This blog post is written by Dr. Tasnova Malek, a primary care physician with extensive experience in diverse clinical settings and a degree from the Bangladesh Medical College. She is currently working for the National Suicide Prevention Center and as a medical reviewer for Sunshine Behavioral Health.
Dr. Malek hopes to bring awareness to the importance of mental health and the ways mental health can impact a person’s life, as mental health is a vital but often overlooked issue.
Mental health issues and human trafficking are both challenges not limited to borders, socio-economic backgrounds or a specific race or gender, they can affect anyone, anywhere. And no matter where a person is from, certain mental health conditions and behaviors may lead to increased vulnerability to human trafficking and a higher risk of being lured into this situation. Having a basic understanding of the mental health conditions that can contribute to this increased risk of human trafficking, and how to identify or avoid them, can help in the fight against modern slavery.
Mental Health Disorders Can Set the Stage
Studies have shown that drug addiction, sexual abuse, trauma, and poverty, as well as being of a racial or ethnic minority can set the stage for a person to be more susceptible to the tactics of a trafficker. The National Center for Safe Supportive Learning Environments put it this way, “Racial and ethnic minority students are more vulnerable to trafficking partly because they are more likely to experience poverty and its associated effects” going on to point out “often one risk factor overlaps with and amplifies others. Particularly vulnerable groups…tend to share histories of poverty, family instability, physical and sexual abuse, and trauma.” Traffickers often seek out those with certain mental health issues that stem from these environments and behaviors, and ply them with attention, compliments, and professions of love as a means to persuade them into non-consensual sex work. In fact, in 2020, nearly 40 percent of human trafficking victims in the U.S. were brought into trafficking by someone they perceived as an intimate partner, while another 42 percent were trafficked by a family member.
One survivor, Jose Alfaro, shared his story with the Polaris Project. Jose grew up in an abusive, religious household in Texas and struggled with his sexuality and the stigmas around it. These experiences left Jose emotionally vulnerable and led to Jose seeking out and entering into relationships with a series of older men. One of these men eventually trafficked him into working in erotic massage.“It was degrading and terrifying,” Jose said. “But I was too scared to leave. I felt like I had nowhere to go, and my trafficker kept reinforcing that to keep me under his control.”
A study about trafficking in England found that 78% of female and 40% of male human trafficking survivors had experienced some kind of emotional health issue. The study states that “Poor mental health may increase vulnerability to trafficking, due to factors directly associated with (existing) poor mental health, such as reduced decision-making capacity or understanding and increased dependence on others.” When a person experiencing poor mental health encounters a trafficker who is skilled at identifying this vulnerability, it becomes an opportunity. The trafficker knows how to leverage poor mental health as a tool and lure potential victims into sex trafficking.
Once trafficked, existing mental health issues are commonly reinforced through the trauma of trafficking. In an article titled Addressing the Internal Wounds: The Psychological Aftermath of Human Trafficking the U.S. State Department wrote: “Because traffickers dehumanize and objectify their victims, victims’ innate sense of power, visibility, and dignity often become obscured. Traffickers also use coercive tactics and force to make their victims feel worthless and emotionally imprisoned. As a result, victims can lose their sense of identity and security.”
Another study found that 61% of men and 67% of women (with 57% of children) who survived human trafficking suffered some form of mental illness. The study showed that trafficking tended to worsen prior behaviors and sometimes trigger more severe mental illnesses. These mental health issues included problems like depression, anxiety, and PTSD. “James,” another survivor who shared his story with the Polaris Project under a pseudonym, said he had a psychotic break while being sex trafficked and saw himself as a “piece of trash.” Viewed as a liability by his traffickers, they abandoned him, and he soon found himself homeless and penniless, thousands of miles away from home. “I didn’t blame the men who left me there,” he said. “I blamed myself. For years, I tortured myself. I replayed these events over and over and over in my mind. Like a prisoner being forced to watch his nightmares on a loop. Every day was the same. Even though time moved forward, I was still living each day in the past. I was stuck and unable to move forward.” said James.
Most studies on mental health and human trafficking point to the fact that emotional challenges make people more prone to potential trafficking situations. James knew from a young age that he was different “being gay in my hometown was not acceptable. My solution was to hide my authentic self and try to become the person that others wanted me to be, hoping eventually that the new “persona” would eventually snuff out the part of me that I was unwilling to accept.” This suppression of his authentic self led to substance abuse as James tried to find peace in drugs and alcohol. “I just wanted to get drunk and high so I could escape the reality that I was a Gay man.” Due to his substance abuse issues, he sought out relationships with people who could support his habit, engaging in behavior that left him vulnerable to trafficking. This behavior was how he eventually met his trafficker.
Are There More Common Disorders Among Victims?
Commonly, human trafficking victims have mental health disorders like depression, anxiety, PTSD, isolation, and identity issues. And, as mentioned, a trafficker plays on these vulnerabilities and uses various emotionally manipulative techniques to make an alienated or isolated person feel safe and comfortable in their presence, like Jose’s trafficker, who promised him shelter, food and love when he had nowhere to live. “He claimed he lived in Austin in a huge, beautiful home and made me all kinds of promises about work, about continuing my education, and all that,” Jose said. “Instead, he began grooming me. He got me to go to the gym, put me on a healthier diet, made me trust him.”
Traffickers may also touch on a person’s feelings of shame and guilt (such as struggling with sexual or gender identity issues) to make them feel accepted in a way they haven’t before. Then, they may continue to prey upon these emotional problems to trap a person in an abusive situation. This way, they can create the illusion of choice and cause victims to stay in a bad situation willingly.
When removed from a human trafficking situation, many people experience worsened depression, anxiety symptoms and substance abuse habits. They may blame themselves for what happened and try to punish themselves with alcohol and drugs. And human traffickers often prey upon these feelings to lure people back into other trafficking situations.
Do Mental Health Disorders Make It Harder for Victims to Leave?
Mental health disorders like depression or anxiety and challenges like drug addiction may lead victims to their traffickers but they also often make it harder for human trafficking victims to leave their situation. Some traffickers even purposefully addict their victims to substances like heroin or meth. They then provide them with a steady supply of the drug to keep them from running away from being trafficked. At times, the tactics a trafficker uses can lead to another mental health condition, Stockholm Syndrome.
Stockholm Syndrome refers to the ways kidnapping victims sometimes emotionally bond with their captors. One famous example of this is Patty Hearst. In 1974, the newspaper heiress was kidnapped and held for ransom by a group of terrorists. Due to the mental health issue of Stockholm Syndrome, she eventually became emotionally involved in their cause and participated in their criminal behaviors. The same type of bonding can happen to people in a human trafficking situation making them feel the “want” or “choose” to stay with their traffickers. Traffickers can actively try to promote this trauma bonding by providing hope of a better life, attacking the victim’s emotional vulnerabilities and self-esteem, and gradually brainwashing them into thinking the best thing for them is to stay in their current situation. This type of trauma bonding can lead to deep emotional scars that make it extremely hard for a victim to decide to try and escape the trauma of trafficking.
Another mental health issue that comes up is Trauma Bonding. Trauma bonding happens when the trafficker uses rewards and punishments to build a powerful emotional connection with the victim. “Traffickers may take on a role of protector to maintain control of the victim, create confusion, and develop a connection or attachment, which may include the victim feeling a sense of loyalty to or love for the trafficker.” Sometimes this trauma bonding may be part of a family relationship, building on the traditional safety felt in a family and turning into mental and physical abuse. “Repeated trauma exposure can negatively affect brain development and the way a person thinks, often resulting in a victim becoming numb and disconnected from themselves,” The U.S Department of State explains. “Therefore, in order for them to feel something, it must be intense. For example, a trafficker’s repeated abuse and the related trauma exposure may result in a trafficking victim returning to the trafficker due to the intensity, familiarity, and routine provided by the relationship.” These factors increase the difficulty of a trafficking victim leaving the situation to find help.
Shamere Mackenzie, who told her story to nonprofit End Slavery Now, was lured into forced prostitution by a boyfriend under the guise of temporary exotic dancing. Her trafficker formed a trauma bond by repeatedly beating and threatening her with a gun before apologizing and promising never to hurt her again. Those promises never lasted long. Shamere eventually escaped, but despite the abuse, continued to keep in contact with her trafficker, who began threatening to hurt her family if she didn’t return. Two weeks later, she came back, only to be raped and sodomized by the trafficker. Eventually, he began to use her to drive other trafficked girls across state lines. Fearful for herself and her family, she complied. “From the very first beating when I was choked to the point of unconsciousness until the day he pulled the trigger on [a] miraculously unloaded gun in my mouth, I knew obedience meant survival,” she said.
How Can We Help Solve the Problem?
Better education about key emotional and mental health issues can help combat the dangers of human trafficking. Teaching people how to spot signs of the most common mental health issues people vulnerable to trafficking may exhibit- looking for substance abuse, disengagement and alienation in friends and family members, and what to do about it, can make it easier for them to intervene if they think they know someone who needs help. And getting vulnerable people out of dangerous situations, connecting them with mental health support services and starting a conversation can decrease their risk of falling into trafficking. SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Similarly, education on human trafficking signs and what to do about them should be increased throughout the world. People in wealthy countries as well as those in emerging economies must understand that everyone, everywhere can be at risk. The public needs to understand the issue, know the mental health warning signs and support programs that help reduce the risk factors of trafficking, like social services, homeless shelters, addiction programs and safe houses.
Lastly, it’s vital to know who to contact if you suspect someone you love is involved in human trafficking on any level. Contact the National Human Trafficking Hotline if you have any concerns about a potential trafficking situation. Call 1-888-373-7888, text HELP to BEFREE (233733), or email email@example.com.
If you spot signs of what looks like some of the behavioral red flags or mental health problems mentioned in this article in those around you, talk to them right away and offer to help. A conversation from someone who cares can make it easier for them to transition to a treatment facility and get the care that they need. Importantly, you can help connect them with the support and the chance to transition to a healthier and safer life. That’s what happened for James, who credits a stranger with putting him on the path to freedom and recovery.
“In the depths of my despair, a stranger found me broken, beaten down and afraid, on the streets and took me to the hospital,” he said. “I was given IV fluids, some food and an opportunity to go to drug and alcohol rehabilitation. I agreed to go because I needed a place to sleep and food to eat. I was sick and tired of eating leftover food from trash cans on the street. I was too tired to fight life anymore.” Though James said he struggled with substance abuse for years after his initial stint in rehab, he has since celebrated three years of sobriety. “Today, I know that I am loved, and I am able to love others without fear,” he said. “I have found that peace that I had been searching for all along. You can find that too. Today, no one has to be alone.”
Resources and Sources
- National Human Trafficking Resource Center (NHTRC) 1-888-373-7888
- SAMHSA’s National Helpline:1-800-662-4357
- OVC.ojp.gov – Office for Victims of Crime
- sunshinebehavioralhealth.com – Resources for Homeless and Runaway Youth
- safesupportivelearning.ed.gov – Vulnerable Populations
- safesupportivelearning.ed.gov – Risk Factors
- polarisproject.org – Love and Trafficking
- polarisproject.org – Survivor Story Jose Alfaro
- ncbi.nlm.nih.gov – Mental Health and Human Trafficking: Responding to Survivors’ Needs
- 2009-2017.state.gov – Addressing the Internal Wounds: The Psychological Aftermath of Human Trafficking
- polarisproject.org – Survivor Story : James Evans
- aspe.hhs.gov – Treating the Hidden Wounds: Trauma Treatment and Mental Health Recovery for Victims of Human Trafficking
- growfreetn.org – Psychological Effects of Human Trafficking: Depression, Anxiety, & Substance Use [Part 1]
- dash.harvard.edu – Medical Education on Human Trafficking
- ncbi.nlm.nih.gov – Does the Stockholm Syndrome affect female sex workers? The case for a “Sonagachi Syndrome”
- fairobserver.com – Stockholm Syndrome and Sex Trafficking: Why Don’t They Do Something?
- state.gov – Trauma Bonding in Human Trafficking
- endslaverynow.org – Modern Slave Story : Forced Prostitution
- state.gov – Identify and Assist a Trafficking Victim
- state.gov – 20 Ways You Can Help Fight Human Trafficking
- acf.hhs.gov – 10 Ways You Can Help End Trafficking