King's College London

PROTECT (Provider Responses, Treatment and Care for Trafficked People) aimed to develop evidence to inform the NHS response to human trafficking. It provides evidence about the healthcare needs and experiences of trafficked adults and children and documents NHS knowledge and experience of responding to the health needs of trafficked people. The programme comprised several studies, including:

• Cross-sectional survey and qualitative research with trafficked people in contact with support services in England to explore health needs and experiences of using NHS care
• Cohort study of trafficked people in contact with secondary mental health services, using clinical informatics
• Cross-sectional survey of NHS professionals to investigate prior contact with trafficked people and knowledge and confidence to respond
• Qualitative research with NHS and other key professionals to investigate experiences of responding to the health needs of trafficked people
• Systematic review of health outcomes associated with human trafficking
• Systematic review of evidence and guidance on caring for trafficked people in healthcare settings

Key findings

• Trafficked people have a high exposure to violence prior to and during trafficking. 66% of trafficked women taking part in our survey reported forced sex during trafficking, including 95% of those trafficked for sexual exploitation and 54% trafficked for domestic servitude. 31% of trafficked women experienced sexual violence prior to trafficking.
• Trafficked people suffer from psychological distress, mental disorders, and physical health problems. 78% of trafficked women and 40% trafficked men taking part in our survey screened positive for anxiety, depression, or PTSD.
• A minority of trafficked people come into contact with health services while trafficked. Services accessed included GP surgeries, walk-in-centres, accident and emergency departments, and termination of pregnancy services.
• Language difficulties and a lack of identity documents act as barriers to healthcare access both during trafficking and after escape.
• NHS professionals report that they come into contact with trafficked people. 13% of NHS professionals working in areas in which police had identified five or more trafficked people in the year prior to our survey reported previous contact with a patient they knew or suspected had been trafficked.
• NHS professionals lack knowledge and confidence to respond to trafficking and are interested to receive training on this issue. 78% of NHS staff taking part in our survey reported they had insufficient training to assist trafficked people. Three-quarters reported they would be interested to receive such training in the future.

Research papers and resources

• Stanley et al (2016), The health needs and healthcare experiences of young people trafficked into the UK. Child Abuse and Neglect 59,100-110
• Read the PROECT Final Report for the Department of Health Policy Research Programme (PDF 2MB).
• Cary et al (2016), Human trafficking and severe mental illness: an economic analysis of survivors’ use of psychiatric services BMC Health Services Research (open access)
• Hemmings et al (2016), Responding to the health needs of survivors of human trafficking: a systematic review BMC Health Services Research (open access)
• Oram et al (2016) Human trafficking and health: a cross-sectional survey of male and female survivors in contact with survivors in England. American Journal of Public Health, 106(6): 1073-1078 (Open Access)
• Ottisova et al (2016) ). Prevalence and Risk of Violence and the Mental, Physical and Sexual Health Problems Associated with Human Trafficking: An Updated Systematic Review. Epidemiology and Psychiatric Sciences. Online First.
• Ross et al (2015) Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking. BMJ Open: 5(8):e008682 (Open Access)
• Oram et al (2015) Characteristics of trafficked adults and children with severe mental illness: a historical cohort study. The Lancet Psychiatry 2(12): 1084-1091 (Free with registration)
• Domoney et al (2015) Mental health service responses to human trafficking: a qualitative study of professionals’ experiences of providing care. BMC Psychiatry (Open Access)
• Video: High levels of mental illness reported by trafficked people
• Video: NHS professionals' contact with victims of trafficking
• Questionnaire: PROTECT scale for assessing health professionals' knowledge and confidence to respond to human trafficking.

Further information

Please join our mailing list to receive more information by emailing protect@kcl.ac.uk. You can also contact Professor Louise Howard louise.howard@kcl.ac.uk or Dr. Siân Oram sian.oram@kcl.ac.uk or follow us on Twitter - @kwmh_ioppn.

Research team

PROTECT’s Principal Investigators are Professor Louise Howard, Professor of Women’s Mental Health and Head of the Section for Women’s Mental Health at King’s College London, and Dr Cathy Zimmerman, Reader in Gender Violence and Health at the London School of Hygiene and Tropical Medicine. Dr Siân Oram (Co-Investigator) led the data collection and analysis and is Lecturer in Women’s Mental Health at King’s College London.

Our Co-Investigators also include:

• Professor Debra Bick, Professor of Midwifery and Women’s Health at King’s College London;
• Melanie Abas, Reader in Global Mental Health at King’s College London.
• Rebecca French, Senior Lecturer in Sexual and Reproductive Health at the London School of Hygiene and Tropical Medicine;
• Professor Nicky Stanley, Professor of Social Work at the University of Central Lancashire (UCLan).

Funding and support

The project is funded by the Department of Health Policy Research Programme (115/0006). The project has also been supported by the Clinical Records Interactive Search (CRIS) system funded and developed by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity. The study team also acknowledges the study delivery support given by the Local NIHR Clinical Research Networks.

Policy briefs

See the PROTECT policy briefs with specific recommendations for:

• Department of Health
• Home Office
• Health Education England
• Royal Colleges
• NHS Trusts
• Voluntary sector

Read the PROTECT final report: Optimising identification, referral and care of trafficked people within the NHS (115/0006) May 2015