Resource

This critical review and research agenda was commissioned by the Freedom Fund and conducted by the Helen Bamber Foundation.

Foreword

Modern slavery, in all its forms, has a profound and devastating impact on human lives. It leads to significant and disabling mental health problems, as well as generational cycles of crisis, hardship and loss. This report reviews the existing research evidence on the mental health impact of enslavement and the efficacy of specific mental health treatment approaches. It identifies gaps in existing knowledge and thereby makes specific recommendations regarding future research priorities. We hope that it represents the first stage in a collaborative, international project to develop effective models of therapeutic care for all people who have suffered slavery, wherever they are located in the world.

Slavery ruthlessly breaks the bonds of healthy human relationships and its continued existence in modern life affects us all. In ‘hotspot’ regions across the world, enslavement of entire communities over generations is normalised. Traffickers transport people away from their homes into slavery, maintaining control by isolating them, threatening to harm their loved ones and manipulating fears related to family and community. At a local level, the lives and relationships of the children, families and communities of each enslaved person are profoundly damaged. However in HBF’s experience, lives and relationships can be gradually restored through the provision of integrated care. Helping one survivor to sustain recovery from the psychological impact of enslavement assists and strengthens every person who is positively connected to them. It supports their community and advocates for a world without slavery.

Over decades, our clinical work with survivors has shown us that people who are left without appropriate care and support after escaping slavery remain specifically vulnerable to further harm and exploitation until they receive it. Research in this area is still in its infancy, yet it is clear from our review that mental health problems including depression, anxiety and Post-Traumatic Stress Disorder (PTSD) occur frequently in survivors, regardless of the form of slavery to which they have been subjected.

Prioritising the mental health needs of survivors is therefore essential for them to sustain recovery from traumatic experiences and to increase their capacity to protect themselves from further harm. In addition to mental health needs, there are risks to a person’s safety and protection which need to be understood and acted upon. The various forms of slavery and the challenges faced by those who are working to assist and support enslaved people, are highly specific to the regions, populations, cultural and socio-economic contexts in which they occur. We therefore recommend the following research agenda:

• Research studies should be conducted with a common framework, appropriate screening instruments and identification methods in areas with a high prevalence of modern slavery. This will enable cross-national and cross-cultural comparisons of the mental health effects of slavery so that the potential benefits of specific treatment approaches can be evaluated.
• Survivors’ experiences of slavery should be fully documented. They have crucial insight into the harm caused by slavery and their own treatment needs. Therefore they should be involved in the development and implementation of research in this area.
• Clinical interventions should be systematically evaluated to determine whether they are helpful to survivors in various regions and contexts, and whether they can be delivered successfully by non-clinicians. Further avenues for research include treatments such as Narrative Exposure Therapy (NET), Cognitive Behaviour Therapy (CBT) and other integrated approaches.

An international network with a collaborative research agenda would enable the sharing of best practice clinical methods and utilise the valuable working knowledge of all those who are currently working in slavery ‘hotspot’ regions. The involvement of survivors is crucial to any such project.