India Needs To Focus On Mental Health Issues Of Trafficking Survivors
Research has revealed that multiple symptoms ranging from nausea, abdominal and back pains, white discharge, anaemia, headaches, fatigue, dizzy spells, to sleeplessness, nightmares and amnesia were reported by girls and young women who had been rescued from brothels in various states including Delhi, Goa and Maharashtra. Psychological evaluation and psychiatric assessment revealed that all survivors displayed feelings of loneliness, helplessness, rejection and social anxiety 87.3% of the survivors were diagnosed with dysthymia and 12.7% with depression, a significantly high figure when compared to the general population diagnosed with depression (1.8%). Keeping all this into account, the government of West Bengal in 2016 issued an order to provide free physical and psychological testing facilities to the survivors of human trafficking.
Depression is a chronic state where the symptoms linger for two weeks or more. It is a typical consequence of trauma. A person diagnosed with depression tends to experience symptoms like listlessness, changes in appetite — weight loss or gain unrelated to dieting, loss of energy or increased fatigue, restlessness, feelings of hopelessness, lack of self-worth, guilt and recurrent thoughts of suicide and death. It would be challenging for a person to build or respond to relationships, take self-care, avail opportunities for self-advancement or respond to any rehabilitation services to build skills and make a livelihood. The subjects of the health study had lived in shelter homes for several months and even years and yet suffered from such chronic health problems, indicating a lack of quality services in these rehabilitation homes.
Although the law, law enforcers, the judiciary and social welfare offices know well about the impacts of human trafficking and the accompanying trauma, strangely the victims when rescued are not offered with any psychological or psychiatric evaluation. When sent for health tests, they are only tested for physical tests including HIV, pregnancy and the two-finger test to determine whether and how much they had been sexually active, keeping the psychological aspect latent. When remanded to shelter homes by the judge or magistrate, where the survivors are often kept for two to three years, these shelters often have no basis for treatment or diagnosis. With low salaries for in-house counsellors and restricted access for the survivors to avail treatment from government hospitals or private clinics, their symptoms remain unrecognized, hidden and untreated. While most social workers and NGOs running shelter homes report rage, depression, impulsivity, lack of concentration, lack of motivation or responsiveness to their services and efforts and even self-harm behaviours, the survivors are not provided with the access to psychotherapy or psychiatric treatment unless there is violent behaviour and extreme dysfunction to be qualified as ‘madness’. In 2017, when Rescue Foundation, an NGO in Maharashtra requested permission to the Child Welfare Committee in Pune after being advised by mental health professionals to strengthen survivors’ access to psychological services, the CWCs refused permission arguing that there was no such need since survivors ‘did not display any abnormal behaviour’.
The health conditions deteriorate because of trafficking wherein survivors suffer physical, sexual and psychological torture. The PTSD gets compounded when they, subsequent to the rescue, find themselves in trapped situations in shelter homes. They have no control, no information regarding their release, are anxious about the stigma and violence they would face through ostracization, intimidation and threats from traffickers when they return to their communities. They have poor access to health and rehabilitation services even when they return home. Their rights to safety, protection, social and economic security is compromised due to the lack of mainstreaming of rehabilitation services through public healthcare system, lack of policies for Panchayats and district administration. Even though the government of West Bengal recognized the gap between the provision of health services when compared with their actual requirements by the trafficked victims and made the services free, its actual implementation requires a planned effort by the Chief Medical Officers of Health of each district. Hence, awareness, strategy, goal setting and a planned initiative to implement the spirit of the state directive is required.
Even when there is a paucity of psychologists and psychiatrists in rural India, there have been a few interesting initiatives within a 15-month period to address psychological disorders like dysthymia, depression and anxiety disorders amongst the survivors in their community settings, which have proved out to be very promising. These have managed to reduce severity rates down to less than 20% from a staggering 83.4%. Psychologists like Uma Chatterjee and Dr. Chandrani Dasgupta, who have designed these interventions, customized services that could be delivered by the grassroots community workers. These are significant developments because mental health problems of survivors of sexual exploitation are not only restricted to trafficked people but also extend to the survivors of rape, domestic violence and sexual abuse. There is cross-cutting experience that without recovery from the trauma and its lingering impacts, girls and women are unable to avail and use education, training or any empowerment opportunities and fall into domestic violence to ultimately suffer from lives of ignominy and wastefulness. They become a social and financial liability for their families and end up remaining as victims perpetually. As India observes the World Human Rights Day on 10th of December 2019, it should address the neglect towards thousands of survivors of human trafficking and the wasteful expenditure towards a custodial rehabilitation approach that is known to provide relief to survivors and have a sustainable impact on their rehabilitation and empowerment.