Sheela was around 32 years old when I met her in a Protective Home (PH). “I am very tense,” she repeatedly said. As we talked, she shared that she felt overwhelmed by the unpredictability and uncertainty in her life. She had been trafficked into the sex trade when she was 16 and wanted to leave it for the sake of her children’s future. But the loan she had taken from the brothel keeper meant she could not leave unless she had the money to repay it.
She experienced symptoms like headaches, sleeplessness, chest pains, and indigestion - signs of stress - that showed her need for mental health support. There was no counsellor available at the PH that day. One counsellor provided by a local NGO visited the PH once a week. On the day of my visit alone, 77 women rescued from the sex trade were housed there.
The journey to recovery for women exiting the sex trade and seeking to reintegrate into their communities is fraught with challenges. Beyond the physical and economic aspects, the mental health needs of survivors are often overlooked. Understanding their past is the key to addressing them.
Women survivors find themselves entangled in a complex web of exploitation. Having worked with many such women, I found that all of them were trafficked when they were 15-16 years old, mostly by a known person. Often, these girls and women belong to marginalized communities. The use of threat, force, or coercion by the traffickers is common; in some cases, girls are “obtained” through payment to the families.
In parts of India, young girls are forced into a life of sex slavery through the Devadasi system. Many girls and women belonging to the Bedia, Banchhada, and Nat communities are caught in a web of intergenerational trafficking as they become victims of their community’s traditions and practices.
Trafficked persons experience multiple forms of trauma, including sexual abuse, psychological abuse, and violence. Extortion over long periods leaves scars that affect their mental well-being. Trauma affects the survivor’s ability to form and maintain positive relationships which are critical in their rehabilitation and reintegration journeys. Recurring trauma symptoms can make the survivors prone to revictimization. It is, hence, essential to approach their rehabilitation with dignity, respect, sensitivity, and empathy. Mental health support right from the time that they are rescued, is of paramount importance.
Some guiding principles need to be followed for the mental well-being of survivors:
- First responders, caregivers, and mental health professionals must aim to create a comfortable and non-judgmental environment for the rescued person through genuine empathy; they should respect their autonomy.
- Trauma lies at the core of the mental health challenges faced by survivors. Trauma-informed care can be incorporated into rehabilitation programs by training professionals and caregivers. There is a need to provide safe spaces where women can share their experiences.
- Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD) are prevalent among women survivors. Survivors of intergenerational sex trafficking may also experience emotional and psychological scarring passed down to them over generations. The recurring trauma leading to flashbacks, nightmares, and severe anxiety requires comprehensive therapy and support to address these conditions.
Reuniting with their families is a common goal for survivors, but it is also a complicated process. Families struggle to understand the experiences of their loved ones, leading to strained relationships. Survivors face judgment and stigma. This stigma can exacerbate existing mental health issues and hinder their reintegration process. Therefore, family counselling is vital to rebuild trust and foster healthy relationships.
Women survivors also turn to substance abuse as a coping mechanism. There is a need to address both substance abuse and mental health issues concurrently. Sober support groups do not exist in India. Such groups specifically tailored to the needs of women survivors, can provide them with a sense of belonging and help prevent relapse. NGOs and safe spaces like ILFAT which is a network of survivors can enable the survivors to share experiences and build a support network.
Empowerment of survivors must also be designed to contain:
- Rehabilitation programs including job training and skill development for the empowerment of women to secure stable employment and regain their independence.
- Financial counselling can help reduce the anxiety associated with economic uncertainty.
- Support in childcare can protect the children of such women survivors from the perils of the sex trade and can ensure they choose their own path.
Successful reintegration into the community is critical for rehabilitation as isolation and stigma can exacerbate mental health issues. Community education programs help reduce stigma and promote empathy and understanding among neighbours and community members. Training, sensitizing and upskilling community-level workers from NGOs, SHGs, and also ASHAs, Anganwadi workers, and Primary health care workers in Psychological First Aid will equip them to better identify those in distress and provide support to help them feel safe, seen, heard, calm and belonged.
Acknowledging the importance of mental health care as a basic human right is crucial to breaking barriers to ensure that those in need receive the help they require. Normalization of conversations around the issues surrounding the mental health needs of the survivors requires a holistic approach.
(Priti Patkar is the co-founder of Prerana, an award-winning NGO which works on intergenerational trafficking and child rights).
