Support needs of male trafficking victims by The Salvation Army UK and Ireland

Support Needs of Male Victims of Human Trafficking:

Research Findings

Gayle Munro Research Manager Research & Development

Chloe Pritchard Researcher Research & Development

The Salvation Army UK Territory with the Republic of Ireland June 2013

Research & Development

1. INTRODUCTION The Salvation Armyâ&#x20AC;&#x2122;s Research & Development (R&D) team were commissioned in 2012 by the Anti-Trafficking Contract Management Team to undertake research into the support needs of male victims of trafficking. The Contract Management Team direct the delivery of specialist support services to adult victims of human trafficking in England and Wales under a contract jointly funded by The Ministry of Justice and The Home Office. Analysis of the profile of victims referred to this service shows a high proportion of male victims (36%). Staff working with these victims noted certain dynamics which were peculiar to male as opposed to female victims. This research, funded by the Garfield Weston Foundation, was therefore commissioned to improve understanding of the particular needs and profiles of male victims so that support services can be adapted to best meet these needs.

2. METHODS AND ETHICS The research was carried out via the following methods: Review of available literature on the support needs of male trafficking victims: There is a limited amount of published literature around the support needs of male trafficking clients, particularly those in the UK. A summary of themes from the available literature follows in section three. Review of client assessment data: Completed initial assessment forms were reviewed for all clients, male and female, referred to The Salvation Army between 4 July 2011 and 3 November 2012. A total of 625 initial assessment forms were reviewed. It should be highlighted that these are initial assessment forms and the available information on client levels of support needs is only based on the most immediate presenting support needs. Typically, the more realistic level of support required is only likely to begin to emerge as the client progresses through his/her recovery and reflection period. There are likely to have been a number of particular experiences of trafficking or support needs which were present in a client, but were not included in the findings of the research as they were not explicitly stated on the initial assessment form. Consequently some of the findings presented in this report should be taken as an indication rather than a complete picture of victims’ support needs. As the main focus of this study was on the support needs of male trafficking victims, quantitative data on females, where available, was also included to draw out any potential differences between the genders and to aid comparisons. Visits to accommodation providers: Visits were made throughout October and November 2012 by researchers to six of the seven sub-contracted accommodation providers who have male residents. Interviews with clients: In total 11 interviews with clients were carried out. The table below shows a breakdown of interviewee profiles. Figure 1:

Interviewee profile

Service provider

Client

Country of origin

Age1

‘Type’ of trafficking

Romania

Domestic servitude

England

Not disclosed

Labour

Ghana

Not disclosed

Labour

Slovakia

Labour

Czech Republic

Labour

Poland

Labour

Malawi

Labour and sexual exploitation

Thailand

Sexual exploitation

Slovakia

Labour

England

Labour

Czech Republic

Labour

1 In the case of one interviewee, the client was not aware of his date of birth and had no documentation. During the rest and recovery period he had ‘chosen’ his own date of birth based on an estimate of his age.

Of the 11 clients interviewed, three were previous clients who had already exited the service but were returning to the service to access informal support. Interviews with staff: In the majority of cases interviews were conducted with two members of staff at each service (usually a centre manager and a support worker). Ethics: The researchers talked through the aims of the study with each client prior to obtaining informed consent to conduct the interview. Each client was given a participant information sheet which included details of the aims of the study, how the report is to be used and the contact details of the research team should the client wish to withdraw consent at a later stage. The anonymity of each participant was stressed. Participants were given time to read through the information sheet and ask questions.

3. REVIEW OF THE LITERATURE There is a dearth of published literature on the support needs of male trafficking victims, especially in the UK. The literature reviewed below for the purpose of this report includes publications by the US Agency for International Development, the International Organisation for Migration, the Norwegian institute Fafo and the NEXUS Institute, Vienna. One further study (Mai, 2011a), not discussed in detail below, on young adult males engaged in commercial sexual services in the EU focuses on the agency of those young men involved and rejects notions of exploitation. There is other research by the London School of Hygiene and Tropical Medicine and King’s College London (in press at the time of writing) on health needs of male trafficking victims.

3.1 Men as ‘victims’ The US Agency for International Development (USAID) published a report in September 2010 on the trafficking of adult men in the Europe and Eurasia region. This study does not include the UK as one of the country case studies but does provide a review of the levels of exploitation suffered by the different ‘types’ of trafficking victim. The report also highlights the lack of available support services across Europe for male trafficking clients and focuses on the low take-up of services by men: ‘Some service providers indicate that adult men are less inclined to accept assistance than women. Many reasons for this are proposed in the literature, including that men’s gender and cultural roles may not allow them to accept help. Men feel they should be strong and self-reliant. Accepting assistance may be seen as a sign of weakness.[…] Some studies also find that men may reject offers of assistance as they do not see themselves as having been victimized. One study found that men not only rejected being identified as a victim but were also offended by the idea.’ (USAID, 2010: 24) This issue of men being reluctant to be described as ‘victims’ is also discussed by Rebecca Surtees in her research (2008) on behalf of the International Organisation for Migration which explored the issue of trafficking of men in Belarus and the Ukraine. This study focused on profile of victims in terms of personal details, such as educational background and family situation, before discussing forms of recruitment and conditions of exploitation and abuse. ‘To self-represent as a “victim” may not mesh with a man’s sense of self or the social ideal of manhood. In many communities this means being strong, self-sufficient and able to care not only for oneself but also for one’s family.’ (Surtees 2008: 92) A study of forced labour in Portugal found that many migrants did not see themselves as victims (Pereira & Vasconcelos, 2006). This avoidance of the concept of the ‘victim’ can also therefore have an impact upon a man’s willingness to accept services and support, especially psychological support which can carry a stigma in some cultures: ‘Further, it merits mention that the provision of psychological assistance is complicated in many environments, particularly countries of the former Soviet Union. Many trafficked persons manifested a general antipathy toward psychological assistance, an antipathy which seemed to be particularly acute amongst men. As one male victim explained,

while medical assistance was important to provide: “… there shouldn’t be mentioned psychological assistance because many men are afraid of these words”. This is arguably consistent with the general attitude to psychology/psychiatry in the former Soviet Union where psychologists are seen to play a controlling function in society and who designate people as sane or insane. Even where the value of this assistance was recognised, it was often not deemed socially acceptable to accept it and many people feared being classified as insane. For many, to visit a psychologist was tantamount to admitting to a mental disease. Many also feared that their decision to consult a psychologist would be part of their permanent record and have negative consequences, like influencing their ability to get a job.’ (Surtees 2008: 87) In some cases it may be that the men simply do not consider themselves to have been exploited; some may consider what has happened to them as something that they are expected to tolerate: ‘In some cases, men may not see themselves either as trafficked or exploited. Far too commonly, exploitation is a normative aspect of migrant labour and many migrant workers may see their trafficking as bad luck rather than a serious human rights violation. This lack of awareness of their own exploitation has a direct and serious impact in terms of decisions about identification and assistance. In essence, one will not accept or seek out intervention when one does not recognize that one has been exploited. In still other situations, trafficked persons may feel that the situation they are in may be the best deal they can hope for, if the alternative is to be at home and have no earnings.’ (Brunovskis & Surtees, 2007) Surtees also highlights the need for services in general to be tailored to male clients rather than the expectation that services for women can be easily adapted for men. ‘Little attention has been paid to the links between labour trafficking and trauma or how different profiles of victims (male vs. female, adult vs. minor) experience trafficking and trauma. However, interviews with men trafficked from both Belarus and Ukraine suggest that many manifested psychological scars as a result of trafficking.’

3.2 Control and coping mechanisms The methods of control by the perpetrators are discussed in some detail in the literature with emotional and physical abuse reported as common techniques, combined with other forms of manipulation such as little or no access to food, electricity, running water, money or freedom of movement. Surtees also highlights how the psychological impact of the migration process itself can take effect: ‘A process in which men often incur debt and high costs to travel/migrate, work in abusive and poor conditions, fear of expulsion when illegally in the country of work, having incurred debt and being separated from family and community. More generally, economic hardship is a source of anxiety, psychological distress and impaired mental health, which can translate into high risk behaviours, like alcohol abuse and also have a direct effect on an individual’s health.’ (Surtees, 2010: 88)

3.3 Effect on the wider family The implications of the return and reintegration of the victim of trafficking to his family is an issue not always considered by post-trafficking support services, particularly considering cultural ‘norms’ and expectations:

‘Children may not know or feel comfortable with the returning parent or may be angry with the parent for their absence. In addition, the problems faced by returning men – whether health problems, psychological issues, financial problems, etc. – may manifest as stress, anger or depression, which result in tensions and problems within the family. How men experience their return to family and how they fit back into the family merits some thought. For example, typically in Belarus and Ukraine, the man is seen as the head of household. However, migration generally requires that his wife (or female relative) assumes that role. Negotiating new roles and responsibilities upon return, therefore, will not be uncomplicated for either the man or his family. Programmes offering family counselling and mediation (including parenting skills, relationship counselling) can be helpful in reconciling families and mending relationships damaged by the trafficking separation.’ (Surtees, 2010: 89) Many of the issues discussed in the literature have resonance with the emerging findings of the research conducted for the purpose of this report, some of which are explored further below.

4. DEMOGRAPHIC PROFILE OF CLIENTS The following demographic data is sourced from a review of 625 initial client assessment forms: 397 (64%) females and 228 (36%) males. The mean age for women is 28 years and for men is 34 years. The age profile for men tends towards the older age brackets more than for women, with 28% of men being aged 40 years or older, compared with 7% of women. 3% of females and 2% of males were undergoing age assessment at the time of their referral. In a small number of cases, the age of the client was not known and the client was not aware of their birth date. The top ten reported nationalities for men were: • • • • • • • • • •

Lithuanian – 22% Polish – 22% Slovakian – 12% Romanian – 11% Czech – 8% Hungarian – 8% British – 6% Vietnamese – 2% Ghanaian – 1% Indian – 1%

The top ten reported nationalities for women were: • • • • • • • • • •

Nigerian – 23% Albanian – 11% Romanian – 10% Slovakian – 5% Ugandan – 5% Chinese – 4% Hungarian – 4% Polish – 3% Vietnamese – 3% Bangladeshi – 3%

A significantly larger proportion of men over women needed an interpreter to engage with service providers at this initial assessment stage (86% for men compared with 58% for women). Females were significantly more likely to be referred with dependent children: 3% of males compared with 24% of females report having dependent children in the UK. There are also, however, cases of men having children still resident in the country of origin. Those male victims who have dependent children in the UK would usually be accompanied by their female partner and children as a family, also victims of exploitation. Most female victims with dependent children were usually referred as single parents with their children.

5. TRAFFICKING EXPERIENCE 5.1 Type of exploitation Determining the ‘type’ of exploitation to which a victim has been subjected is not always straightforward. In some cases a victim will have been exploited in different and multiple ways and a ‘tick box’ category might not always be appropriate. In some of the assessments, it was clear where the victim had been subjected to more than one kind of exploitation. Where victims had been clearly subject to more than one ‘type’ of exploitation, the ‘secondary’ exploitation type is show in figure 3 below. Figure 2 shows the ‘main’ type of exploitation identified for both men and women. Data on type of exploitation was available in 610 of the 625 assessments reviewed. Figures 2 & 3: Types of exploitation – gender comparison Type of exploitation 1

Females (% of total females)

Number females (total n=383)

Males (% of total males)

Number males (total n=227)

Sexual

274

Labour

194

Domestic servitude

Criminal activity (other)

Benefit fraud

0.3

0.4

Type of exploitation 2

Females

Number females (total n=51)

Males

Number males (total n=19)

Sexual

Labour

0.9

Domestic servitude

Criminal activity (other)

Potential organ removal

0.3

Benefit fraud

0.3

N/A

332

208

The vast majority of men were victims of labour exploitation, examples of which included farm and other agriculture work, factory work, charity work (for example bag collections) or caring for a child or ill person. More women than men were subject to multiple forms of exploitation, with sexual exploitation combined with domestic servitude being a common form of multiple exploitation. The following section discusses some of elements of the trafficking experience, the data around factors potentially making an individual vulnerable to being trafficked, followed by some of the control techniques in use by the trafficker(s).

5.2 Financial elements of the trafficking experience The following data was gathered from assessments: • Bank accounts: 24% (54 cases) of males were forced to open a bank account, compared with 2% (8 cases) of females. The victim then had no control over said bank account; this will have a subsequent impact on support needs as victims deal with the repercussions.

• Loans: 5% (11 cases) of males were forced to take out a loan compared with 0.3% (1 case) of females. • Credit cards: 1% (3 cases) of males were forced to take out a credit card compared with 0 females. Those nationalities forced to open bank accounts included: Polish, Slovakian, Czech, Romanian, Lithuanian, Hungarian, Portuguese, Cameroon, Nigerian. This applied mainly to those trafficked into labour exploitation or criminal activity with smaller percentages for those trafficked into sexual exploitation or domestic servitude. There were also a small number of clients who were forced to take out phone contracts or sign tenancy agreements, which they were not able to use.

5.3 Vulnerabilities The level of background detail contained in the initial client assessments varied from case to case, but where possible, data has been gathered from any available background information on clients, prior to their trafficking experience. Possible ‘vulnerability’ factors were then drawn out from available background information. It was possible to elicit information on potential vulnerabilities in 54% of cases. In some cases more than one vulnerability was identified, therefore the percentages below total to more than 100%. From those 54% of cases (336 individuals: 202 female and 134 males): • 59% of cases were coming to the UK in search of a ‘better life’, in some cases directly as a result of a trafficker’s ‘promise’. • 12% of cases had experienced the death of one or both parents. • 17% of individuals had experienced family breakdown. This was in some cases where, following the death of birth parents, the relationship had broken down with a guardian or in other cases where the marital relationship had broken down. • 20% of cases were vulnerable because of their gender. In the case of women this would sometimes lead to sexual exploitation in the country of origin, or in the case of men and some women this referred to situations where an individual was gay/lesbian or perceived to be gay/lesbian in a society where this was not considered acceptable. • 4% of individuals had existing mental health issues prior to their trafficking experience or learning disabilities. • 4% of individuals had been caught up in conflict in their country of origin. • 3% of cases had been rough sleeping immediately prior to their being picked up by traffickers. Vulnerability factors by gender are as follows: • Coming to the UK in search of a better life was indicated in 43% of female cases, as opposed to 82% of males. • Loss of one or both parents was a factor in 17% of female cases as opposed to 4% of males.

• Family breakdown was identified as potential vulnerability in 24% of female cases as opposed to 7% of males. • Gender affected 32% of females as opposed to 1% of men. • Existing mental health conditions or learning disabilities were identified in 2% of females and 6% of males. • Conflict in country of origin was identified as a factor in 7% of females and 1% of males. • Rough sleeping was an identified vulnerability in 1% of female and 6% of male cases. The available data on vulnerability by nationality shows that: • The majority of British nationals were rough sleeping prior to being trafficked and/or had existing mental health or learning disabilities which may have made them vulnerable to a trafficker. • All Polish nationals (where there is background data available) were coming to the UK in ‘search of a better life’. • Those victims of trafficking who reported having experienced conflict in the country of origin were: Ugandan, Nigerian, Sri Lankan, Kenyan, Rwandan, Somalian and Angolan. • Gender was mentioned as a factor in 70% of Albanian trafficking cases where there is background information available. • Loss of parents, family breakdown and gender featured highly in Nigerian cases.

5.4 Trafficker control techniques Victims reported a number of control techniques in use by traffickers, including: • IDs: 27% (61 cases) of males had their ID removed by the trafficker, compared with 23% (90 cases) of females. • Physical assault: 36% (83 cases) of males were subject to physical assault whilst in the trafficking situation compared with 67% of females. This figure includes sexual assault. • Threats to the victim’s family: 6% (14 cases) of males experienced threats to their family, compared with 10% (40 cases) of females. • Freedom of movement: freedom of movement was restricted whilst in the trafficking situation in 38% of male victims and in 53% of females. • Food: data was gathered on victims who, whilst in the trafficking situation, either ate one meal a day, were forced to eat leftovers or mentioned insufficient food. This applied to 18% of male victims, compared with 3% of females. • Juju: 12 cases (2%) of victims had been subject to a juju ritual as part of their trafficking experience. All those who reported at the initial assessment being subject to juju were female, all had been subject to sexual exploitation and 10 of the 12 cases were of Nigerian nationality.

6. SUPPORT REQUIREMENTS A total of 91% (206 cases) of men and 72% (277 cases) of women were reported destitute at this initial assessment stage. This may reflect the higher proportion of women receiving support from friends/family/community support or those already in NASS accommodation. The table below shows the support requirements identified at the initial assessment stage by gender. In the majority of cases, more than one support need was reported; these are all reflected in the data shown in the table below, and therefore the data totals to more than 100%. Figure 4:

Support requirement â&#x20AC;&#x201C; gender comparison

Support requirement

Females (%)

Number females (total n=380)

Males (%)

Number males (total n=227)

Accommodation

316

220

Subsistence

274

201

Counselling

Mental health assessment and/or follow-up for ongoing mental health needs

Repatriation

Asylum or immigration matters

134

ESOL

Education/training

Finding employment

Spiritual

0.3

0.4

Health check and/or follow-up for ongoing health needs3

Family reunification

3.0

Practical/living skills

Sexual health assessment and/or follow-up for ongoing sexual health needs

Clothing and/or toiletries

165

Accommodation and subsistence both feature high for males and females in terms of initial support needs. There are significant differences between men and women in reported support needs at this stage regarding counselling, support in claiming asylum and support in finding employment. The stated desire on the part of many men to find employment as quickly as possible was also a theme which was drawn out through the interviews with residents (see following section). There are also differences in requests for health checks (possibly because of pregnancy), sexual health checks and support with practical living skills.

6.1 Health need The table below shows the data available for the main reported health needs at the time of initial assessment. The final row (70% for females and 72% for males) refers to the proportion of clients for whom no health needs were identified/specified. 2 3

Includes informal emotional support as well as professional counselling. This category also included pregnant women.

Figure 5:

Type of health need – gender comparison

Type of health need

Females (% of total females)

Number females (total n=121)

Males (% of total males)

Number males (total n=65)

Dental

Malnutrition

Physical injuries (sustained whilst in the trafficking situation)

Cancer

0.3

Heart problems

Optical problems

High blood pressure

Headaches/Migraines

Mental health conditions

Hepatitis

Unknown or N/A

276

163

7% of men and 6% of women reported having more than one health need and 1% of both men and women reported having more than two health support needs. Other reported and largely isolated health problems in men, not shown in the table above, included kidney problems, diabetes, arthritis, asthma, hearing difficulties, malnutrition and hernia. Alcohol use: the use of alcohol in initial assessments was mentioned in 19% of males, compared with 2% of females. This mainly applied to occasional alcohol use, ie, ‘one or two drinks’ a week, as opposed to problematic alcohol use. Reports of alcohol use at the initial assessment stage are low when compared with qualitative data from support staff, who report much higher problematic alcohol use amongst males, leading to aggression. Reports of other substance use at initial assessment were received for 2% of male victims compared with 3% of females. Examples of other substances included heroin and cannabis.

6.1 Emotional need The data showed that the primary emotional need expressed by both men and women at this initial stage is ‘distress’ (24% of males and 43% of females), followed by depression in females (29%) and fear of the trafficker (22%) in males. Emotional needs were more commonly reported in females than males, with no data on emotional needs available in 45% of male assessments and 21% of female assessments. Reported diagnosed PTSD or symptoms of trauma and selfharming or thoughts of suicide are significantly higher in females than males (PTSD 22% in females compared with 5% in males; suicidal thoughts 17% in females compared with 4% in males). It is interesting to note that reports of ‘aggressive feelings’ were slightly more common in women than men at the initial assessment stage, whereas aggression is much more commonly reported in males than females by support staff.

The data shows that those victims trafficked into sexual exploitation express more emotional support needs at the initial assessment stage across every â&#x20AC;&#x2DC;categoryâ&#x20AC;&#x2122; of emotion. This may reflect the level of detail to which the assessments on victims of sexual exploitation were completed and/or the fact that the majority of victims of trafficking into sexual exploitation were female and therefore more likely to disclose at this earlier stage. The difference in self-harm/suicidal thoughts is particularly significant with 25% of those trafficked into sexual exploitation expressing selfharm or thoughts of suicide, compared with 12% of those trafficked into domestic servitude, 11% of those trafficked into criminal activity and 5% of those trafficked into labour exploitation. The following sections discuss the main themes arising from the interviews with staff and residents. A total of six visits were made to support providers with at least one (usually two) members of staff interviewed at each site and eleven male clients interviewed across the six locations.

7. CLIENT SUPPORT ‘IN THEIR OWN WORDS’ Clients were all asked questions according to a set interview template which focused on current support needs, help already received and plans for the future, rather than the trafficking experiences. The overwhelming impression that all clients communicated was gratitude for the support that they had received and relief that they had exited the exploitative situation. Most interviewees had no suggestions for any improvements in service delivery, although access to a computer was mentioned and smoking on site by other residents was also highlighted as a concern. ‘I feel safe here, that’s all I can say really. Am OK. Am alright.’ ‘I am really happy to be here and have some help after my very bad experience, I feel secure now. It’s good here because there is a mix of Polish people, Czech people, it’s good for the language. I would like to say a big thank you for the opportunity to live here and for the help.’ ‘Staff are super here. Residents – depends, sometimes nice, sometimes not very polite, depends on who lives here. I like everything here. I could be happier if there was some computer, that would help me to translate letters and other things.’ ‘I have every support that a person needs here. I have food, my own room, they give me clothes and I meet a counsellor. The behaviour of some residents is difficult. I don’t smoke, some other residents they smoke, not when the staff are here but when they leave they smoke in the lounge or the kitchen. I have no problem when they smoke in the lounge because I can go to my room but in the kitchen is a big problem for me, we only have one space there, I find it hard.’ ‘Everything is alright, they are looking after us, they are very pleasant people and they try to sort out all our problems. I think everything is alright.’ ‘At the moment, I have a lot of things to do, everything, studying, working, paperwork, housing, everything. At the moment, I am still sorting out my travel documents. I get a lot of help here, with everything. They taught me everything, even the cooking, shopping, buying food, go to get English class, library, everything I need they help me. I have counselling every week on a Tuesday, they take me there every week. All the help I could wish to have they help me.’ The role of the supportive staff was highlighted by many interviewees as playing a key part in their recovery process: ‘The most thing I liked was the feeling of love from the people – the staff. I want my Mum to be proud of me like they are.’ ‘I don’t have any family, it’s only me and my brother who was killed in 1982 in [country of origin]. My mother was killed and that was the end of us. The staff are helpful. When I say I have no family it is them, they have been there every time for me.’ In terms of aspirations for the future, the majority of those clients interviewed were emphatic in their desire to make a life for themselves in England, to move on with their lives, to learn

English (for those who do not already have well-developed English language skills), to get paid employment and to be independent. ‘I don’t want to ask for benefits, I want to work. Going to ESOL is a problem for me, I can’t understand English at all so an English teacher is a problem for me. It would really help me to have a Slovakian teacher. I want to stay here and find a job and live. Any job – just a job.’ ‘I am happy here, I have everything I need, just a problem with the language. I just want to find a job – any job – and work.’ ‘I feel disappointed and fed-up that I just have to sit here and cannot do anything. I want to be an equal part of life in England.’ ‘I feel safe now. I used to sleep at the terminal where I knew there were no cameras, I couldn’t sleep on the street, it wasn’t safe. I just want to find a job and home and have a normal life here in England.’ ‘My first plan is to find a proper place for me. I would like to stay in England.’ ‘First I need to learn some more English then I would like to get involved in the property business, I would love to learn that. I would like to stay here in England.’ ‘I want to find a job as soon as possible – some kind of factory work – here in England, I need to learn the language properly and to work.’ In terms of moving on from the service, the level of support offered to clients once they had left the service differed between providers. All services noted that many of their clients opted to remain in the local area once they had left the service and chose to keep in touch with the staff based at the organisation. Arrangements varied from dropping in for a casual cup of coffee, some company and a chat, to more formal floating support provided through an outreach service.

8. ACCESS TO COUNSELLING Providers focused on the length of time it can take clients, particularly male clients, to open up enough to request assistance in dealing with any emotional trauma as a result of their experiences. ‘We have had very little take up of counselling, especially with the A8/A2 male nationals. It’s offered to them but they say they don’t want it, they will talk about it when they are drunk. It could be screaming out to you that this person needs to talk about what has happened to them but you still need to respect their choice. Females will go more but sometimes you know enough is enough, it will depend on how often they have to go through their story. The issue with counselling is getting one who understands about trafficking and getting a good, reliable interpreter, that’s always a challenge – getting one who doesn’t put their own spin on it. Our counselling service always makes sure that they put the lid on, they make sure that the person isn’t going out with something really really raw. There is a massive massive waiting list for counselling through GP service.’ ‘They are all asked whether they need emotional support and it’s always, no, no, no. But we know they do. Especially around alcohol. They just don’t see that they have an issue.’ ‘Women are very open to saying I want to talk about it, men will go down all sorts of different routes before admitting that they want to talk about what has happened.’ ‘Counselling is also very expensive and hard to find. To get an experienced counsellor in the 6.5 weeks is almost impossible. Trying to get men to that point, they will go to anything else first before they get to the point where they say “I think I need some help”, they will go to alcohol, drugs, whatever – we had one guy who used to get up at 5am every morning to go for a 2 hour run, they will do anything to avoid saying they need help.’ Some staff have commented on the difficulties in accessing appropriate counselling, especially during the 45-day period and the impact that beginning a counselling course without completing it can have on the client. ‘Quite often we would get a case and refer for assessment for counselling, the victim at this point may be in the system for three to four weeks already. Counsellor may say need seven weeks but the victim may need to leave at week five. That concerns me as you are really opening up a can of worms, that doesn’t sit well with me and I don’t feel good about it.’ ‘One African lad was so broken, he wouldn’t leave this room. We put him in touch with the rape crisis team but they wouldn’t touch him because he’s a man. So, the Home Office put us in touch with this guy, he’s amazing and he’s transformed this guy but he’s expensive.’ Some services have trained counsellors as staff members and they remark that much of their support could be deemed ‘informal’ counselling: ‘Sometimes they just want to come in here and sit, not even talk, just sit. Showing them that you’re there for them, not forcing them, showing that you’re there when they’re ready. Sometimes it takes weeks for them to start trusting here.’ ‘Men tend to open a lot more with me (female) and talk to each other. It seems as if they are just not used to talking about emotions, on that level. When they are given that chance,

they just talk and talk, but it’s more about what’s going to happen to them, if they have to go back and about money. Money is definitely the main thing they want to talk about.’ ‘A lot of them look on me as an older woman, they call me grandmother in Polish and I am qualified counsellor. They may say they don’t need counselling but we are doing it anyway, they are having it anyway. When this contract started I asked about money for counselling but there isn’t enough.’ ‘With most of them once they feel comfortable and safe it can go one of two ways, they can either hit the bottle because they don’t know how to deal with what has happened to them, they are struggling with feeling secure and happy or they actually start opening up to you and then you start understanding where they’ve come from and where they’re at. We had one guy and I had to keep coming out night after night but he needed to talk and what happened with him […] it’s a little bit like when they become warm and they start taking the layers off and that’s what happened to him and as he started doing this, he became suicidal. So, the support worker would ring me and say she was really worried so I would come in and we would sit here and talk and I would be here for a couple of hours. Sometimes I thought, he just wants to talk so he would threaten suicide to get me to talk with him. But in the end that doesn’t matter does it because he wanted to talk.’

9. RELATIONSHIPS Interviews with both staff and residents indicated that relationships and trust were important

aspects of a client’s time at a service and recovery from their experiences. Many clients had been misled and tricked into their trafficking situations, often by individuals who had spent time building a relationship with them as part of a ‘grooming’ process. This made it very difficult for clients to build trust with others once they had been exploited. In addition, the trafficking situations were often devoid of any positive relationships or safe and nurturing environments where clients could feel valued, not to mention the cruelty and inhumane treatment involved. To describe the impact that these experiences had on clients, staff used words such as ‘broken’, ‘withdrawn’ and ‘reclusive’, which indicates the detriment to their self-esteem and ability to form/sustain relationships in particular. This quote highlights many comments made in the same vein by staff: ‘A lot of these men are just broken. That’s the thing that shocked me, I knew they’d need a lot of nurturing but I didn’t expect to see them so broken. We’re talking about men that have come from a very male-dominated society, so they’re very macho men…’ Furthermore, there was a significant amount of talk of ‘family’ throughout the interviews as clients had not been able to contact their families or had perhaps lost members or been separated from children. There were also clients who had never had any family at all. Consequently, they did not have access to the buffer of family and the security this provides around them. Staff therefore spoke a lot about the work that they do in attempting to deconstruct some of the effects of experiences by providing a safe and supportive environment, which made the service feel like a home they could belong to. Terms such as ‘cosiness’ and ‘warmth’ were used during interviews to describe both the design of the buildings, as well as the approach taken to clients, to engender trust and ensure that clients felt comfortable enough to open up and discuss their feelings. Services would also try to arrange group activities to foster relationships within the service, so that clients are able to get to know one another as individuals. ‘We are very strong on the family thing, it does have a family feel here.’ ‘Every few months we have a trip or a day out together. We don’t want it to be that they are just the people who live in that house because they are victims.’ ‘I tell you what happens, they come in here and they’re very afraid and unsure of what they’re coming into. So we tend to give them a lot of attention in the first few days – partly because I do all the paperwork with them, and we take them shopping if they need clothes – so we sort of fuss them in order to help them feel comfortable and safe.’ ‘Generally now, here, it doesn’t take weeks [to open up] because there’s a warm atmosphere. Because I think what happens is, when they come in we involve everybody in the preparation for them coming. So they make them sandwiches, and when they first come in I always get the lads to make coffee and tea for them, and then it’s that thing about – because they’ve been there. And when we leave, I always say “look after them”, and then of course they’re then saying, “They’re good, they do this for you.” So it doesn’t take as long now for them to actually come to you because the other guys have said…’

There were also gendered aspects to this and the way in which support was delivered. For example, a number of staff referred to the positive way in which male clients would respond to the ‘motherly’ approach that some female staff would offer (eg, kind and warm, but firm). Some staff also commented on the ‘calming’ effect that the presence women or a baby could have on the male residents. ‘We’ve opened it up and are now taking couples, so we’ve had one couple. And that was very interesting having the one woman – we’ve got a couple of double rooms so she was downstairs with her partner – she didn’t want to go anywhere without him – and the whole dynamics of the building changed actually. In a way it was better because they cut down on their drinking, and their room downstairs became like a community room really, and everybody sort of descended on them. Personally I just think it would be better if we could have a few mixed couples because it does change the dynamics.’ Relationships were also important to clients in terms of their enjoyment of the service. Many mentioned the support from staff as well as the friendships they struck up with other residents as being some of the positive aspects of their experiences of the service. Similarly, when talking about difficulties they might have encountered, the main issues tended to be around conflicts with other residents. As with the issue around access to counselling, the relatively short timeframe that clients spend within a service can be problematic in terms of the work that staff do around relationships, as it can take some clients weeks or months to feel safe enough to open up and begin to engage on that level. This can often be close to or even following a client’s departure from the service. ‘With some of them, you never quite get there – with one guy from Poland, the barrier was always up, and it’s only now he’s left and comes back that he’s more comfortable about opening up emotionally.’ This therefore impacts on the move-on of clients, as they rely on the relationships they have developed within the service, and value the company of the staff and other residents they have come to know and trust. They will therefore be likely to return to the service to spend time there and seek continued support from staff, which can become a significant pressure for some, particularly where floating support is not available. It was felt by many staff interviewed that continued emotional support was an important factor in a client’s successful recovery from their trafficking experience: ‘They do need space to talk – I don’t think 45 days is enough. If we’re going to settle them in this country and they’re going to be productive members of this society – not crippled members of this society – and I don’t just mean work wise – then we need to make sure that they are emotionally and psychologically ready.’

10. CULTURAL CLASH In the commissioning stages of the research, anecdotal evidence was reported that some services

were experiencing incidences of a ‘clash of nationalities’ between residents within the home. Interviewees were asked to elaborate further; however, the problems were usually reported to be generational inter-ethnic, ie, residents of the same ethnicity ‘just not getting along’ rather than different ethnicities or nationalities. ‘Very rarely do we have problems between different nationalities, it often tends to be more of an age thing, for example the younger clients may upset older clients with their loud music or something. At the beginning they are like rabbits caught in headlights but when they start to settle in that’s when they might have a drink and the problems may start.’ ‘We have one chap who’s 18 and he’s bonded with someone a bit older than him. But in the main they are between 30 and 50 so age hasn’t really been an issue. But we have had issues between the same ethnic group, so for example, we had one Polish lad who was having problems with another Polish lad but if that does happen that tends to be fuelled through alcohol. It wasn’t a national thing, it was more about a cultural thing, like the dislike for example between Manchester and Liverpool. They do tend to sort it out themselves very quickly and they are on to the next issue. But they do know that we are on top of it, they know that we will call the police if they cross that line. The other clients have to feel safe here especially as they have experienced so much violence in their life.’ ‘Aggression is a main one, culture clash, young and old is another one. Young person may want to sit around the house all day and play on the X-box whereas the older one may say no, we need to get out and get a job. Rest and recovery means a different thing to different people, we need to ensure that they understand that everyone is different and cope differently.’ ‘We have had a few fallings out between the European guys drinking when they have been a bit bolshy with each other. We had two girls in one flat that just didn’t get on. Not everybody gets on with each other all the time. The women tend to knock on each other’s doors and chat with each other more often. The African and Asian nationals women tend to be in and out of each other’s flats, eat and socialise together. The East European nationals tend to drink together more. We try to get them out and about together, to language lessons or shopping – safety in numbers.’

11. ALCOHOL AND AGGRESSION Problematic alcohol use is highlighted on only a limited number of client assessment forms. However, the links between alcohol use and aggression were highlighted throughout all interviews with staff members. Interviewees report British nationals and Eastern European nationals being the most prolific drinkers, sometimes with related anger issues. ‘UK nationals who are usually homeless initially, often come malnourished, beaten, usually want to have a bath and shave, some clothes, quite often will have substance misuse issues, drinks or drugs. [As part of their trafficking experience] they will be given a bottle of cider each night as their treat which will build up an addiction over time.’ ‘Temperament, especially towards each other has been an issue in the past. Understanding the trigger points is very important to get them to recognise that.’ ‘We have had to call the police. They keep things in as men do and when they have a drink it comes out, and it can come out in the form of violent aggression towards others and staff. But it is about understanding the trigger points. They can be very impatient, even the ones that have left because there is an air of dependency that you will assist them.’ ‘Alcohol can be a problem. They go round in loops with us, even when they have exited they can still access support through the alcohol service. All the male clients have had some form of addiction issue.’ ‘It’s [alcohol] an issue, yeah, it’s usually when they move on to other providers who are less supportive that they fall back into dependency.’ ‘Sometimes they don’t understand that not everyone is entitled to the same kind of benefits, that can cause tension when they talk amongst each other.’ Some service providers talked about the interventions around alcohol that they have found to be positive. ‘We do see a lot more issues around drinking, particularly with the A8 nationals. A8 nationals tend to binge drink more, we get them to sign additional licence agreements, take them to fellowship meetings and treatment assessments, drink diaries, changing patterns of drinking. Reduce and give slowly subsistence money – has to be client led. They cannot be intoxicated in the building. It cannot impact upon the other service users. B runs an alcohol project so has a good understanding of working with individuals with alcohol problems. If A8 guys together can encourage each other to drink. Most of the times they are affable but we have had one or two issues.’ ‘Alcohol and money are main trigger points. They borrow off each other, nobody gets paid on the same day, we always try and encourage them to take what they need. But of course we can’t reinforce that. That tends to be the best way to do it. Once they get on the benefits ladder, you tend to get a big wadge of cash in one go and then they tend to go these little merry benders and take the others with them. We have stopped that. We talk to them all the time. Communication is very important, at least two or three times a day with each of them. And that they know what the rules are.’

One provider discussed the possible longer-term effects of allowing anger issues in clients to go unmanaged: ‘There are a couple of guys who are so scarred that I didn’t want them in the city centre, I actually feared for women, that’s something that they haven’t thought of, there have been a couple of guys, there has only been one guy who I was afraid of but the anger in them…. Some of them they have these layers of it and then they have been cruelly twisted by these traffickers.’ ‘We can’t just think short-term, we have to think long-term, a lot of these guys are going to be settling long-term in the country, they are going to fall in love or whatever and if this stuff isn’t dealt with, who are they going to take it out on? The women and then the children. We have to think that far ahead.’

12. SELF-ESTEEM The level of trauma and issues of self-esteem were raised by all interviewees, with services emphasising the psychological effects that exposure to abuse and exploitation have had on the male residents of their services. Programmes and interventions which are designed to develop the client’s self-esteem were highlighted as positive examples of assisting men in the recovery process and in the longer-term helping them to develop resilience and reduce the risk of being re-trafficked. ‘Forced labour victims can be very insular in how they present. Some feel very ashamed and can’t believe what has happened to them. Many others think it’s still better than in their home country, for those individuals it is very difficult to say there is a level they should expect, because of their vulnerability they are still at risk of being exploited. They just don’t expect to be able to do a decent day’s work for a decent day’s pay. We have to say to them, “The situation you have been in does not mean that you are entitled to less than anybody else.” It is quite difficult to get them to see that they are not worth less than anybody else, esteem is something that we really have to work with. Those who were alone in their trafficking or those who escaped alone haven’t had the wherewithal.’ ‘The most traumatic thing is the theft of what makes someone a human being. We can deal with the bruises, those can heal. Stealing what makes someone human is what traffickers do, that’s what we are trying to help with on top of all the practical things. Dealing with the benefits is one thing but we need to make them see, “You are a human being, you can laugh and have emotions.” It can be a challenge with the 45-day cut-off, it’s about setting really good groundwork. It’s about helping them to realise that who they were before everything that happened to them is still there. We had one English guy who was held for three years for forced labour and he was really losing his faith. He has it back now, it gives him comfort but his trafficker nearly took that away from him.’ ‘Every single person who has been through here have been special, you see them and you think, you survived, you are an amazing human being to have got through all that.’ ‘We have another young Polish lad, if he meets a woman he goes totally to pieces. He met this young woman and he came and asked us if he could have £10 and I said what do you want it for and he said to buy her some flowers but he’s never even spoken to her! So, he’d met her in this hostel where one of our guys was living, so I said “Why don’t you go up and introduce yourself and ask for her name?” Do you know, he burst into tears. And then he went away, came back and he was shaking and said, “But I can’t just go up to her” so he was going to buy her some flowers and leave them outside her door. He was shaking, I have never seen anyone shake so much and he sobbed like a baby.’

13. INTERPRETING SERVICES AND LANGUAGE TRAINING The quantitative data analysis showed that a total of 86% of males required an interpreter to engage with service providers at the initial assessment stage. This, combined with the stated desire by so many men to gain employment as quickly as possible, means that the demand on both interpreting and ESOL services is likely to be high. This was reinforced through the following two interviews with service providers: ‘The biggest thing that is a problem is translation and accessing health services. A lot of NHS services don’t know that they have to provide interpreting services, the practice manager can say, no no no, it’s not in our budget. We use Google a lot. The hospital are brilliant, they often have a member of staff in order to give that client the face-to-face service, we stay there with them the whole time in the hospital while that translation is going on. The younger male clients pick up English quite quickly, the over-40s find it much more difficult. Someone in their 30s at the end of the 8-week ESOL course you can have a conversation with them. There is a language course available locally but a lot of the A8 won’t go.’ ‘If they want to stay in the country then English language support is the biggest need, there just aren’t enough tutors in the region to do this and it’s expensive. We offer a mish-mash of piecemeal courses through charities. The job centre has a very long waiting list for ESOL, once you are on it it’s very good. Some of them aren’t in the position to access it anyway because of alcohol or underlying support needs.’

14. KEY FINDINGS A review of the data showed the following main findings:

Victim profile • Male victims tended to be in the older age brackets than females. • The majority of male victims were from A8 states or the UK, while the nationality profile of female clients was much more diverse. • 86% of men required an interpreting service, 30% more than women. • The majority of men (86%) were trafficked into labour exploitation.

Trafficking experience, vulnerabilities and control techniques • Significantly higher proportions of men over women report being forced to open bank accounts and take out loans during their trafficking situation. • Freedom of movement was restricted in a lower proportion of male over female victims. • A significantly higher proportion of men report having restricted access to food whilst in the trafficking situation than women. • More than a third of men report being subject to physical assault whilst in the trafficking situation. • Those vulnerabilities more prevalent in males than females were rough sleeping, the ‘desire for a better life’ and existing mental health conditions and/or learning disabilities.

Support needs • The main health needs for men at initial assessment were physical injuries (sustained during the trafficking situation), dental care and asthma; whereas for women the main presenting health needs were headaches/migraines, physical injuries (sustained during the trafficking situation), high blood pressure and gynaecological problems. • Problematic alcohol use at the point of referral was significantly lower than reported prevalence once clients have been in residence for a longer time. • The main emotional support needs expressed by men at the initial assessment stage were distress, fear of the trafficker and depression; whereas for women the main emotional support needs were distress, depression and symptoms associated with PTSD. More than twice the proportion of men than women did not disclose any emotional support need at this stage of assessment. • Victims of trafficking for sexual exploitation disclosed more emotional support needs than other ‘types’ of trafficking at the initial assessment stage. • A high proportion of men (91%) presented as destitute. • The main support needs for men at initial assessment were accommodation and subsistence, with support in finding employment, need for clothing and assistance with repatriation also figuring highly. • Access to counselling and signposting to immigration advice were support needs reported in a significantly higher proportion of women than men.

The demand on interpreting services is high and there is a long waiting list for ESOL courses in some areas. Access to an appropriate counselling service is reported as essential by service providers. Take-up of offered counselling, especially amongst Eastern European males, is reportedly low, especially during a period of 45 days. All services reported significant difficulties with moving clients on from the service, either because of a lack of suitable accommodation or because of a problem accessing benefits. Many men would benefit from support associated with the family, either support for the family they have with them in the UK or help with reconnecting with family members in the country of origin. Positive interventions reported by staff included: • Preparing clients for independence from the point of acceptance into the service. • Implementation of programmes to foster self-esteem and reduce the risk of further exploitation. • Introduction of ‘meaningful activities’. • Firm house rules. • A mixed gender house. • Encouraging connection to the local community. • In terms of partner agencies, establishing a named point of contact.

15. RECOMMENDATIONS The findings of the research have led to the following recommendations and implications relating to practice, policy and issues to be explored further:

Practice • Each service to develop ‘welcome packs’ for new clients available in the appropriate language. • Staff to encourage existing clients to help welcome and ‘settle in’ new clients. • Development of a programme of ‘meaningful activities’ within each service – for example, gardening, crafts, DIY, etc. • Where the client indicates that he/she wishes to remain in the local area, after exiting the service, to encourage local community connections as early as possible to aid the establishment of support networks, post exit of the service. • Programmes which foster self-esteem are to be encouraged to reduce the risk of the client being exploited in the future, particularly in those clients who present with a high level of vulnerability. • Consideration should be paid to encouraging victims (particularly men) to make/reestablish contact with family members, in cases where such contact would be considered to aid support. • In cases where more than one family member has been exploited or is being supported within the service, consideration to be paid to support/counselling to the victims as a family, in addition to individual support. • Training in anger management techniques would be recommended for support workers.

Policy • The length of time necessary to gain access to an appropriate counselling service is often significantly longer in some areas than the 45-day reflection period. There would appear to be a lack of counsellors trained in working with trafficking victims (particularly male victims). • The need in many clients to retain contact with the support service post exiting the service should be considered in the development of services, particularly the demand on staff time and the impact on existing clients. • The demand for language services, both interpreting services and ESOL classes, is high and in some areas far outstrips the supply with long waiting lists for courses. Further consideration needs to be paid towards the training of interpreters and supply of ESOL courses, particularly given the proportions of clients who wish to remain in the UK and find work. • The research has shown a significant number of male victims being forced to open bank accounts/loans/credit cards. Consider further training programmes for financial sector staff in identification of potential cases.

Further exploration • The research has highlighted a significant gender difference in the numbers of those trafficking victims also seeking asylum. The Anti-Human Trafficking Team have indicated

that they would find it useful to explore further the experiences of those asylum seekers within the service. • The research has shown that take-up of proffered counselling services is significantly lower in men than women. Further exploration of the reasons behind the lower take-up of counselling in men would be valuable, in particular a review of the experience of other agencies which either provide emotional support services/counselling to men or refer to specialist support services. • Further exploration into the use of alcohol as a coping mechanism, and training for support workers in managing clients who are alcohol dependent, would be particularly valuable in avoiding the potential danger of stereotyping or labelling alcohol use as a ‘cultural trait’.

16. REFERENCES Anette Brunovskis and Rebecca Surtees (2007) ‘Leaving the past behind? When victims of trafficking decline assistance’, Fafo, Oslo and NEXUS Institute, Vienna Nick Mai (2011a) ‘Tampering with the Sex of “Angels”: Migrant Male Minors and Young Adults Selling Sex in the EU’, Journal of Ethnic and Migration Studies, 37(8): 1237-1252 Nick Mai (2011b) ‘In whose name? Migration and Trafficking in the UK Sex Industry: delivering social interventions between myth and reality’, London Metropolitan University S. Pereira and J. Vasconcelos (2006) ‘Combating human trafficking and forced labour: case studies from Portugal’, MTSS and ILO Ruth Rosenberg (2010) ‘Trafficking of adult men in the Europe and Eurasia region: final report’, US Agency for International Development Rebecca Surtees (2008) ‘Trafficking of men - a trend less considered. The case of Belarus and Ukraine’, NEXUS Institute and the International Organisation for Migration

The researchers would wish to gratefully acknowledge the co-operation of all those who contributed to this study, especially those clients and staff who gave of their time and consented to being interviewed The study was made possible with a grant from the Garfield Weston Foundation 32