Failure to Identify a Human Trafficking Victim

Around the world, 40 million people suffer from human trafficking enslavement (1). In Texas, labor and sex trafficking victimizes more than 300,000 individuals annually (2). Human trafficking is defined as “the recruitment, transportation, transfer, harboring, or receipt of persons,” by means of threat, force, coercion, abduction, fraud, deception, the abuse of power, or payments, “for the purpose of exploitation” (3). Labor exploitation includes some agricultural and fishing industry work, repetitive labor, domestic servitude, debt bondage, and other forms of slavery. The identification of victims and provision of treatments and services is limited by a lack of research on human trafficking.

Human trafficking utilizes psychological methods to coerce victims into bondage, including isolation, monopolization of perception, induced debility, occasional indulgences, threats, and degradation (4). Victims, including men, women, children, refugees, migrants, and members of the LGBTQ community, may be trafficked locally or moved across borders. Sex workers, some of whom are trafficked, risk prosecution and criminalization (5). Survivor studies indicate that the majority of trafficked persons see a health care professional at least once during captivity (6). Given the vulnerability of psychiatric patients to becoming trafficked, as well as the psychiatric consequences of trafficking (7), it is important that mental health providers recognize and treat trafficked patients.

There is both a lack of validated screening tools to identify victims of trafficking (8) and a paucity of outcome-based training for health care professionals and trainees (9). Patients with psychotic and severe depressive disorders may require more intensive support. Underutilization of integrated multidisciplinary teams may result in fragmented care, contribute to undertreatment, delay access to resources, extend captivity, and exacerbate the economic health care burden.

Patient-centered, trauma-informed, and multidisciplinary care is recommended for managing victims of trafficking (7). Given that few formal recommendations have been made for treatment (10), therapeutic interventions may follow evidence-based protocols for other traumatized populations. Providers may experience vicarious trauma, which may undermine their willingness to question patients about psychological and physical violence. Providers should also be mindful that questioning and physical examination can retraumatize victims. Patients may distrust or fear authority figures or government officials and hesitate to seek help from health care providers. A safe house should be provided on discharge. Better identification, provision of a comprehensive model of care, and widespread connections to community advocates, safe houses, and services will help connect victims of trafficking with resources, reduce the possibility of retraumatization, and improve outcomes for similar patients in the future.

The patient described here went undetected as a trafficking victim for nearly 2 years as she cycled in and out of hospitals, in part because of her decompensated state and complex presentations. A plethora of challenges undermine recognition and treatment of victims and deserve our attention. Breaking the cycle of trafficking should be viewed as a challenge for research and innovation in medicine, especially in psychiatry.