Mental health care services continue to require strengthening to support survivors

In the Asia region, countries vary widely in their capacity to provide mental health care support to trafficking survivors, and even Thailand’s more robust health care system demonstrates limitations to the support available.

Thailand is recognized as a pioneer in health care coverage for migrants. The Compulsory Migrant Health Insurance policy covers all migrants, with the exception of those employed in the formal sector, who are covered by the Social Security scheme. The insurance policy has been expanded to include migrant children up to the age of seven and even undocumented migrants may opt in. Singapore has followed suit with recently expanded programs to improve health care access for this population. However, challenges such as language barriers, lack of information and uneven implementation continue to impede access and leave migrants prone to high out of pocket costs. For mental health care in particular, access is further hampered by the limited availability of therapeutic counseling. With only 14.36 mental health care workers per 100,000 population (as of 2017), practitioners report high levels of burnout and emotional exhaustion. Rural-urban disparities in access exist as well, as mental health care is concentrated in more urban settings.

Migrant workers and vulnerable groups such as labor exploitation and trafficking survivors have acute mental health care needs, including high rates of depression, anxiety, post-traumatic stress disorder (PTSD), self-harm and attempts at suicide. In a study of trafficked people in the Greater Mekong subregion, 61% of participants reported symptoms of depression and 39% reported symptoms of PTSD. While those mental health care needs may be obvious to aftercare services professionals, these vulnerable groups can have other conditions that add layers of complexity to their mental health needs. Some needs, such as treatment for drug and alcohol addictions, might come as a result of their displacement, exploitation and abuse. Other needs may include pre-existing conditions that led them to become more vulnerable to trafficking and exploitation in the first place. Histories of childhood sexual abuse, experiences of stigmatization amongst sexual and gender minorities, or cognitive disabilities are examples where, especially in disadvantaged communities, there is less general awareness and education about mental health issues, and the lack of support compounds trauma. These complex and overlapping health care needs require specialized treatment, which may be lacking due to stigmas and perceptions of stigma interfering with care, or because the trauma and substance abuse addictions arising from trauma mask pre-existing conditions.

Thailand has come a long way and many services are now available–in Bangkok, for example, there are government hospitals as well as a number of private health care clinics, including two Christian clinics. There is one major public hospital that provides psychiatric care, and sex workers can receive services there. However, NightLight International shares that, in their experience, demand continues to outstrip service availability. Service is primarily limited to an evaluation, basic check-ups and prescriptions for medication. Though the care is generally affordable, survivors often find it unhelpful. Moreover, government hospitals tend to be flooded with patients, which requires patients to arrive early and wait long hours to receive care. For those trafficked into the sex trade, and who may be awake until 3 or 4 am, it can be nearly impossible to get in line for healthcare first thing in the morning, which means they end up not following up on the care they need from their doctors.

To receive access to counselors who really sit with patients and provide truly transformative care, the survivors need to go to the higher-end hospitals, private healthcare centers, online counseling from therapists in their home countries, or utilize therapeutic care that NightLight coordinates via support from IOM. Survivors more often choose private care; however, it is more expensive. Private care, for example for substance abuse rehabilitation, can cost $600-800 USD per month – or even thousands a month for rehab clinics that cater to foreigners. There are a couple rehabilitation centers in more rural areas in the north, but survivors who are used to living in cities generally aren’t keen to move to such a different way of life.

Another major difference between public versus private health care centers is the availability of care in native languages. In NightLight’s experience, the language barrier can be a huge obstacle in receiving care, where gaps in communication and understanding hinder proper treatment, and even translation services can’t always fully bridge the gaps in language and culture. While private hospitals can offer translation services in many different languages, public hospitals generally don’t have that level or diversity of access.

NightLight International has successfully circumvented shortages in available services through support from IOM or by reaching out to therapists in trafficking survivors’ home countries to provide counseling online. In the face of continued challenges accessing truly transformative therapy, maintaining funding for access to private and other creative healthcare options remains essential to strengthen the support services available to survivors.

Have You Considered…?

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