Leave no one alone to fight demons of the past

Ahead of the World Mental Health Day (October 10), there's a spurt in discussions on mental well-being across the world. However, the focus is mostly on celebrities, rich people or  privileged students dealing with depression or anxiety. No one talks about the mental health of the poor. Underlying this selective outrage is a rationalisation that poverty, failure, violence and hardships in life may cause depression, anxiety disorders or other psychological problems.

Sadly, in a Corona-affected India, no one has seen how sex workers and survivors of human trafficking have suffered trauma through the lockdowns and even after. Quite falsely, some aid organisations and NGOs have inferred that this trauma is due to lack of shelter homes for survivors.  

The nationwide lockdown from March triggered one set of challenges — of people without ration and Aadhaar cards or bank accounts not getting rations or cash transfers. Survivors of trafficking are high among this group since they often lose their identities in the process of being sold or even after being rescued. For example, survivors of trafficking in Bengal, who were rescued from Delhi, Maharashtra or Goa, reported that no one had provided them with any identity papers when they had been rescued, put into shelter homes for years and repatriated back home.

Vimukthi, a sex workers’ group in Andhra Pradesh, has been pleading for the attention of the State Government for rations and welfare services. It took the AP State AIDS Control Society (APSACS) months to verify identities, until the Supreme Court ordered the State to ensure accessibility to food for sex workers.

Saans, a group of survivors of labour trafficking in the brick kiln sector from Chhattisgarh, reported the distress suffered when captive labourers in the kilns were left to fend for themselves post the lockdown and they received little or no support while returning home. Meanwhile, the lockdown also led to identification and rescue of children and adolescents from Bihar, Gujarat, Rajasthan and Bengal through ingenuous sting operations and intel-mining by non profits such as Mission Rescue Operation and Mission Mukti Foundation, start-ups that specialise in investigations on trafficking.

In the midst of lockdowns, quarantines, stranded migrants, inactive child welfare committees and anti-human trafficking units, the police and NGOs managed to return survivors to their families.

As usual there were no services to address the panic, fear, trauma and distress of survivors. This is because activists and NGOs working on mental health mostly prioritise working with populations in residential institutions and their suffering in poor institutional care, their stigma and exclusion by families and the State. Many of them have also taken up working with the homeless mentally ill, who live on the streets in absolute distress.

However, communities such as sex workers, trafficked people, drug users and trans-people, who are particularly vulnerable to psychological distress, have been peripheral in dialogue spaces or policy engagement processes. The terms “psychosocial counselling” and “psychosocial counsellors” are commonly used by NGOs and by governments in policies when it comes to recovery of survivors of human trafficking. This happened in the late 90s, when activists believed that not all survivors of trafficking are clinically depressed, or ill and may not require clinical services.

Recovery was understood to be a set of services that would help a trafficked person, often an adolescent or young adult, find safe spaces in shelter homes, be offered group counselling or individual counselling where each could be helped to assimilate what he/she had been through and emerge resilient and work for rehabilitation. If the person showed any clinical symptoms, such as violence, self-harm, suicide attempts, then the person could be taken to a psychiatrist for medication. So mental health assessment was largely done only through observation by people not trained to do so (activists, CWC chairpersons, judges, or magistrates). The understanding of trauma was largely associated with violence and withdrawal. In the last three decades, this understanding has not been challenged despite clinical research showing that survivors of human trafficking suffer dysthymia (a condition of chronic depression and anxiety disorders) even after having gone through rehabilitation services in shelter homes. Even today, they are not tested for PTSD to check trauma symptoms and decide the need for therapeutic and recovery services.

The approach of NGOs hiring social work graduates, or people who have done diploma courses on basic counselling, expecting them to be able to respond to PTSD suffered by people who have experienced sexual violence, physical torture, confinement and multiple betrayals in their childhood and adolescence, is a severe over-expectation. While many of these NGOs may even be aware of this and speak about their limitations of salary, or recruitment of people with training, the alternative of helping survivors access therapy from senior and established therapists has not emerged. That’s because these shelters are run on a closed door policy, where survivors are incarcerated and NGOs held responsible to keep them in custody. So any external mobility requires permission and is severely disapproved by the judiciary or CWCs, bodies which have very little orientation on the implications of incarceration on mental health of survivors of trafficking.

As the Ministry of Women and Child Development has been determined to bring about legal reforms for protection of human trafficking victims, it would be worthwhile to consider how to correct the ills of some of the bad rehabilitation and recovery practices that have proved to be ineffective and expensive. The recommendations that have emerged from the experience of survivors of trafficking are: Ensure PTSD testing and mental health assessments for all survivors. Recovery services must be based on diagnosis. Quell the myth that psychological distress can be diagnosed by lay people.

Restrict the periods of stay for survivors in shelter homes to not more than three-six months. The law and policies should shift the focus to community-based rehabilitation approaches. The law should define rehabilitation and recovery. Disband the current myth that incarcerating survivors in shelters or returning them home without any services for their rehabilitation means reintegration. Provide community-based social workers to support survivors’ access to health services at local hospitals and clinics.

Rescue, institutionalisation and repatriation may not be feasible for all survivors of human trafficking. For example, a person trafficked for domestic labour ten years ago, who since then has escaped the traffickers, may still be suffering from the traumatic impact of trafficking, but may not need to be institutionalised or returned back to his/her native village. Mental health services, both clinical and community-based approaches, need to be made available to all vulnerable groups such as sex workers, substance-users and survivors of trafficking.

Roop Sen is a co-founder of Sanjog (www.sanjogindia.org) which is a non profit that studies, deconstructs and empowers people and communities to resist violence. Mental health is a thematic area of work for Sanjog.

Disclaimer: This article was first published on The Pioneer. Republished here with the author's permission