Rehabilitation of torture survivors in five countries: common themes and challenges. (original) (raw)
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Research Rehabilitation of torture survivors in five countries: common themes and challenges
International Journal of Mental Health Systems, 2010
Background: Torture continues to be a global problem and there is a need for prevention and rehabilitation efforts. There is little available data on torture survivors from studies designed and conducted by health professionals in low income countries. This study is a collaboration between five centres from Gaza, Egypt, Mexico, Honduras and South Africa who provide health, social and legal services to torture survivors, advocate for the prevention of torture and are part of the network of the International Rehabilitation Council for Torture Victims (IRCT).
Protocols, 1996
Background Torture is widespread, with potentially broad and long-lasting impact across physical, psychological, social and other areas of life. Its complex and diverse effects interact with ethnicity, gender, and refugee experience. Health and welfare agencies offer varied rehabilitation services, from conventional mental health treatment to eclectic or needs-based interventions. This review is needed because relatively little outcome research has been done in this field, and no previous systematic review has been conducted. Resources are scarce, and the challenges of providing services can be considerable. Objectives To assess beneficial and adverse effects of psychological, social and welfare interventions for torture survivors, and to compare these effects with those reported by active and inactive controls.
25 years rebuilding lives: United Nations Voluntary Fund for Victims of Torture
2006
Morocco Medical and psychological 16. Kanyarwanda A.S.B.L. Rwanda Medical, psychological and social 17. Rwandan Women Community Development Network Rwanda Medical, psychological and social 18. Victimes de Violences Réhabilitées (VIVRE) Senegal Medical, social and legal 19. Community Association for Psychological Services (CAPS) Sierra Leone Psychological 20. Centre for the Study of Violence and Reconciliation (CSVR) South Africa Psychological 21. African Center for Treatment and Rehabilitation of Torture Victims (A.C.T.V.) Uganda Medical, psychological, social, legal and financial 22. Foundation for Human Rights Initiative (F.H.R.I.) Uganda Legal 23. Refugee Law Project Uganda Psychological, social and legal Asia Nr Name of organization Country Type of assistance 24. Bangladesh Rehabilitation Centre for Trauma Victims (BRCT) Bangladesh Medical, psychological, legal, financial, training and seminar 25. Naogaon Human Rights Development Association Bangladesh Medical, psychological, social, legal, financial 26. Centre for Care of Victims of Torture (CCTV) India Medical, psychological, social, legal, training and seminar 27. People's Watch Tamil Nadu India Medical, psychological 28. Society for Social Research, Art and Culture (SOSRAC) India Medical, psychological, social, training and seminar 29. Torture Prevention Centre India Trust India Medical, psychological, social, training and seminar 30. International Catholic Migration Commission (ICMC) Indonesia Medical, psychological and social 31. Public Committee Against Torture in Israel (PCATI) Israel Legal assistance Nr Name of organization Country Type of assistance 32. Golos Svobody Kyrgyzstan Medical, psychological, social and legal 33. Khiam Rehabilitation Centre for Victims of Torture Lebanon Medical, psychological and social 34. Restart Centre Lebanon Medical, psychological, social, training and seminar 35. Gaza Community Mental Health Programme
Psychiatric assessment and treatment of survivors of torture
BJPscyh Advances, 2015
SummaryTorture remains an ongoing global problem. Many individuals who have migrated from areas of conflict and political instability have suffered some form of torture. Survivors of torture can present significant challenges to general practitioners, voluntary bodies and mental health services. This article describes the many physical, psychological and social effects of torture. An understanding of these will hopefully aid comprehensive assessment of survivors of torture by local mental health teams. Also described are the current treatment options and their evidence base.
Supporting interventions after exposure to torture
Torture : quarterly journal on rehabilitation of torture victims and prevention of torture, 2010
A wide range of reactions as panic, demoralisation, feelings of being insecure and unsafe, hopelessness and any kind of dysfunction dominate after torture. The range of PTSD and other psychiatric disorders can be explained by variations in severity, frequency and duration of traumatic events. The advanced numbers of refugees and asylum seekers illustrate the need of people after the experience of torture to find a safe place for recovery. The various steps for immediate coping strategy after being tortured are evaluated. Stressors after torture, as pressure on families, decline of social and economic life, threats, feelings of guilt and shame and health problems due to torture act as remainders for the torture experience. Coping with exposure to torture starts immediately during the experience. A phase-oriented research, taking into consideration internal and external resources, risk factors and protective factors, as well as pre-trauma status, could help to understand more about th...
The Mental Health Effects of Torture Trauma and Its Severity: A Replication and Extension
Psychology, 2013
To clarify the effects of torture trauma and its components on PTSD and other mental health conditions, we investigated the relationship between measures for PTSD, Cumulative trauma disorders CTD, cumulative life trauma, torture and torture severity in a sample of 326 torture survivors. Hierarchical multiple regressions found no significant association between torture and PTSD. However, when we examined the effects of different types of torture we found witnessing and sexual tortures were significant predictors of PTSD and CTD. Path analysis results found that torture trauma and its severity may not be predicative of PTSD; but it is highly predictive of the more complex syndromes of CTD. The implications of the results for treating torture survivors were discussed. One of the important findings is the potential effects of torture on decreased re-experiencing and emotional numbness. Torture trauma may be too emotionally and physically painful experience that tends to be suppressed decreasing re-experiencing and increasing dissociation.
Torture : quarterly journal on rehabilitation of torture victims and prevention of torture, 2016
Torture survivors face multiple problems, including psychological difficulties, whether they are refugees or remain in the country where they were tortured. Provision of rehabilitation varies not only with the needs of survivors and resources available, but also with service models, service provider preferences and the local and country context. Despite increasing efforts in research on effectiveness of psychological interventions with torture survivors, results are inconclusive. We undertook a Cochrane systematic review of psychological, social and welfare provision, with meta-analysis to best estimate efficacy. The process raised conceptual, methodological and ethical issues of relevance to the wider field. We searched very widely, but rejected hundreds of papers which recommended treatment without providing evidence. We found nine randomised controlled trials, from developed and under-resourced settings. All conceptualised survivors' problems in psychiatric terms, using outco...
INTERNATIONAL TORTURE SURVIVORS: AN ANTHROPOLOGICAL PERSPECTIVE
My partnership and research with the Center for Survivors of Torture Dallas Fort Worth (CST DFW) investigated the struggles that torture survivors have endured within an unfamiliar healthcare and social service system. Many survivors who have faced Post Traumatic Stress Disorder (PTSD), anxiety, and depression also endure a secondary threat which leads to re-traumatization through the struggles of acculturation. The aim of this research study was to: 1. Identify differences and assumptions between service providers' and clients' definitions of self-sufficiency; 2. Examine prominent barriers to self-sufficiency that survivors encounter; 3. Pinpoint the survival strategies that survivors use in order to cope with life in DFW; 4. Determine what resources CST staff, area service providers, and survivors felt needed improvement at CST and in the DFW metroplex.
P.4.b.005 Treatment approach to mental health outcomes of torture among former prisoners
European Neuropsychopharmacology, 2014
Background: The report of the public defender of the republic of Georgia published in 2012 revealed that in recent years (2006-2012) Georgian law enforcement institutions established the environment of torture and inhuman treatment in prisons that had systematic and permanent character. GCRT − The Georgian Centre for Psychosocial and medical Rehabilitation of Torture victims has worked with former prisoners after their release from prison. Since 2012, the center has served 564 victims in 4 regions of Georgia. The team has offered multidisciplinary approach, medical and psychological assistance, diagnosis of mental and somatic disorders and pharmacological and psychological treatment. The obtained data have been used to study: (1) The common mental problems among victims of torture falling into different crime categories, (2) Relation between torture methods and developed mental disorders, (3) Treatment efficiency with medication in comparison with treatment using medication and psychotherapy together. Methods: The data were grouped according the imprisonment length: (1) up to 6 months; (2) 6 months to 1 year; (3) 1−5 years; (4) more than 5 years and crime content: (1) financial crime; (2) drug addiction; (3) violent crime; (4) political reason; The Istanbul protocol classification has been used for registration of torture methods. All of our beneficiaries were subject to severe psychological torture, mostly in combination with severe physical methods. The prescribed medications included antidepressants (mainly serotonin reuptake selective inhibitors), mood stabilizers, low-potency neuroleptics, hypnotic and sedative drugs. The psychological therapies involved trauma focused CBT and brief eclectic psychotherapy. Patients were diagnosed by ICD-10. The structural clinical interview, dynamic clinical assessment and retesting by Brief Psychiatric Rating Scale, Beck depression inventory, Spielberger State-Trait Anxiety Inventory, Horowitz's Impact of Event Scale, and the Clinician-Administered PTSD Scale − CAPS have been routinely administered. Results: The most frequent psychiatric diagnoses were depressive conditions with various severity (31.2%), stress related and anxiety disorders (14.3%), personality and behavioral disorders due to brain disease (7.8%), damage and dysfunction, personality disorders, mental and behavioral disorders due to psychoactive substance abuse. Co-morbidity and dual diagnosis with drug addiction were common (29.5% of all cases). Imprisonment length and torture intensity correlated with severity of mental state (Pearson correlation, p = 0.007). The treatment efficacy was very low for both combination treatment and psychopharmacological treatment alone without significant statistically differences. Conclusion: Prolonged physical punishment and repressive psychological methods, inaccessibility of medical and psychiatric assistance and abuse of psychotropic medication cause pronounced mental disturbances and increase risk of behavioral problems. Torture destroys the very core of a human being, results fragmentation and disintegration of the personality. Healing of the wounds caused by torture is a very long-term and complicated process with poor outcome. The consequences of torture go far beyond the individual concerns, but rather have a destructive impact on the society.
Correlates of symptom reduction in treatment-seeking survivors of torture
While a growing body of literature addresses the psychological consequences of torture and war trauma, there are few empirical examinations of treatment for survivors of torture. This study offers a program evaluation of a comprehensive torture treatment program in New York City. We present literature surrounding the interdisciplinary "wraparound" approach to treating survivors of torture, and examine the relationship between clinical services and symptom reduction in a multinational sample of refugees (N ϭ 172) receiving treatment over a 6-month period. Clients were administered the Brief Symptom Inventory (BSI) and the Harvard Trauma Questionnaire (HTQ) during their intake interview and six months later. We found that approximately 45% (n ϭ 77) of treated clients displayed clinically significant improvement on either the HTQ, or the BSI subscales of Depression, Anxiety, or Somatization, over the six months following their intake evaluation. Generalized linear models revealed that gaining secure immigration status was the strongest correlate of clinical improvement. However, psychotherapy and attendance at educational sessions predicted improvement in symptoms beyond adjusting to a more secure immigration status. While this study's correlational design does not establish that treatment caused the observed improvement, results point to the pivotal role of both clinical and "nonclinical" services and provide preliminary support for the value of an interdisciplinary approach. More research is needed to understand mechanisms of change and improvement in this sensitive population.