Healing the wounds of torture survivors through 'rights-based mental healthcare'

For survivors of torture, mental health consequences can last a lifetime. Refugees and asylum seekers who have undergone torture face additional challenges - they have experienced deep losses and have the potential for exposure to even more trauma during their flight to safety, and in their new country.

Many asylum seekers also lose access to basic services because of their new country’s immigration laws. Such laws may limit their access to services such as healthcare, employment, and housing.

Specialised in trauma and international psychology, Dr. Guptais currently a mental health clinical advisor with the Center for Victims of Torture, supporting their program in Jordan.  The US-based Center, which provides direct services to survivors, is financially assisted by the UN Voluntary Fund for Victims of Torture (UN Torture Fund).

The process of seeking asylum can be 'retraumatising' for survivors of torture, so an important part of Dr Gupta’s work is supporting them during this process.  

"When a survivor tells you their story, there is an element of your being a witness, and of them testifying to their experience. It can be quite healing to be able to share your story with someone else."

Jane’s story

Dr. Gupta recently spoke at the UN Torture Fund’s Annual Expert Workshop, this year focusing on assistance to survivors of sexual and gender-based violence, which can amount to torture.

There, she told the story of Jane.*

Twenty-five year old Jane was one of Dr. Gupta’s clients, a survivor of torture who was seeking asylum. In her country of origin, Jane had previously been in a relationship with a man who, unbeknownst to her, was a member of a political opposition group.  

Government officials targeted her, and within two months, three of her four brothers disappeared, she and her mother were physically assaulted and subjected to forced nudity, and Jane was later detained for three days. During this time, she was interrogated about her boyfriend, sexually harassed and assaulted, gang-raped, and threatened with death. She managed to escape detention with the help of a female military officer.

"The impact on Jane was profound," said Dr. Gupta. "Her sleep suffered, she had frequent nightmares, she had no appetite, and lost any feelings of pleasure or happiness. She suffered olfactory hallucinations where she could smell her perpetrators. She experienced suicidal thoughts on two occasions, and met criteria for the diagnoses of post-traumatic stress disorder, major depression and panic disorder."

Although Jane did improve over time, she continued to struggle when faced with reminders of her torture – such as people in army clothes – and would experience intense feelings of fear. While trying to obtain asylum, she said she felt "stuck," unable to pursue her life goals. She mourned the loss of her home country, and her family and friends.

Tragically, around six to eight months after ending her therapy with Jane, Dr. Gupta found out that she had been killed through intimate partner violence.

 "I was deeply impacted by Jane’s death – which speaks to the relationship that one develops with one’s clients – and am grateful to her for what I learned in the context of our time together: mental health providers need to be aware of not only the consequences of torture, but the challenges of seeking asylum."

Dr. Gupta believes that mental health providers should take on an advocacy role when appropriate, but need to exercise caution when advocating on behalf of the survivor.

"We need to continue empowering the survivor and to respect their autonomy," she stresses.

She also believes immigration policies must allow survivors who are asylum seekers the right to access housing and healthcare and the legal right to work as they go through the asylum process. "This is crucial for their rehabilitation. They need a sense of stability, safety, and a sense of normalcy."

A rights-based approach to mental health: what does that mean?

Through her work, Dr. Gupta strives for a ‘rights-based approach’ to mental healthcare. For her, this means – in part - giving survivors a choice to decide what kind of therapy and services they want.  "It is imperative that survivors give informed consent to the services they are offered, that they have the opportunity to make decisions throughout the therapeutic process."

If or when asylum is granted, it is a "powerful event" in the rehabilitation process of torture survivors, according to Dr. Gupta. "Their safety and security has been enabled. They have had, hopefully, some of their basic human rights reinstated."

"As a clinician, the opportunity to contribute to that process is very rewarding."

Find out more about the UN Torture Fund and its work with organisations such as the Center for Victims of Torture, to provide direct assistance to over 50,000 torture survivors each year. 

* Name has been changed to protect identity. Country of origin and country of asylum is not mentioned to also offer this protection.

24 April 2019