Getting to grips with human trafficking and modern slavery:

  • January 3, 2021

Like most people, I suspect, I have had a hazy idea of human trafficking as something to do with women from Eastern Europe being forced into sex work and men being trapped into low-waged agricultural or other jobs.  Occasionally stories surface about vulnerable individuals trapped in dire conditions by unscrupulous families, and most recently about the fate of 39 trafficked Vietnamese who died in transit. Prompted by the Many Stories Matter book group in my university, I decided to find out more and have been educating myself as a starter with two books on the subject.

Modern Slavery: A beginner’s guide. Kevin Bales; Zoe Trodd; Alex Kent Williamson. Oneworld Publications 2011

Bales, Trodd and Williamson are academics with long-standing interests in slavery and commitment to its abolition.  All three are now based at the University of Nottingham in England. Not surprisingly, their book is a model in presenting the global facts about trafficking and slavery (a distinction helpfully clarified early on) and their diversity in the modern world. The book has something of a US bias because of the origins of the authors, but really doesn’t suffer for that.

Some of the book’s messages are predictable ones: risky environments are made by poverty and the social disruption caused by globalised destruction of rural life and the drift to slum dwelling. Displacement through environmental degradation and war are major contributors.  At an individual level exploitation of groups is defined by ethnicity, caste (in India), religion and especially gender. The highest prevalence of slavery in the world turns out to be in India, in the form of coercive/indentured labour and domestic servitude linked to the caste system.

A less familiar finding is the importance of corruption at national government level in tolerating or even actively supporting slavery and trafficking. Sometimes this amounts to active pursuit of policies that enslave – in Burma and China for example. And although poverty makes a ready source of people to prey on, it is affluence that creates a market for trafficked people. It is rich, illiberal and corrupt countries like Japan and Israel that top the lists as recipients of those trafficked for labour or sexual exploitation.

Unlike many books on problems in the modern world, the book ends with an outline of the practical steps that can be taken to tackle slavery – starting with proper data collection and sharing, international and national anti-slavery plans should include education programmes, active law enforcement and funded rehabilitation schemes for survivors. Industry must be held to account – and especially in an interconnected global world industry must look to its own supply chains and ensure they are not supported by slavery (recent revelations about the rag trade in Leicester came to mind while reading this).  A corollary of the global scope of the book is that pointers for individual action are a bit less incisive – being alert to spotting victims, raising awareness, pressing businesses on their practices.

This is where my second book comes in – I was looking for something to help me understand more what was going on in my own country, and to think about what I might do about it.

Stolen Lives: Human Trafficking and Slavery in Britain Today. Louise Hulland Sandstone Press 2020

The blurb on her publisher’s page says Louise Hulland has been investigating the plight of victims of modern slavery and human trafficking since 2010, whereas in the book itself Hulland says she started researching for the book when Theresa May was PM, in other words in 2016, and in her final summing-up chapter she says she has spent “six months immersed in the world of ant-trafficking and slavery, speaking to those on the front line…” . In truth that’s how the book reads – as a breathless whistle-stop tour of key informants with little or no deep reading or analytic work behind it.  There is to take one example no discussion of the implications of so many faith-based organisations being involved in anti-slavery and anti-trafficking activities.

The tone of the book owes as much to lifestyle writing as it does to research rigour. The presentation consists essentially in a series of interviews apparently transcribed verbatim and introduced by odd personal vignettes.  Kathy Betteridge, the Salvation Army’s Director of Anti-Trafficking and Modern Slavery, is petite with short blonde-grey hair and is hugely passionate. Norree Webb, the Army’s First Response co-ordinator, is by contrast warm, calm and seemingly unflappable. Rachel Harper, manager of Helpline is warm and engaging. Andrew Wallis, CEO of Helpline, is tall friendly but intimidatingly intelligent. Caroline Haughey, a barrister with a special interest, is tiny and wears a bright pink jumper; she is warm and incredibly modest.  Colin Ward, a DC with Greater Manchester Police’s Modern Slavery Coordination Unit, is tall without being intimidating, calm with a warm northern accent. Apparently he’d clearly seen more than any human would wish to.

Once you get past this stuff there is a reasonable amount (although not 270 pages’ worth) of information about how slavery and trafficking are approached in the UK. Most of it is available without the padding from the Global Slave Index 2018 report on the UK. The Modern Slavery Act 2015 tidied up a messy legal framework and makes prosecution cases easier to pursue, and a National Referral Mechanism provides a framework for identifying victims of modern slavery and ensuring they receive support, but there are formidable barriers to tackling the problem at scale – not least underfunding. Not many people know, I suspect, that the main recipient of Government funding to support victims is the Salvation Army, which in turn contracts work to several partners including other faith-based organisations. The picture that emerges is of groups of dedicated individuals working for statutory bodies and in the third sector, struggling to do the best they can in the face of official indifference and hostility. The hostility comes mainly from racism and from the fact that so many victims are either immigrants without the right papers, or UK nationals who need extensive help from our (much diminished) welfare state.

What can an individual do?

As a former health professional, I thought the best place to start would be in the area of health of victims of trafficking and slavery which is, not surprisingly, terrible. Poor nutrition, physical abuse, sexual abuse, unhygienic living arrangements and inadequate access to primary healthcare contribute to poor physical health. Poor mental health comes from the burden of abuse and neglect that constitutes the defining condition of the people involved, and may be compounded by pre-existing problems that increased initial vulnerability to exploitation.

To get a flavour, I started by sampling the websites of four hospital Trusts (two acute, two mental health) and two large CCGs. None had a link to a modern slavery statement on its home page and for 5/6 a search on their website using <slavery> or <human trafficking> produced no hits. One acute Trust had a statement about its compliance with the Modern Slavery Act’s requirement for transparency in supply chains. One of the CCGs mentioned that its safeguarding teams were helping local NHS staff to recognize and respond to people who were at risk or had been trafficked or enslaved. One Trust’s maternity service had a nice page about maternity care for refugees and asylum seekers, but none of the sites indicated specific services, or even specific individuals to contact, in relation to slavery or human trafficking. I couldn’t find anything relevant in a search of the RCPsych website.

Part of the problem here is one of scale.  The Global Slavery Index (an excellent site well worth a visit) estimates that there are 136,000 people in modern slavery in the UK, about 2/1000 of the population. If we assume that half are in or around London, my back-of-an-envelope calculation puts anything from 500 to1000 in Leeds where I live, or about 1/10 of 1% of the population. Every one of those people needs help but put against the scale of problems being dealt with routinely by our under-resourced health and social services it is easy to see why slavery doesn’t get top billing.  At the same time, it is unclear what exactly is the need of services and whether it is specific or can be subsumed within other services designed to support the traumatised and exploited. There are barriers to presentation, personal and imposed by circumstances, which add to difficulties in planning a ground-up response.

Regardless, what makes work in slavery and trafficking different is the involvement of organised crime and the concomitant need for liaison with other agencies, good record-keeping and reporting. There is nothing about the current UK government that inspires confidence in the likelihood of effective action. Perhaps a small step in the right direction would be for all Trusts to identify a liaison clinician with responsibility for advising about and overseeing services and liaison with relevant statutory and 3rd sector organisations, as has been recommended to improve healthcare for people with a learning disability.

Down with “mental health”?

  • October 14, 2019

I was lucky, early in my career, to meet Professor Geoffrey Rose.  One of his (typical) quietly provocative remarks was that there are no categories in nature – I remember we touched on dead/alive and pregnant/not pregnant and then gave up trying to think of examples to prove him wrong. So for a long time I’ve been keen on the idea of illness or disability as being on a spectrum or continuum.

In my own field the umbrella term “mental health” has come to represent this idea – not that all mental disorders are the same but that they all share something important that makes them related to each other, belonging in the same category of illness.  Recently I’ve begun to wonder if it’s such a good way of talking.

An article in the Guardian newspaper this month highlighted a damning series of investigations by the Care Quality Commission (CQC) into the care offered by privately run mental health units. As I read to the end my eye was caught by the line of tabs at the bottom, linking to “related stories”, and particularly this first one in the row.


Really? How is the anger and dismay of let-down football fans “related” to the neglect and abuse of vulnerable and severely disabled inpatients in special units?

I have come to see some serious disadvantages to “mental health” as a catch-all.  There are several versions of an unintended but malign effect of the term – which can trivialise or distort the true nature of mental disorder.

  • Success or “recovery” stories from one part of society can overplay the likely benefits of intervention in what are essentially intractable problems, as pointed out recently by the parent of a child with autism, who wrote:  ‘These stories don’t show the child who is non-verbal, who screams and growls for hours on end and attacks his or her parents on a daily basis’…”For once I’d love to see a story that celebrated a child managing to say “drink”, rather than screaming for two hours. That’s our idea of success.”
  • When “diagnostic” labels are applied (especially following self-diagnosis) the result can be misleading and demeaning to others. Being socially awkward isn’t the same as having autism; lacking emotional equanimity isn’t the same as having bipolar disorder; being greedy isn’t the same as having bulimia.
  • Well known people “coming out” about their own mental problems may indeed be helpful.  A healthy society needs to be able to acknowledge and respond to all aspects of the lives of its individual members, and we are all better off for the brave people who have in recent years talked about their sexuality or emotional problems.  There is however a downside to the invited comparison, as there is to all celebrity endorsement – most people with mental disorders aren’t rich or creative or successful: if they are lucky they are ordinary; if unlucky then they are disabled, poor and harassed. 

I have concluded that we’d be better to drop the term “mental health” – making the effort instead to be specific about each particular problem in which we are interested.  Maybe it’s evidence of rising levels of distress or anxiety in school students, or self-harm in middle-aged men, or moderate levels of depression in people consulting their GP. With more specific use of vocabulary we can have a more meaningful discussion than we do currently about public health and health services for those struggling with emotional disorders and mental illness.  Changing how we discuss things is easier said than done, but I’m going to give it a try.

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