Human trafficking and health in UK public policy

Background: The issue of human trafficking has risen up international and national political agendas in the last decade. Existing evidence suggests that many trafficked people suffer from a range of health problems as a result of their experiences. This research sought to analyse how health was incorporated into the UK response to trafficking between 2000 and 20 I O. Methods: Qualitative data was collected through semi-structured interviews, participant observation at policy-relevant events and document collection. Data analysis was organised according to the principles of framework analysis. Results: Trafficking has been defined in the UK as a problem of organised immigration crime and the dominance of this definition has limited the extent to which health was incorporated into the national policy response. Non-governmental organisations (NGOs) strategically used information about the health consequences of trafficking to support their arguments for the provision of support and protection to trafficked people. They did not use the information, however, to argue for health- related policy change. The Department of Health (OH) and healthcare providers were not engaged in trafficking policymaking and there was no discernable domestic pressure to develop a health- based response. A limited amount of health-related policy change did occur following the UK's ratification of the Council of Europe Convention on Action against Trafficking in Human Beings, but the scope of these changes was restricted by the lack of awareness in the health sector about trafficking and by the shortage of information relating to how trafficked people use health services. Conclusions: Future health-related policy change is likely to be limited so long as healthcare providers fail to act as advocates within the policymaking process and the OH remains on the margins of the policy subsyste

Mental health and human trafficking: responding to survivors' needs.

Mental health professionals have opportunities to intervene and provide care for trafficked people. Research shows that mental health problems - including depression, anxiety and post-traumatic stress disorder - are prevalent among trafficked people, and that at least some trafficked people come into contact with secondary mental health services in England

Maternity care for trafficked women : survivor experiences and clinicians’ perspectives in the United Kingdom’s National Health Service

Background Although trafficked women and adolescents are at risk of unprotected or forced sex, there is little research on maternity care among trafficking survivors. We explored health care needs, service use and challenges among women who became pregnant while in the trafficking situation in the United Kingdom (UK) and clinicians’ perspectives of maternity care for trafficked persons. Methods Cross-sectional survey and qualitative interviews with trafficking survivors recruited from statutory and voluntary sector organisations in England and qualitative interviews with maternity clinicians and family doctors undertaken to offer further insight into experiences reported by these women. Findings Twenty-eight (29%) of 98 women who took part in a large study of trafficking survivors reported one or more pregnancies while trafficked, whose data are reported here. Twelve (42.8%) of these women reported at least one termination of pregnancy while in the trafficking situation and 25 (89.3%) experienced some form of mental health disorder. Nineteen (67.9%) women experienced pre-trafficking physical abuse and 9 (32.%) sexual abuse. A quarter of women were trafficked for sexual exploitation, six for domestic servitude and two for manual labour. Survivors and clinicians described service challenges, including restrictions placed on women’s movements by traffickers, poor knowledge on how to access maternity care, poor understanding of healthcare entitlements and concerns about confidentiality. Maternity care clinicians recognised potential indicators of trafficking, but considered training would help them identify and respond to victims. Main limitations include that findings reflect women who had exited the trafficking situation, however as some had only recently exited the trafficking situation, difficulties with recall were likely to be low. Conclusions More than one in four women became pregnant while trafficked, indicating that maternity services offer an important contact point for identification and care. Given the prevalence of sexual exploitation and abuse among trafficking survivors, clinicians should ensure antenatal care and screening for sexually transmitted infections can be readily accessed by women. Clinicians require specialised training alongside designated pathways and protocols with clear referral options to ensure confidential maternity care tailored to each woman’s needs

Carers’ experiences of involuntary admission under mental health legislation:systematic review and qualitative meta-synthesis

Background Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. Aims We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. Method We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. Results The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. Conclusions Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends

Improving the mental health of women intimate partner violence survivors: Findings from a realist review of psychosocial interventions

Intimate partner violence (IPV) is highly prevalent and is associated with a range of mental health problems. A broad range of psychosocial interventions have been developed to support the recovery of women survivors of IPV, but their mechanisms of action remain unclear

Improving the mental health of women intimate partner violence survivors: Findings from a realist review of psychosocial interventions

Background Intimate partner violence (IPV) is highly prevalent and is associated with a range of mental health problems. A broad range of psychosocial interventions have been developed to support the recovery of women survivors of IPV, but their mechanisms of action remain unclear. Methods Realist review following a prospectively published protocol in PROSPERO (CRD42018114207) and reported using the Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMSES) guidelines. Results Evidence was extracted from 60 reviews and triangulated in expert consultations. Mechanisms of action were categorised as either associated with intervention design and delivery or with specific intervention components (access to resources and services; safety, control and support; increased knowledge; alterations to affective states and cognitions; improved self-management; improved family and social relations). Conclusions Findings suggest that psychosocial interventions to improve the mental health of women survivors of IPV have the greatest impact when they take a holistic view of the problem and provide individualised and trauma-informed support

Responding to the health needs of trafficked people: A qualitative study of professionals in England and Scotland

Trafficked people require timely and ongoing access to healthcare services. Yet, many encounter difficulties accessing and utilising healthcare services, both while in situations of exploitation and after their escape. This research investigated barriers that hinder healthcare providers from identifying, providing care and making necessary referrals for trafficked people in the United Kingdom (UK). Semi‐structured, face‐to‐face interviews were conducted with healthcare (n = 23) and non‐health (n = 27) professionals with relevant policy or practical experience related to human trafficking in the UK. Topic guides covered identifying, referring and providing care to trafficked people. Transcripts were analysed using thematic analysis. Four interconnected themes emerged: trafficked persons’ entitlements to healthcare, availability of healthcare resources, providers’ knowledge about trafficking, and the particular needs of trafficked individuals. Providers explained that policies limiting entitlements to healthcare created significant obstacles to care, as did the inadequate resourcing of interpreter services, trafficking support services, and specialist mental health services. Few healthcare professionals reported having received training on responses to trafficked people and most were unaware of support options and referral routes. Healthcare professionals will be better equipped to serve trafficked individuals if they are provided training to identify and respond to human trafficking, guidance on referral and support options and entitlements to care. Simultaneously, improving trafficked people's healthcare access and use will also require government interventions to ensure they are not unjustifiably denied healthcare