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Mental Health Needs

Key Term: Polyvictimization

Polyvictimization, also known as complex trauma, describes the experience of multiple victimizations of different types, such as sexual abuse, physical abuse, bullying, exposure to family violence, and more. This definition emphasizes different kinds of victimization, rather than just multiple episodes of the same kind of victimization, because it signals a generalized vulnerability. Research shows that the impact of polyvictimization is much more powerful than even multiple events of a single type of victimization.

- National Children’s Advocacy Center

The types of physical and psychological abuse human trafficking victims experience often lead to serious mental or emotional health consequences, including feelings of severe guilt, posttraumatic stress disorder, depression, anxiety, substance abuse (alcohol or narcotics), and eating disorders. Victims of trafficking often need psychological care as part of comprehensive medical treatment.

Providing culturally appropriate and trauma-informed mental health treatment can be challenging. Some of the commonly reported barriers and challenges to helping victims with their trauma include:

  • Limited availability and access to appropriate mental health services.
  • Difficulty establishing trusting relationships with survivors.
  • Mandated treatment efforts may be counterproductive when working with victims. This is particularly relevant in communities where the only means to access mental health services is to be kept in a locked treatment facility.
  • Co-occurrence of trauma, diagnosed mental health conditions, and substance abuse or addiction.
  • Victims have a long history of polyvictimization.
  • Victims may not define their experience as abusive or attempt to escape.
  • Cultural, linguistic barriers and isolation from home community.
Symptoms Reported by Traffickng Survivors
Depression, hopelessness, feelings of sadness and unhappiness, sudden or inexplicable crying  Fear of being alone, distrust and fear of strangers
Loss of interest in things and/or inability to plan for the future Recurrent or intrusive memories of abuse
Stress-related disorders, avoidance, disorientation, confusion, anxiety, phobias and panic attacks Feeling inferior to others, feeling of being permanently damaged, fear of rejection
Sleeplessness, sleep disturbances, nightmares, and/or insomnia  Sexual problems, including lack of sexual desire or oversexualized behaviors
Denial, memory loss, difficulty concentrating Obsessions and compulsions
Anger, aggression, irritability, mood changes Hallucinations or delusions
Changes in appetite or eating patterns, eating disorders Somatization/psychosomatic symptoms
Exhaustion and constant fatigue Self-harm and suicidal ideation
Isolating behavior  Trauma bonds and attachment issues, Stockholm Syndrome

Guilt, shame, and/or self-blame 
Numbness

(Chart from OVC TTAC Human Trafficking Resource Paper)

Tools: Have You Used EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) therapy is recognized as an effective form of trauma treatment. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies. Clinicians and trainings are available through the EMDR Institute.

In addition to the challenges noted above, it is also important to recognize that after such trauma, some victims may not feel comfortable with their sexuality. Individuals who experience severe exploitation may consider same-sex interactions. Service providers need to be aware, ready, and comfortable in helping victims through this process, as it can be a coping skill to deal with their traumatic experience by disassociating with their born gender.

In order to meet the mental health needs of survivors of human trafficking successfully, it is important to first ensure basic safety and service needs. Establishing physical and psychological safety is a prerequisite in working with trafficking victims with trauma history. This requires working collaboratively with those involved with the case to assess current client safety needs and planning. Ensuring that task force members involved in a case span across systems of care can help in addressing multiple needs.

In addition to assessing a client’s physical and mental health, it is important that providers working with victims have access to a range of trauma-specific interventions, including well trained clinicians who are willing and culturally competent to work with victims. There are many treatment approaches for polyvictimization, particularly for adolescents, including the use of educational support groups to address skills development, interpersonal connections, and competence and resiliency building.

Peer-to-Peer Support Example

SAGE is a human rights, nonprofit, survivor-run, drug, mental health, and trauma treatment center in San Francisco, California. Its peer counseling model avoids a traditional approach to trauma treatment that positions service providers as clinically neutral authority figures. Rather, SAGE provides client-centered supportive partnerships that address the social, political, and economic contexts of client difficulties. SAGE combines peer counseling with a host of other services, including alternative trauma treatments such as acupuncture, art therapy, massage, healing touch, movement, and drama.

Many victim service providers utilize art and music therapy to help survivors build connection between their physical symptoms and mental health, which has proven promising in rehabilitation programs. It is also important to consider the client’s cultural background and how that plays a role in resiliency and experience of receiving mental health support, particularly in the case of foreign national victims. Western-centered psychology practice may not emphasize culture and community relationships that can support survivor reintegration and promote healthy relationships. Social workers should be mindful that the therapy privilege does not apply in group settings and therefore be cautious about victim disclosure regarding aspects of the trafficking experience.

An alternative to clinical mental health support is a peer-support model. Peer-to-peer counseling and mentoring from survivors who are now serving in a victim services capacity make great support sources for victims. Victims are often more comfortable with peers who understand and experienced similar pain and exploitation in a nonjudgmental, empathetic way. It is also a way to help survivors build a new identity and remove feelings of isolation.

Additional Resources: 

  • Project REACH is a program that provides consultation and brief mental health services to trafficking victims throughout the United States. Project REACH provides services to pre-certified victims of human trafficking. The program has operated for 6 years and served hundreds of victims of human trafficking, including victims of sex trafficking, domestic servitude, and other forms of labor trafficking, and can serve as a great resource for training and technical assistance.
  • Trauma-Informed Approach and Trauma-Specific Interventions  SAMHSA follows six key principles of a trauma-informed approach to address trauma’s consequences and facilitate healing. Also featured are several evidence-based trauma-specific interventions. 

Address trauma bonding. Some traffickers have a complex emotional relationship with their victims, similar to a relationship where domestic violence is present. In this “relationship,” the trafficker wields complete control and induces commercial sex acts or forced labor in order to make money. Control and obedience are maintained through a combination of emotional manipulation, feigned affection, cultural beliefs about debt, and physical and emotional abuse. Victims often develop traumatic bonding and identification with their trafficker. Trauma bonding with an abuser is a survival strategy for victims of abuse and intimidation. For example, a victim who was abducted and raped may, years later, describe the captor as a “great person” with whom he/she formed an emotional bond, thus showing characteristics of a victim suffering from a trauma bond. Trauma bonding also does not have to be romantic in nature; it is essentially a false sense of relationship to another. Ensuring that mental health professionals trained in trauma bonding are available within your victim services response can be critical.

Though there are many challenges to meeting the mental health needs of trafficking victims, an effort to create a comprehensive approach across multiple systems of care offers the promise of responding to victims where they most need it. Building long-term trusting relationships, ensuring flexible models of treatment, and peer-to-peer support will empower and build self-esteem in your clients.

Tip: Legal practitioners may underestimate the importance of the mental health needs of trafficking survivors, and how these needs and trauma can affect the strength of a legal case. Partner with mental health providers to assist victims. 

 


For additional information and tools, visit the Resource page for Section 4.4 Comprehensive Victim Services.