Common Mental Health Issues Commentary

Essential Standard: Your agency is informed on the most common mental health issues associated with victims of trafficking

Survivors of human trafficking can experience a variety of psychosocial impacts from their exploitation and experiences. One significant impact is the heightened risk and prevalence of mental illness among survivors. Your agency and staff should be aware of and continuously educated on:

The most common mental health issues that may affect your clients
The diagnosis, prevention, and treatment of such mental health issues

This table specifies both required and recommended attributes that are evaluated during the accreditation process. Those attributes labeled as required must be present for accreditation. Attributes labeled as recommended could be reviewed, but are not necessarily required, during the accreditation process. Each requirement and recommendation is further explained in the sections below.

Required

Staff education on the most common mental health issues associated with survivors of trafficking
Staff education on what policies and programs seek to contribute to positive mental health for clients & mediate the increased risk of mental health problems
Staff education on how your agency is assessing, preventing, and treating mental health issues
Staff education on considerations for working with clients with mental illness

Education

NTSA urges agencies to stay up-to-date and informed on the most common mental health issues among survivors and how these issues can be assessed, prevented, and treated. Staff at your agency should be educated on what mental health issues may impact their clients and how to provide services with considerations for their mental health.

Common Mental Health Issues

The physical and psychological abuse and complex trauma that accompanies human trafficking can often result in a variety of mental health issues for survivors. Your agency’s staff should be informed on what mental health disorders are most prevalent for survivors of human trafficking, including the following:

Depression
Anxiety / Stress-related disorder / Panic attacks
Post-Traumatic Stress Disorder (PTSD) and Complex PTSD
Bipolar Disorder
Psychotic Disorders, such as Schizophrenia
Eating Disorders
Substance Use Disorder

Prevention of Mental Health Issues

For agencies serving survivors of human trafficking, it is essential to work towards the prevention of mental health issues with clients by fostering protective factors and addressing risk factors. Your agency should inform staff on what policies and programs seek to contribute to positive mental health for clients and mediate the increased risk that survivors have of developing mental health problems.

Factors that influence survivor’s risk of mental illness include:

Pre-trafficking abuse
Duration of exploitation
Violence and restrictions on movement while trafficked
Greater numbers of unmet needs
Lower levels of social support following trafficking

At your agency, while you cannot prevent abuse and exploitation that has previously occurred, you can efficiently address it within the treatment of mental health issues for survivors. To help mediate the increased risk of mental illness among your clients, agencies should be intentional about addressing the following two factors that influence risk: greater numbers of unmet needs and low levels of social support following trafficking. Your agency should seek to address all the basic medical, emotional, social, and mental health needs of survivors. If your agency does not provide those services on site, it is essential to provide referrals and access to external services and resources to meet these needs.

A critical component of addressing a client’s needs is promoting positive mental health, which can include developing social and environmental support. Your agency can provide survivors with opportunities to access and foster social support for themselves, which can act as a critical protective factor. This social support can come from organizing group activities and programming that allows them to connect with other clients and form new positive experiences and relationships. Staff should regularly be educated on how to meet and address the needs of clients and facilitate this social support, in order to promote positive client mental health.

Treatment for Common Mental Health Issues

Staff should additionally be educated on how your agency is providing clients with interventions for their mental health issues, including through the use of clinicians and mental health professionals on staff or in connection with your agency. Research has supported that offering survivors of sexual and emotional trauma specific types of mental health treatment, including Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing therapy (EMDR), can improve their psychological health (See Appendix for additional information). Clinicians and the designated professionals should consider what treatment plan and intervention would best serve the individual and specialized needs of their client. Regardless of what specific interventions and treatments are utilized at your agency, staff should be informed on generally how clients with mental illness are being treated so they can better understand the healing process for the clients they are working with. A general set of mental health principles for treatment include the following:

Acknowledging the trauma
Exploring the trauma at an acceptable pace to the client
Exploring the individual’s self-identity to avoid re-victimization and stigmatization
Participate in setting new life goals and helping individual to plan to meet those goals
Setting in place continued mental health support and general health surveillance
Encouraging good sleep patterns, physical activity, and nutrition
Helping the client to reframe experiences to identity positive attributes of themself and recognize their accomplishments
Establishing support for life skills, including health recreation and maintaining healthy relationships

Considerations for Working with Clients

Staff should be informed on how survivors of human trafficking may feel unease or discomfort disclosing information about their experiences and feelings associated with their trauma and mental health. Survivor’s experiences and exploitation can understandably result in a mistrust of care-giving individuals and systems, which can make service delivery more difficult.

When providing treatment for mental health issues or general services at your agency, providers should seek to address these common concerns of clients and ensure they feel comfortable within their treatment plan. Staff should use a communication style that is safe, reassuring, non-judgemental, consistent, and trustworthy. In order to facilitate a feeling of comfort and care, staff can utilize the following tactics for providing effective support:

Being non-judgmental and supportive, while validating what the client is saying
Providing practical care and support that responds to client’s concerns, but does not intrude
Providing particular care and listening carefully when client is discussing sensitive topics
Providing or mobilizing social support for the client
Helping client to access information about necessary resources, including legal and other services

Staying Informed

Clinicians/ Mental Health Professional

To stay informed on these common mental health issues and the prevention and treatment of them, agencies can utilize the expertise of clinicians and mental health professionals. As experts in the field and as the individuals working with survivors to address mental health, they are a wealth of knowledge on this intersection of human trafficking, trauma, and mental health issues. Having a clinician or mental health professional regularly educate staff at your agency on these mental health considerations will not only ensure you are informed on the information and practices, but will help you to foster and maintain a trauma-informed approach.

If you have a mental health professional on staff or associated with your agency, ask them if they can train your direct staff on:

The most common mental health issues among survivors of human trafficking
- Common symptoms and signs of those issues in survivors
How they assess and treat those mental health issues
How to pursue the prevention of mental illness at your agency through increasing protective factors, such as social supports, and decreasing risk factors, including client isolation
How to best serve survivors in a trauma-informed approach that considers their vulnerabilities

Research

To be informed, agencies can additionally keep up with research on mental health disorders and recommended treatment plans and considerations for the mental health issues survivors commonly face.

While the World Health Organization reports that there has yet to be research evaluating the effectiveness of interventions specifically utilized to support recovery and healing of survivors of trafficking, we hope this research gap will soon be filled. As research continues to look at trauma-informed care and mental health, we believe critical insights can be provided about how to better care for survivors who experience a variety of complex problems, including mental illness. We urge you to periodically look into current and new research on the intersection of mental illness and trafficking and educate your staff on how this can impact and inform their work.

Appendix: Additional Information

Treatment of Mental Health Issues

The most common treatments for mental health issues are summarized below, with consideration for how these interventions should be tailored to survivors.

Cognitive Behavioural Therapy (CBT)

The World Health Organization (WHO) recommends individual Cognitive Behavioral Therapy for individuals who have experienced violence, including sexual trauma, and are suffering from PTSD, depression, and/or anxiety.

Considered to be a cornerstone for mental health treatment, CBT centers upon helping clients to understand and manage their thoughts, which are believed to dictate feelings and behaviors within CBT theory. While CBT can vary depending on the specific mental health issue, it often utilizes a cognitive aspect, where the client is helped to develop the ability to identify and challenge unrealistic and negative thoughts, partnered with a behavioural component. In working with survivors of trafficking, CBT interventions may utilize a trauma focus, where a specific traumatic event for the client is focused on.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR therapy is considered to be an effective method for addressing trauma in individuals, particularly with PTSD. The therapy utilizes elements of various psychotherapies, including cognitive behavioral and psychodynamic, and rapid, rhythmic eye movements to address the symptoms and emotional distress that derives from traumatic experiences. Clinicians and designated professionals should assess whether this may be the best treatment approach for clients suffering from trauma.

Trauma-Informed Approach

All treatment and interventions for survivors of human trafficking should follow best practice and clinical guidelines for providing services to victims of trauma. Utilizing a trauma-informed approach to the treatment of and interventions for mental health issues is considered essential within this field (See NTSA’s Trauma-Informed Baseline).

Considerations for Treatment

It is likely that survivors of trafficking may be unfamiliar with mental health services and the corresponding treatment for mental health issues. Mental health professionals or designated staff providing services should take care to explain in-depth any care plans, coordination, and duration, ensuring that clients are providing informed consent and can have agency within their own treatment.

Assessment of Mental Health Issues

Assessments of clients should be completed by mental health professionals or clinicians and should include psychiatric evaluations with consideration for the client’s experiences before trafficking and their experiences during trafficking.

During assessments of survivors, mental health professionals should seek to explore common post-trafficking responses, including: