Care lacking for victims: study

By: Rebecca Moss

While mental health services are crucial to the recovery process for the Kingdom’s victims of human trafficking, stigma and limited resources remain a barrier in the provision of and access to those services, according to a new study published yesterday.

The research, published in the International Journal of Mental Health Systems, reveals that poor access to mental health services is linked to both how Cambodians seek care and the limited capacity of organisations to treat the trauma of trafficking victims.

“Health-seeking behaviour isn’t there in the same way for mental issues as it is for physical problems,” said Charlotte Aberdein, the lead author of the study. “You see that manifest in high suicide rates, in people just living with anxiety and depression.”

Aberdein noted a cultural tendency in Southeast Asia to “save face”, and sweep issues under the rug.

“It is just not talked about,” she said.

Between 40 and 65 per cent of trafficking survivors experience depression, anxiety and PTSD, while 5 per cent expressed suicidal tendencies, according to a study of Mekong region victims published earlier this year by the London School of Tropical Health and Hygeine.

For her study, Aberdein conducted interviews with seven “aftercare” and mental health organisations in Cambodia on how they treat these symptoms. Most programs were focused around institutionalised care facilities and the use of both trauma-focused cognitive behaviour therapy and EMDR eye movement therapy, which allows victims to reprocess traumatic memories or associations by controlling their eye movements.

The research indicates that many organisations have made strides in cultivating individualised treatment programs, matching victims with counsellors who they can relate to in gender or ethnicity, and working within religious beliefs.

However, from a resource perspective, Cambodia’s mental healthcare system remains in its infancy. Just 1 per cent of the country’s healthcare budget is allocated to mental health. For men and boys specifically, and in rural areas, these resources are even sparser. In 2010, only 35 trained psychologists were working in the country, according to a report from the Leitner Center for International Law and Justice at Fordham University.

In 2012, that number had risen to 49, according to Aberdein, with the Royal University of Phnom Penh graduating its first class of master’s degree candidates in clinical psychology and counselling that year.

“The tendency is for donor funds to go to things where there is an easy fix, where you can cure or treat people,” said Aberdein. “One of the problems with mental health is that it is not very easy to show growth.”

Dr Katherine Welch, who consults in aftercare programs for trafficking victims in Asia, emphasised that mental health cannot be separated from physical recovery.

“Often, there is a history of abuse and neglect in the past of someone who has been trafficked, so it becomes a cycle,” she said. “What really tends to be lacking is the long-term continuity of care when people are back in their own communities.”

However, she disagreed that emotional wellbeing was something that Cambodian culture systematically ignores. Mental health care, in its purest form, has always been a part of peoples’ culturally acceptable way of healing.