Abstract
BackgroundPrevious studies have found a high prevalence of depression and post-traumatic stress disorder (PTSD) among survivors of human trafficking. European countries are required to assist trafficked people in their psychological recovery, but there are no rigorous data on the costs of doing so. The objectives of this study were to quantify the use of secondary mental health services by survivors of human trafficking; to estimate the cost of survivors’ use of secondary mental health services provided by the UK National Health Service (NHS); and to identify factors that predict higher costs of mental health service provision.MethodsHistorical cohort study of psychiatric patients who had experienced human trafficking. The South London and Maudsley NHS Trust (SLaM) Biomedical Research Centre Case Register Interactive Search (CRIS) database was used to identify anonymised full patient records of patients who had experienced human trafficking and who had accessed SLaM mental health services between 2007 and 2012. Data were extracted on socio-demographic and trafficking characteristics and contacts with mental health services. Total costs were calculated by multiplying each resource use item by an appropriate unit cost. Factors that predicted high mental health service costs were analysed using regression models.ResultsOne hundred nineteen patients were included in the analysis. Mean total mental health service costs per patient were £27,293 (sd 80,985) and mean duration of contact with services was 1490 (sd 757) days (approximately 4 years). Regression analysis showed that higher costs were associated with diagnosis of psychotic disorder (p < 0.001) and experiences of pre-trafficking violence (p = 0.06). Patients diagnosed with psychotic disorders cost approximately £32,635 more than patients with non-psychotic disorders/psychological distress but no formal diagnosis and patients whose clinical notes documented pre-trafficking violence cost £88,633 more than patients for whom pre-trafficking violence was not documented.ConclusionsTrafficked patients’ use of mental health services – and the cost of providing care – is highly variable, but patients with psychotic disorders and with experiences of pre-trafficking violence are likely to require more intensive support. Evidence is needed on the effectiveness of interventions to promote the recovery of survivors of human trafficking.
Highlights
Previous studies have found a high prevalence of depression and post-traumatic stress disorder (PTSD) among survivors of human trafficking
Research has shown a high prevalence of mental health problems among victims of human trafficking in contact with support services, including depression, anxiety and posttraumatic stress disorder [2,3,4,5], and has demonstrated that secondary mental health services in the United Kingdom (UK) are providing care for survivors of human trafficking with a range of diagnoses, including schizophrenia and related disorders [6, 7]
This study addresses this evidence gap by providing robust estimates of trafficked people’s use of secondary mental health services and the associated cost to the UK National Health Service (NHS), and identifying factors that predict higher mental health service costs
Summary
Previous studies have found a high prevalence of depression and post-traumatic stress disorder (PTSD) among survivors of human trafficking. European countries are required to assist trafficked people in their psychological recovery, but there are no rigorous data on the costs of doing so. European law requires that governments assist victims of trafficking in their psychological recovery [8, 9], but to date there are no rigorous data on the likely costs of doing so. This study addresses this evidence gap by providing robust estimates of trafficked people’s use of secondary mental health services and the associated cost to the UK National Health Service (NHS), and identifying factors that predict higher mental health service costs. We hypothesised that the costs of mental health service use would be significantly higher among: 1) Trafficking survivors with a diagnosis of psychotic disorder, versus other diagnoses; 2) Trafficking survivors who experienced sexual exploitation, versus those who had experienced other forms of exploitation (e.g. domestic servitude, labour exploitation); 3) Trafficking survivors who experienced pretrafficking violence, versus those who had not
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