Torture Journal

Imagery Rehearsal Therapy and mianserin for trauma-affected refugees

Anders Nielsen — 2024-09-25

Introduction:

In order to identify the efficacy of treatment interventions for trauma-affected refugees follow-up studies are highly warranted. Hence, the overall aim of this study was to examine the efficacy of sleep-enhancing treatment, IRT and mianserin, in a sample of 219 trauma-affected refugees at six-month follow-up post-treatment.

Methods

Data were derived from a four-armed randomized controlled trial in a sample of trauma-affected refugees with PTSD. All four arms received Treatment as Usual (TAU), an interdisciplinary treatment approach: one group received solely TAU, serving as a control group, whereas the remaining three groups were active-treatment groups receiving add-on treatment with either IRT, mianserin, or a combination.

Mixed models were used to analyze the combinations of the two treatment factors (IRT vs. non-IRT and mianserin vs non-mianserin) and time (baseline vs follow-up and post-treatment vs follow-up) for the primary outcome sleep quality and for several secondary outcome measures.

Results

A total of 36.7% of the participants had been exposed to torture and 44% had been imprisoned.

The only significant effect of IRT was on well-being (measured with WHO-5), where IRT showed higher improvement in well-being six months post-treatment (p = .027). There was no significant effect of mianserin on any of the outcome measures.

Discussion

This follow-up study found improvements from baseline to post-treatment on sleep quality and most of the secondary outcome measures that were maintained for all treatment conditions at the six-month follow-up assessment. A limitation of the study was that a high proportion (53.4%) of the participants did not attend the follow-up evaluation.

The results indicate that add-on IRT-treatment and add-on mianserin-treatment were not superior to TAU at six-month follow-up post-treatment.

Torture, Livelihoods and Rehabilitation

Tania Louise Herbert — 2024-09-25

The understanding of torture has evolved to encompass a complex interplay of factors including poverty, politics, health and psychosocial factors which increase vulnerability to torture. While torture remains a grave human rights violation, it is acknowledged as widespread and intertwined with broader human rights abuses. In response to this evolving understanding, rehabilitation efforts for torture survivors have expanded beyond medical and psychological care to encompass broader socio-economic dimensions, including livelihoods support. Livelihoods are not only a means of making a living, but also a source of purpose and identity. Where torture disrupts or destroys the assets, capabilities and supports that sustain livelihoods, the resulting suffering can be profound, particularly for individuals unable to flee or resettle. This article explores the intersect between livelihoods loss and torture, exploring where livelihoods loss co-occurs with torture, is a consequence of torture, or may be an act of torture in itself. The importance of documenting livelihoods losses in torture assessment and the integration of livelihoods into rehabilitation programs is considered. Programs must aim to restore sustainable and meaningful livelihoods whilst addressing inherent risks and limitations including the lack of capacity, expertise and resources of treatment centres. Although research in this area is sparse, existing evidence suggests that combining livelihoods rehabilitation with psychological and physical interventions, alongside long-term support are important components. For livelihood restoration to be effectively integrated, it must be survivor-centred, holistic, evidence-based and focused on safety. While the field is to date underexplored, this article provides a foundational framework for torture treatment centres and stakeholders to consider the role of livelihoods in both conceptualising and treating survivors of torture.

Small funding can make a big difference

Berta Soley — 2024-09-25

Half of all survivors of torture (SOT) worldwide live in poverty. When treating SOT, rehabilitation and mental health treatment cannot be expected to work independent from supplemental support (specifically livelihoods) ensuring that individuals’ most basic needs are met (Mukwege and Berg, 2016; Patel, 2019).

It is said that rehabilitating SOT without livelihoods support is comparable to “a car without wheels.” For instance, a doctor may inform a patient that they must eat prior to taking their medications, unknowing of the patient’s lack of reliable access to food. Or, a SOT may attend weekly sessions for counselling to no avail as they return to a home without sufficient food for the family— another stressor deterring focus from rehabilitation.

Outcomes of integrating livelihood into mental health and psychosocial support program among survivors of torture

Diwakar Khanal — 2024-09-25

Introduction: From 1996 to 2006, Nepal experienced a decade-long armed conflict that adversely impacted survivors of torture. The conflict posed threats to various facets of their lives, such as mental health, socio-economic status, human rights, and the process of reintegration into their original communities. This study was done with the survivors of torture from the armed conflict.

Objective: This study aims to generate evidence on the impact of livelihood support (supporting individuals with earning their livelihood through business development, farming/animal husbandry and micro-entrepreneurship) upon mental health and psychosocial wellbeing as well as social empowerment of survivors of torture.

Results: In total, 44 out of 46 torture survivors reported improvement in their mental health and psychosocial well-being after the livelihood intervention was instituted. Significant reduction in the severity of symptoms of depression (21.7% to 2.3%; P<0.001), anxiety (15.2% to 6.8%; P<0.001), and post-traumatic stress disorder (44.4% to 4.5%; P<0.01) was observed with medium to high effect size. Similarly, improvement in social relationship, economic status, and autonomy (increase in self-confidence and motivation) were noticed post-intervention.

Discussion and conclusion: Our study concludes that the livelihood intervention has significantly contributed to economic uplift, improved mental health, psychosocial well-being, social empowerment and quality of life among the survivors of torture. The data provide preliminary evidence of positive outcomes from integrating a livelihood program into an MHPSS (Mental Health and Psychosocial Support) program. Although the lack of a control group prevents us from isolating the specific impacts of the livelihood program, our qualitative data indicate that the intervention is well-received, culturally relevant, and promising. The study has yielded certain recommendations for further research.

Keywords: Conflict, survivors of torture, livelihood, mental health and psychosocial support (MHPSS) and social relations.

Integration of livelihood support with MHPSS in rehabilitation of torture survivors in LMICs

Ayesha Mushtaq — 2024-09-25

Introduction: The integration of livelihood support with mental health and psychosocial support (MHPSS) is crucial for the rehabilitation of torture survivors in low- and middle-income countries (LMICs). This study aimed to explore the intersectionality of poverty and mental health, and the integration of livelihood support within MHPSS frameworks within the rehabilitation settlements of torture survivors in LMICs.

Method: A cross-sectional study was conducted using a semi-structured questionnaire distributed to members of the International Rehabilitation Council for Torture Victims (IRCT) in LMICs. The questionnaire was designed to gather data on the extent to which poverty contributes to poor mental health outcomes among torture survivors and the effectiveness of integrating livelihood support into MHPSS interventions.

Results: The study found that 92% of respondents believed that poverty and mental health outcomes of torture survivors are strongly linked. Economic and social inequalities were identified as key determinants of mental disorders in the country, emphasizing the need to address these inequalities in rehabilitation programs for torture survivors. The study also highlighted the significant economic challenges faced by torture survivors, indicating a high prevalence of extreme poverty among this group.

Discussion: The study underscores the critical connection between poverty, mental health, and the experience of torture, emphasizing the need for comprehensive support. The integration of livelihood support with MHPSS is essential for addressing economic disparities and promoting long-term resilience among survivors. The study recommends enhancing coordination among stakeholders, addressing cultural and social barriers, securing sustainable funding, and developing strategies to overcome anticipated challenges or barriers in integrating livelihood support with MHPSS for torture survivors in LMICs. By addressing the diverse needs of torture survivors, including economic empowerment, mental health support, and social integration, this integrated model can contribute to holistic recovery, long-term resilience, and overall well-being.

Does prison labour rehabilitate, punish, discipline or exploit a traumatised and racialised population in Australian and American prisons?

Andreea Lachsz — 2024-09-25

This article describes the incarcerated population in Australia and the US as being comprised of people primarily from racialised and marginalised communities, of whom many have histories of trauma. It is argued that their pre-existing trauma is compounded by trauma arising from both deprivation of liberty in and of itself, and their treatment and conditions in prison. The article compares and draws parallels between rehabilitation as understood under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment with rehabilitation as an objective of the criminal legal system, arguing for the need for the criminal legal system to refocus from reducing reoffending to pursuing healing. The article argues that contemporary prison labour in Australia and the US should be analysed in the context of historical slavery and forced labour. It considers the different objectives of prison labour, concluding that it is not feasible to effectively achieve multiple objectives (e.g. rehabilitation versus recouping State costs associated with incarceration). The significant risk that prison labour as it currently operates can amount to exploitative or degrading treatment is explored in the article, which argues that international legal protections need to be strengthened. The article also recommends that there needs to be improved transparency and research regarding the use and effectiveness of prison labour in these jurisdictions (and more broadly) in achieving rehabilitation, particularly livelihoods in the community, after release from prison.

Cross-cultural forensic reports of torture survivors based on the Istanbul Protocol

Pau Pérez-Sales — 2024-09-25

The text provides an overview of the key considerations for conducting a cross-cultural assessment of a torture survivor. The first part provides an introduction to essential concepts in anthropology, medicine, and cross-cultural psychology and psychiatry. The second part reviews the most relevant elements in relation to a forensic report of a survivor, with a particular focus on cultural considerations regarding the ethical aspects of the Istanbul Protocol. It also addresses aspects related to the encounter with the survivor and the interview, medical aspects including the physical examination with a special focus on pain and suffering, the psychological and psychometric assessment. It also briefly discusses aspects related to consistency and credibility analysis. In the last section, the text provides an overview of cultural consideration following the outline of the Istanbul Protocol.

UN Special Rapporteur on Torture’s most recent report to the General Assembly: ‘Investigating, prosecuting and preventing wartime sexual torture, and providing rehabilitation to victims and survivors’

Berta Soley — 2024-09-25

The latest report by Dr. Alice Jill Edwards, UN Special Rapporteur on Torture (SRT), presented at the 79^th session of the General Assembly on the 12^th of June 2024.