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Treatment of mental trauma

The problem

The mental health needs of people coming out of slavery are wide-ranging and often severe.
Many suffer from trauma, especially because most people in slavery experienced violence, were threatened with violence and saw violence against others. The emotional and mental health needs of slavery survivors differ from one person to another but difficulties often include depression, anxiety and post traumatic stress disorder.

According to research by Free the Slaves and the Helen Bamber Foundation, most people coming out of slavery need to develop:

  • Trust in other people
  • Self-confidence
  • A sense of self
  • A feeling that they have personal power and control

Many also need help in:

  • Learning how to relate to other people
  • Understanding their own feelings and problems

When these mental health needs of former slaves are not adequately met, then whether they are living in a shelter or in the community, it causes additional problems, beyond the immediate mental suffering of the individual, regardless of whether they are living in a shelter, at their place of work  or in the community.

The mental health support of slavery survivors is one of the single greatest gaps in the global response to slavery. Many anti-slavery workers providing general services to survivors do not have a clear understanding of the mental health challenges these individuals are enduring, or knowledge of how best to support them. They then feel a sense of helplessness in the face of the pain of their clients and this contributes to the stress and often exhaustion of these workers.

Researching the mental health needs of survivors of slavery

Although learning about mental health support for slavery survivors has begun, it is happening much too slowly. Little is known about which therapies and combination of therapies are found to be most helpful in which contexts of slavery and which therapies could be safely offered by non-clinicians, with special precautions for former child slaves and those who have been sexually exploited. Above all, lack of investment in psychological support means that those suffering the continued mental pain of slavery are simply not getting the therapeutic help they need.

The Freedom Fund made a grant to the Helen Bamber Foundation, which provides comprehensive assistance including in-depth psychological support to trafficking survivors in the UK. This grant enabled the Helen Bamber Foundation to produce a report representing the first stage in what we hope is a wider initiative focusing on the mental health needs of survivors of modern slavery. The report contains a critical review of the existing research evidence and found that mental health problems, including depression, anxiety and post-traumatic stress disorder (PTSD) occur frequently. Prioritising the mental health needs of survivors is essential for sustained recovery from traumatic experiences and to increase capacity to protect themselves from further harm. Whilst there is limited evidence on the efficacy of specific treatment interventions, some treatments that are adaptable for use in a wide range of cultural contexts have been found to be effective in some areas, such as the reduction of PTSD symptoms.

The practical experience of NGO fieldworkers around the world has also begun to identify emerging possibilities for cost-effective care within low resource settings:

  1. The experience of anti-slavery workers has shown the importance of a comprehensive approach. To be effective, mental health support needs to be provided in a context of practical help for the survivor to stabilise their life. Helping survivors with these immediate needs creates the essential conditions in which emotional recovery has the chance to take place.
  2. There is growing research to understand different kinds of trauma, recognising that in some cases, the trauma of former slaves should be categorised as “complex”. These different types of trauma require different treatments.
  3. There is an emerging range of experiences of treatments for affected individuals. There are examples of shelters where caseworkers are using selected aspects of cognitive behaviour therapies or “mindfulness”. Across several countries, new approaches to “task shifting” in general mental health services are showing that there are some safe and cost-effective ways to assist healing in places where there is no psychotherapist.

Possible approaches

This range of experiences, combined with the literature and evidence from the Helen Bamber report, helps us to identify possible treatment approaches and pathways for research. The Freedom Fund is therefore currently developing an agenda for research together with practical implementation of mental health treatment for those who are most in need.

We are currently piloting an approach to diagnosis of mental health problems within our hotspots and using the results to prepare a psychological intervention that is tailored to the specific needs of those in the area. This approach is being piloted in South-east Nepal and we plan to roll this out in other hotspots as well as share our learning.