In 2016, the Department of Health and Family Welfare, Government of West Bengal, issued an order directing all health service providers to provide free physical and psychological testing facilities to survivors of human trafficking. This was a result of a research conducted by an organisation called Sanjog wherein girls and young women, who had been rescued from brothels in Maharashtra, Delhi, Goa, and others states, and had returned to their homes and families, reported multiple symptoms - ranging from nausea, abdominal and back pains, white discharge, anaemia, headaches, fatigue, dizzy spells, sleeplessness, nightmares and amnesia.
Psychological evaluation and psychiatric assessment revealed that all survivors (100%) displayed feelings of loneliness, helplessness, rejection and social anxiety. It also showed that 87.3% had dysthymia while 12.7% were diagnosed with depression which is significantly high compared to general population (1.8%).
On World Mental Health Day, we look at the help that is sorely lacking for these victims.
Dysthymia is chronic state where symptoms linger for two years or more with episodes of major depression, and is a typical consequence of trauma. Such a person experiences listlessness, 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, to take care of oneself, to avail opportunities for one’s advancement or respond to any rehabilitation services for their skills building or livelihood.
That the subjects of the health study had all been through living in shelter homes for several months and years where they were given rehabilitation services and yet suffered from such chronic health problems indicate lack of quality services in these rehabilitation homes.
Tests for HIV, Pregnancy, But What About Mental Health?
Although the law, law enforcers, the judiciary and social welfare offices are well versed with the impact of trafficking and sexual exploitation causing trauma to victims, strangely, such victims when rescued are not offered any psychological or psychiatric evaluation.
When sent for health tests, they are only tested for HIV, pregnancy and the two-finger test are used to determine whether they had been sexually active. When remanded to shelter homes by the judge or magistrate, where they are often kept for two to three years, the counselling these shelters offer have no basis of treatment or diagnosis. With poor salaries for in-house counsellors and restricted mobility for these survivors to avail treatment from government hospitals or private clinics, their post traumatic stress remains unrecognised 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, or even self harm behaviours, unless there is violent behaviour and extreme dysfunction qualified as ‘madness’ by them, survivors are not provided with access to psychotherapy or psychiatric treatment. 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’.
Dealing with PTSD
The health conditions may well have been the impact of trafficking wherein survivors suffered physical, sexual and psychological torture. The PTSD gets compounded when they, subsequent to rescue, find themselves in trapped situations in shelter homes where they have little control, no information regarding their release, anxiety regarding the situations they would face at home once they return and subsequent to their return to their communities, the stigma and violence they face through ostracisation, intimidation and threat of traffickers.
They have poor access to health and rehabilitation services even when they return home because of lack of mainstreaming of rehabilitation services through public healthcare system, lack of policies for Panchayats and district administration to ensure their rights to safety, protection, social and economic security.
Even though the government of West Bengal has been the pioneer to recognise the gap in health service delivery to trafficked victims and therefore issued an order to make services free, its actual implementation and enabling survivors to approach hospitals and clinics, building capacities of health service providers to understand the symptoms in relation to trauma requires a planned effort by the Chief Medical Officers of Health of each district. That requires awareness, strategy, goal setting and a planned initiative to implement the spirit of the state directive.
Given the paucity of psychologists and psychiatrists in rural India, there have been a few interesting initiatives to address dysthymia, depression and anxiety disorders amongst survivors of trafficking in their community settings, which have been very promising and within a 15 month period, has 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 customised services that could be delivered by 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 survivors of rape, domestic violence and sexual abuse.
There is cross cutting experience that without a recovery from trauma and its lingering impacts, girls and women are unable to avail and use education, training or any empowerment opportunities, fall into domestic violence and ultimately suffer lives of ignominy and wastefulness. They become a social and financial liability for their families and end up as remaining victims perpetually.
As India observes the World Mental Health Day on 10th October in 2019, it may do well to address the neglect towards thousands of survivors of human trafficking and the wasteful expenditure towards a custodial rehabilitation approach that is known to have provided relief to survivors and had any sustainable impact on their rehabilitation and empowerment.
(Roop Sen is a researcher, facilitator, and an activist, who works on issues of gender-based violence and personal growth. He is a certified coach and a practitioner of behavioural sciences, and works with individuals, groups and organisations for growth and development.)