An Exploration of the Mental Health Needs of Adults Working in the Commercial Sex Trade and Their Experiences with Mental Health Services Open Access
Grandoit, Shanaika (Spring 2019)
Abstract
Background: Sex trafficking is an international challenge, which is increasingly having a global impact. This complex public health challenge has unique ramifications for mental health conditions. While sex trafficking, in relation to adverse mental health outcomes, has been documented in prior research, this has mainly been explored from provider’s perspectives. There is a dearth of contemporary literature regarding survivor’s perspective on their experiences with mental health services.
Methods: This was a qualitative study of female adult sex trafficking survivors and commercial sex workers residing in the United States. In depth telephone interviews were conducted with 10 participants who were identified from victim service agencies in Atlanta, Georgia and the National Survivor Network. Data were analyzed to understand the mental health symptoms experienced, services accessed, barriers encountered when seeking service, recommendations for service improvement, and trafficking experience of participants.
Results: Participants reported utilizing a myriad of mental health services to address their mental health symptoms, which included: faith based programs, psychiatric hospitals, group therapy, and individual counseling services. Several facilitators and barriers to accessing mental health services were identified. Participants expressed comfort with service providers who practiced trauma-informed care approaches and a preference for female providers. Barriers to accessing services included: self-deprecation, limited financial resources, logistical complications, and a lack of awareness and knowledge of services.
Discussion: The findings of this study suggest that each woman’s experiences are unique, however, overall commonalities exist. Participant’s recommendations for service improvements included: continued efforts in incorporating survivor-led initiatives, expansion of service organization efforts to better meet the needs of survivors, structural efforts, and community based initiatives to aid in the recovery process for women exiting the life. The results of this qualitative study are invaluable to understanding the mental health needs and trafficking experiences of survivors from their perspective. Our results may inform future efforts to address the recovery process for survivors.
Table of Contents
I. CHAPTER 1: INTRODUCTION.................................................................................. 1
Introduction and Rationale...................................................................................... 1
Problem Statement....................................................................................................... 3
Purpose Statement....................................................................................................... 5
Objectives and Aims...................................................................................................... 5
Significance Statement................................................................................................ 6
Definition of Terms...................................................................................................... 7
Action Means Purpose (AMP) Model.......................................................................... 7
Commercial Sexual Act................................................................................................ 7
Human trafficking........................................................................................................ 7
Mental Health.............................................................................................................. 8
Prostitution.................................................................................................................. 8
Sexual Exploitation....................................................................................................... 9
Sex Trafficking............................................................................................................. 9
Commercial Sex Work (CSW)..................................................................................... 9
Trauma...................................................................................................................... 10
Trauma Informed Care (TIC)................................................................................... 10
Victim/Survivor.......................................................................................................... 11
II. CHAPTER 2: COMPREHENSIVE REVIEW OF THE LITERATURE................... 12
Understanding the Global and Domestic Burden of Sex Trafficking.............. 12
Contributing Factors for Sexual Exploitation..................................................... 14
Health Implications of Sex Trafficking................................................................. 16
Mental Health Outcomes of Sex Trafficking....................................................... 19
Current Mental Health Services for Survivors................................................... 23
Viewing Trafficking as a Human Rights Issue........................................................ 25
Conclusion.................................................................................................................. 27
III. CHAPTER 3: MANUSCRIPT.................................................................................. 29
Student Contribution................................................................................................ 30
Abstract....................................................................................................................... 31
Introduction............................................................................................................... 32
Methods....................................................................................................................... 34
Results......................................................................................................................... 36
Discussion.................................................................................................................... 43
References................................................................................................................... 53
Table and Figures...................................................................................................... 56
IV. CHAPTER 4: METHODS........................................................................................ 60
Sample Population..................................................................................................... 60
Study design................................................................................................................ 62
Data Collection Procedures................................................................................... 63
Data Management..................................................................................................... 64
Thematic Analysis..................................................................................................... 65
Ethical Considerations and Informed Consent.................................................... 66
Conclusion.................................................................................................................. 66
V. CHAPTER 5: RESULTS............................................................................................ 68
Survivor Participant Characteristics..................................................................... 68
Qualitative Findings.................................................................................................. 71
Experiences with Mental Health Services............................................................. 73
Trafficking Experiences of Survivor Participants................................................ 76
Participants Recommendations................................................................................ 84
Conclusion.................................................................................................................. 88
CHAPTER 6: DISCUSSION......................................................................................... 89
Discussion.................................................................................................................... 89
Experiences With Mental Health Services............................................................ 89
Trafficking Experience............................................................................................. 92
Significance of the Current Study........................................................................... 95
Limitations................................................................................................................... 96
CHAPTER 7: RECOMMENDATION, FUTURE RESEARCH, AND CONCLUSION98
Recommendations....................................................................................................... 98
Future Research....................................................................................................... 103
Conclusion................................................................................................................ 104
REFERENCES............................................................................................................... 106
APPENDICES................................................................................................................ 118
Appendix 1: IRB Approval Document.................................................................... 118
Appendix 2: Consent Forms..................................................................................... 119
Appendix 3:Recruitment Email to Anti-Trafficking Agencies.......................... 121
Appendix 4: Recruitment Flyer.............................................................................. 122
Appendix 5:Mental Health Resource Guide....................................................... 123
Appendix 6: Interview Guide................................................................................... 124
Appendix 7: Codebook.............................................................................................. 127
Table of Table and Figures
Figure 1.0: Social Ecological Model adapted to conceptualize the potential risk factors for commercial sexual exploitation among adult survivors. Adapted from (National Research Council et al., 2013)..... 15
Figure 2.0: List of human rights relevant to trafficking. Adapted from (United Nations Human Rights Office of the High Commissioner, 2014).......26
Table 1: Socio-demographic characteristics of participants (N=10)................................ 69
Table 2: Reported physical health problems of participants (N=10)............................... 70
Table 3: Reported mental health conditions of participants (N=10)................................ 70
Table 4: Experiences with Mental Health Services (N=10)............................................... 72
Table 5: Key Emergent Themes from Trafficking Experience (N=10)............................... 78
Table 6: Participant Recommendations (N=10)..................................................................... 83
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