The Gaps We Still Haven’t Closed: Addressing the Mental Health Needs of Trafficking Survivors

Nearly two decades ago, as an undergraduate intern at the only domestic violence shelter in a major city, I had my first encounter with the complex psychological needs of human trafficking survivors. Fresh into social work, I was eager to learn and contribute. Later, in my full-time role on the crisis team, I answered calls from women in the immediate aftermath of violent assaults, desperate for safety. Sometimes, the violence was still unfolding as they reached out.

I believed in the work we were doing. I respected the nonprofit I worked for. But it didn’t take long to see the systemic gaps in services—failures that extended far beyond the reach of any one organization. Nearly twenty years later, many of those gaps remain.

Who Gets Access to Care—And Who Doesn’t

One of the most glaring failures was the lack of support for male survivors of domestic violence. When men called for help, my job was to safety plan and connect them to resources. But there were none. The only option I could offer was a local homeless shelter—far from the secure, trauma-informed spaces designed to protect victims from their abusers.

Male survivors faced the same skepticism, blame, and dismissal that women often do—amplified by gender stereotypes.

I took those calls regularly. It was a heartbreaking and powerless feeling.

Gender was only one barrier. Survivors of all identities, nationalities, and backgrounds were falling through the cracks. Many LGBTQIA+ survivors had nowhere to turn. Non-English-speaking survivors struggled to find trauma-informed support in their language. Immigrant survivors, particularly those undocumented, feared deportation if they sought help.

Trafficking does not discriminate. Yet too often, our systems do.

When the System Fails in Real Time

Law enforcement often brought domestic violence survivors to our shelter. But one evening, they arrived with a group of women and children just freed from a human trafficking bust.
There were no trafficking-specific services available, but because these women were female, they were allowed access to the shelter’s resources—childcare, case management, group therapy.

But there was a problem. A huge one.

Trafficking survivors had entirely different needs. The existing domestic violence framework, while some-what effective for intimate partner abuse, failed these women. The interventions we relied on did not account for the level of psychological manipulation, coercion, and systemic trauma they had endured.
Within a week, every single one of them was gone—almost certainly back to their trafficker.

The message was clear: The system wasn’t built for them.

And it still isn’t built for many others.

We cannot keep forcing survivors into outdated, one-size-fits-all models of care. Human trafficking survivors—whether male, female, nonbinary, LGBTQIA+, immigrant, or from any walk of life—need services that recognize their unique challenges. They need a system that sees them.

The Complex Needs of Human Trafficking Survivors

Unlike single-incident trauma, trafficking involves sustained psychological, physical, and emotional abuse, often reinforced by coercion and institutional failures. The impact is profound, affecting survivors across multiple areas:

Severe Psychological Distress

• Complex PTSD (C-PTSD), suicidality, and self-harm

• Trauma bonding and Stockholm Syndrome, making it difficult to leave their trafficker

• Attachment disorders and deep mistrust of authority

• Identity erasure

Cognitive and Developmental Impacts

• Memory and executive function impairments

• Delayed cognitive development for those trafficked in childhood

• Disrupted education, leading to lower academic achievement

Chronic and Acute Physical Health Conditions

• Untreated fractures, head injuries, and chronic pain

• Neurological damage from repeated physical abuse

• Gastrointestinal disorders due to prolonged neglect

• Cardiovascular and respiratory issues linked to chronic stress

Reproductive and Sexual Health Consequences

• High rates of STIs and reproductive trauma

• Infertility from forced pregnancies or untreated conditions

• Sexual dysfunction and genital trauma

Substance Use Disorders

• Many survivors are coerced into drug use as a method of control

• High rates of addiction due to self-medicating trauma and pain

Even after escaping their traffickers, survivors face additional barriers:

• Mistrust of authorities due to past failures by law enforcement and social services

• Legal and immigration struggles, particularly for undocumented survivors

• Lack of safe housing, leaving them vulnerable to re-exploitation

• Stigmatization from families and communities, making reintegration difficult

• Discrimination within shelters and services

Some survivors may not even realize they were trafficked—coercion and manipulation blur the lines of consent, making it difficult for them to recognize their own victimization.

A Multi-Disciplinary Approach is Essential

Given these intersecting challenges, survivors need comprehensive, trauma-informed care that includes:

✔ Mental health support tailored to complex trauma
✔Medical treatment for trafficking-related conditions
✔ Legal and immigration advocacy
✔ Safe, stable housing
✔ Education, vocational training, and financial empowerment

Without addressing the full scope of trauma and systemic barriers survivors face, recovery is often incomplete or unsustainable. The fight against trafficking doesn’t end with rescue—it begins with rebuilding lives.

Looking Ahead: A Commitment to Change

Over the years, I’ve worked across multiple systems—domestic violence shelters, child and family services, inpatient facilities, homelessness intervention, veteran support, hospital social work, prison reform advocacy, nonprofits, and crisis response. Now, in private practice, my focus is on trauma-informed, inclusive care.

What I’ve observed across various settings is a consistent challenge: while many services aim to support trafficking survivors, the complexities of their needs often go unmet because existing models aren’t fully equipped to address the full scope of their experiences. Many services specialize in one aspect of care, but they don’t always integrate the many layers of trauma that survivors face.

This is not just a challenge—it’s an opportunity for growth and improvement.

Therapeutic interventions specifically tailored to address the complex needs of trafficking survivors are still underdeveloped. Currently, clinicians rely on a range of trauma-informed approaches, including evidence-based therapies like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Dialectical Behavioral Therapy (DBT), which have proven effective for some populations, particularly survivors of child trafficking.

While existing crisis intervention methods can be valuable for addressing immediate needs and de-escalating situations post-rescue, this is just a drop in the bucket.

With human trafficking generating an estimated $150 billion annually, it’s clear that addressing this issue requires a far more robust response. We need some billion-dollar research to develop comprehensive, specialized interventions that can truly meet the needs of survivors. This begins with fully acknowledging the scope and urgency of the problem.

While clinicians are trained to tailor treatment plans to the individual needs of each patient, when it comes to human trafficking survivors, therapists must be prepared to adapt their survivor-centered approaches. They need to be open to utilizing their entire range of tools and interventions, while also embracing a collaborative, partnership-based approach to treatment.

It's essential to be patient, as the healing process can be slow and challenging, but with the right approach, it is both possible and incredibly rewarding.

Survivors deserve more than short-term crisis intervention. They deserve a system that deeply understands their needs and supports them with long-term, specialized care to truly heal. This requires us to expand and enhance our services, collaborating across sectors to provide comprehensive, integrated care.

Two decades later, I’m more certain than ever: the gaps in our system are real, but they can be closed. The way we support trafficking survivors must evolve—because while rescue is a critical first step, rebuilding lives is the essential work that follows.

Cristina Chinchilla, LCSW