* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Slavery survivors face trauma and often social stigma - mental health support should be a key part of recovery programmes
Parinita Kumari is the founder of the ADITHI nonproft organisation, and Dilip Kumar is a 17-year-old survivor of labour trafficking. Both are members of Human Liberty Network which work to combat human trafficking in the Indian states of Bihar and Uttar Pradesh.
Each day in India, a huge number of minor girls and boys fall into the vicious circle of human trafficking. In Bihar, a hotspot of trafficking, numerous victims are rescued regularly from brothels, red light areas, local dance groups, beauty parlours, dhabas or street food joints, car and scooter mechanic shops, confectionary shops and factories.
According to the latest report of National Crime Record Bureau (NCRB) 2020, one of the worst abuses of human rights, that is, child trafficking, has been reported to be at a rate of over one per day in Bihar, ranking the state as third among other high-prevalence states in India.
Most of these rescued survivors are seen to be under depression and anxiety due to multiple victimization of different types– sexual, physical, verbal and psychological abuse. ADITHI, a nonprofit organization based in Bihar, in collaboration with other agencies, has rescued 36 children and minors from brothels and red-light districts in the state between 2018-2020.
While rescue, safety and physical rehabilitation are primary priorities, for survivors and victims of sex trafficking, there are several secondary issues which need urgent attention, such as trauma, effects of alcohol and drug use, depression and other mental health ailments, which add to the psychological burden of trafficked victims.
Survivors of trafficking are often socially stigmatized because they cannot return to their homes and communities. All over the country, forensic, physical health management and treatment is mandatory for survivors of trafficking but mental distress or mental health management has not yet garnered the required level of attention and scope in India. In such circumstances, trafficking survivors are vulnerable to revictimization even after rescue.
Other critical considerations while working with survivors of trafficking include fear, anxiety, inability to articulate, lack of trust and trauma that may make it difficult for them to seek help and treatment. Some victims may be accompanied by their trafficker or have the fear of being recognized. There are instances where children rescued from slavery and rehabilitated at Child Care Institutions (CCI) remain for long in trauma, fear and depression with a feeling of hopelessness and sadness. Many are addicted to substance abuse (alcohol or narcotics).
Sometimes due to mental stress, social taboo and severe trauma, victims even commit suicide which was seen in the case of Chetana, (whose name has been changed) who was rescued from an orchestra band in Bihar and reintegrated with her family in West Bengal. Lack of access to counselling and psychological services, coupled with family and social stigma perhaps left her with little choice but to end her life.
The issue of re-trafficking is very much correlated to the rescue, post-rescue scenario and rehabilitation process. Currently, a big gap exists between the various processes. Survivors of trafficking (and even their families in some cases) often need psychological care as part of comprehensive medical treatment. But unfortunately, mental health is not given the same level of priority as other health services. Available facilities are usually inadequate and mental healthcare service providers and counsellors are very few in number or not trained to help survivors cope with the challenges.
ADITHI, a partner organization of the Human Liberty Network was part of a study conducted among 27 child care institutions across 10 districts of Bihar in 2016. At the time of the study, a total of 591 children were present in these homes. Among them, only 17 out of 27 homes had part time doctors for health treatment. None of them had psychiatric or mental health services and only 10 had trained counselors. While a child care plan was underway for the institutions, a a comprehensive mental health plan was missing.
Also, at the ground level in Bihar, one mental healthcare professional has to visit 2-4 districts, which itself is a considerable burden on the counsellor. The situation is gradually improving as Government and non-governmental institutions have started giving attention to mental health services, but shortage of skilled providers needs to be addressed.
Recommended actions to reduce mental stress and trauma of trafficked victims and enabling them to lead a better and happier life include psychological rehabilitation of human trafficking survivors through assessment, daily monitoring, and providing individual and group psychological counseling. Family and community counseling is also essential.
Mental health management has to be taken as priority for victims of trafficking. There is a need to capacitate and train health workers, counsellors and community volunteers along with psychiatric support at district level, at police thanas, health departments and CCI homes.
As financial support is a key requirement, release of rehabilitation packages and compensation should be ensured within a certain period. There have been cases where survivors couldn’t get compensation even after 3 years. In addition, details on mental health services provisions and care plans should be explained to survivors to ensure informed consent and, whenever possible, to allow individuals to participate in decision-making about their care.
Lastly, there are many treatment approaches for poly-victimization, particularly for adolescents, including the use of educational support groups to address skill development, interpersonal relations, competence and resiliency building. This should be provided in primary and middle schools.