the next six months after rescue, survivors experiencing severe symptoms received focused psychiatric treatment and counselling or therapy, resulting in 60 per cent of the survivors experience a reduction in the symptoms.

When a survivor returns to her home community, both the community and the survivor experience tensions in relatedness. However, it would be amiss if we also do not recognise that allies and supporters for the survivor also emerge from the community. They become critical in the survivor’s journey of recovery from trauma. They reinforce the survivor’s sense of relatedness, of being valued and cared for, which further bolster her resilience.

The SHAKTI CBR Model intends to strengthen, smoothen and speed up the rehabilitation process by focusing on alleviating the impacts of trauma and supporting survivors to build their resilience. It adapts the rehabilitation approach to the 4-Rs of Trauma-Informed Care. 

The four key strategies that have emerged to be significant contributors to survivors’ recovery and rehabilitation are: 

  1. Survivors’ Voices Being Central to their Recovery Roadmap: Any model or intervention that aims to support survivors with recovery and rehabilitation must put the survivor’s agency and decision-making at the centre. This is critical in restoring the person’s sense of certainty and control over their own lives.
  1. Engage the Family: Survivors’ mental health and wellbeing exist in the context of their family’s engagement with them. Therefore, it is vital to engage the family in the survivor’s roadmap of recovery and rehabilitation. As the survivor undertakes her journey of recovery; so does the family. Family members often deal with multiple pulls and push around social norms and expectations, their care and protection needs, and strengthening their connection with the victimised family member herself. When they are supported to engage meaningfully and are informed about mental health, stigma, and the supportive role they can play, their role becomes highly valuable.
  1. Engage the Community: The survivor’s identity and self-image, their sense of resources and relationships are intricately linked to their connection with their community, and vice-versa. When a survivor returns to her home community, both the community and the survivor experience tensions in relatedness. Prevalent patriarchal norms lead to the community often stigmatising and ostracising the survivor, and the survivor herself often withdrawing and isolating herself. However, it would be amiss if we also do not recognise that allies and supporters for the survivor also emerge from the community. These allies and supporters become critical in the survivor’s journey of recovery from trauma. They reinforce the survivor’s sense of relatedness, of being valued and cared for, which further bolster her resilience.
  1. Hold Duty-Bearers Accountable: When survivors are supported to apply for services to address their mental healthcare needs and take steps when faced with discriminating and stigmatising attitude from duty-bearers and service providers, it changes the power dynamics and reinforces the survivor’s sense of control over their own lives. 

It is this four-pronged strategy, inculcated into the broader framework of community-based rehabilitation, that enabled the significant recovery amongst survivors who were initially surveyed in 2014.

Pompi Banerjee is a Psychologist, Researcher and a member of Sanjog, a technical resource organisation based in Kolkata that works with governments, civil society organisations and businesses, individuals and collectives to combat violence against children and women.