Mental Healthcare Services As A Human Right Of Survivors Of Human Trafficking

There has been evidence of a market for human beings as commodities all through recorded history in various ways. In some enlightened circles, variably in different contexts, such practices had been objected to and argued against. The race-based phenomenon of Black African persons being enslaved and transported across continents for ownership by families of White families has been perhaps one of the most well-known large-scale phenomena of human trafficking. This single largest instance was corrected in steps by the conscientious American society and nation, although in steps and a bit tardive. That entire set of experiences of the freedom of slaves in the 19th century and the racial justice movement in the late 20th century by themselves ought to have awakened the global community to be able to completely root out any such occurrences. 

The two world wars in the first half of the 20th Century, especially World War II and the consequent human rights movement could well have been expected to arouse the collective conscience of this most evolved species to ensure complete elimination of the phenomenon. 

The issue of legal enforcement and bringing about deeper sociocultural changes can be matters of another set of discourses, but the fact remains that despite how old this evil is, there is a lack of appreciation of the need for mental health services for the persons rescued from trafficking situations. One of the glaring gaps in the services for the survivors viz. the need for mental health services, requires to be urgently recognised and corrected as a human right. The theme of Human Rights Day 2023 ‘Freedom, Equality and Justice for all’ cannot be fulfilled without an explicit understanding of and commitment to the mental health needs of people such as trafficking survivors, whose human rights have been brutally trampled.

The unbelievable nature of not only commodification but also dehumanisation of humans by their own kind leads to the impact on the psyche and the behaviour of the survivors that is difficult to understand. The immediate impact of extremely low self-esteem, significant depressive symptoms or disorder, suicidal tendencies, inability to trust bordering on paranoia, and even indifferent or hostile reactions to any help offered are not only significant phenomena to deal with in themselves, but these can also create impedance in the initial rapport-building and supportive counselling services if made available. 

Supporting Human Trafficking Survivors 

The delicate aspect to be understood herein is the need for the survivors to experience a sense of safety, as a first step, almost always. The physical reality of their safety being assured, along with the basic needs of food, water, and clothes work adequately in most survivors for the reassurance required. No amount of verbal support or counselling can match or replace these basic needs with a sense of being protected from further exploitation. A few or some of the survivors with more symptoms of severe trauma may require supportive counselling besides these, and rare instances of need for anxiety-relieving medications. These form the first set of ‘relief’ measures soon after rescue.

The next few steps in relief measures will need to include appropriate medical examinations and treatment in as non-invasive and neutral manner as possible. 

Mental health disorders or psychiatric disorders may have predated the trafficking survivor’s experience or may result as a consequence. The time for screening for disorders of depression, anxiety, or any other psychiatric disorder can be after the initial few days, preferably after sufficient opportunities for ventilation and catharsis in age-appropriate and culturally suitable modes. The fact that many a time these survivors are women, young children, or adolescents makes the task of screening for sexual violation imperative, and yet delicate. 

Beyond these measures, candid and real-time discussions of the situation and the future possibilities of rehabilitation contribute to psychological well-being and active participation. Resilience can and does help in long-term consequences of the high levels of stress experienced, including post-traumatic stress disorder (PTSD), a dreaded complication of such situations. The underlying sociocultural strengths and individual resilience can be invoked for less likelihood of complications like PTSD and a higher level of mental well-being if the above-mentioned steps are followed, with at least professional supervision and backup from mental health experts.

Supportively structured services, specifically focused on reducing social exclusion or other negativity, with screening for possible problems in adjustment in sexual, marital, and socio and occupational spheres can meaningfully supplement the other rehabilitation measures.  

Barring relatively infrequent instances and availability of such sensitive services, many if not most of the survivors of human trafficking situations in many parts of the world —including India— are left to fend for themselves and do not get the benefits that can accrue from standardised but individually tailored mental health services at any of the stages of rescue, relief, or rehabilitation. The fact that many of the survivors are not only women, young children, and adolescents, but also persons from socio-economically marginalised groups, and persons with invisible psychosocial or neurodevelopmental disabilities further underscore the need for mental health services- for assessment and remediation.       

Until humans achieve the not-so-lofty but utopian-looking goal of eliminating human trafficking, mental health services being made available and accessible, it would seem is one of the items in the ‘the Least we must do’ for this abominable example of the worst face of human beings, the self-proclaimed highest form of evolved living beings. 

(Dr. Nimesh G. Desai is an Independent consultant in psychiatry and mental health, who is also a qualified public health professional. He is a former Director of the Institute of Human Behaviour & Allied Sciences and currently works with non-governmental organisations.)