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   Providing Mental Health Services to Torture Survivors in San Diego County

   Survivors of Torture, International Mahvash Alami-Rad, PhD, CPRP Program Manager Trish Hilliard, MSW Senior Mental Health Clinician Survivors of Torture, International
2. Survivors of Torture, International A local San Diego non-profit Founded in 1997 Serving survivors of politically motivated torture living in San Diego County Has served over 1,400 individuals from 70 different countries Survivors of Torture, International
3. Mission of Survivors of Torture, International Facilitates the healing of torture survivors and their families; Educates professionals and the public about torture and its consequences; Advocates for the abolition of torture. Survivors of Torture, International
4. What is Politically Motivated Torture? US Torture Victims Relief Act of 1998: Intentional infliction of severe physical or mental suffering by someone acting under color of law upon someone within his custody or physical control Survivors of Torture, International
5. Who Tortures? Governments Military, Police, Security Forces Paramilitaries, Death Squads Guerrilla Armies, Insurgents Survivors of Torture, International
6. Who is Targeted? People perceived as a threat by government authority Family, friends and associates of those people Members of an identified, persecuted group ethnicity religion gender sexual orientation nationality political affiliation Random targets victimized for mass terror and intimidation Survivors of Torture, International
7. Methods and Symptoms of Torture Torture can take various forms, including: Physical Psychological Sexual Deprivation, Sensory over-stimulation Most torture survivors report that the psychological damage from torture is the most long lasting. Survivors of Torture, International
8. The Aims of Torture To punish and silence a voice of opposition or difference To break the personality To terrorize others into compliance To obtain information It is the single most effective weapon against democracy Survivors of Torture, International
9. Where Do Survivors Come From? Middle East Africa Central Asia Latin America Asia Eastern Europe Survivors of Torture, International
10. Legal Status of Survivors Asylum Seekers Asylum seekers apply after arrival to the United States Asylees Asylees have been granted asylum by the court. Refugees Refugees are screened and assigned refugee status before reaching the US. Legal Permanent Residents Citizens Survivors of Torture, International
11. Who is affected by torture? Individuals physically,psychologically,spiritually, socially Families Surrounding communities Society at large Survivors of Torture, International
12. How can you tell if someone may be a survivor? Refugee, immigrant or asylee status From a country experiencing civil war or widespread repression Reluctance to talk about experiences in their country of origin Physical evidence of trauma Somatic symptoms May have difficulty functioning Survivors of Torture, International
13. Severe Human-Induced Trauma Treating survivors is similar to treating other human induced trauma – with some special considerations Survivors of Torture, International
14. Special Considerations Mistrust of institutions and authorities Pervasive losses – “Triple Trauma” Language, financial, economic and legal problems Participation of doctors or psychologists in torture Confidentiality; not reportable Use of interpreters Survivors of Torture, International
15. Common Experiences which Evoke Torture Memories Waiting rooms, crying children Loud, pounding noises Men in uniforms Dealing with people in official positions Surveillance cameras Accessing medical care and being treated in hospital settings Survivors of Torture, International
16. Professional Approach to Torture Survivors Avoid walking behind the person Conduct interviews and sessions with clients in a room with windows Maintain a calm, reassuring manner Explain procedures clearly in advance Allow client control of setting, breaks, pacing Invite client to share; don’t interrogate Be aware that most survivors don’t want to talk about the torture Survivors of Torture, International
17. Common Psychological Diagnoses in Torture Survivors Post-Traumatic Stress Disorder Chronic, complex Major Depression With or without psychotic features Anxiety Survivors of Torture, International
18. Psychological Symptoms Depressed mood, lack of energy Anxiety, irritability, easily angered or agitated Easily startled, difficulty concentrating Memory loss, difficulty remembering Insomnia, nightmares, intrusive thoughts Low self-esteem and poor self-care skills Survivors of Torture, International
19. More Psychological Symptoms Paranoid thoughts Detachment, withdrawal Avoidance of situations which arouse memories of torture Panic attacks, fatigue Inability to form or maintain personal relationships; extreme difficulty trusting others Survivors of Torture, International
20. Physical Signs and Symptoms Headaches Muscular-skeletal pain and dysfunction Dental pain or trauma Neurological damage Scars Effects of sexual assault, including pregnancy, disease, dysfunction or infertility Survivors of Torture, International
21. Factors Affecting Recovery Severity and nature of the torture Age at torture Safety - Fear of deportation Stability – Social/ economic support system Past and current political activism Religion, spiritual beliefs, cultural background and worldview Treatment Survivors of Torture, International
22. Treatment Principles Holistic Client-centered Attend to basic needs Culturally sensitive Patient and accepting First things first – safety, stability Survivors of Torture, International
23. Treatment Options Case management Referrals for basic needs – food, housing, job, education Primary medical care Psychotherapy Psychiatry Cultural/Social/Spiritual resources Survivors of Torture, International
24. Initial Steps in Recovery for Torture Survivors Survival needs safety, shelter, legal status Identifying and treating physical conditions Identifying psychological effects often unrecognized despite intensity Belonging and community Survivors of Torture, International
25. Ongoing Treatment Socio-economic: job or school; reuniting with family Physical: treating chronic conditions; accepting limitations Psychological: re-framing the torture experience; learning about after-effects; mourning losses; adapting to new country Survivors of Torture, International
26. Considerate Professionals Benefit Survivors Rebuilding trust Increasing self-esteem Restoring dignity and hope Establishing a future Building Strength Survivors of Torture, International
27. Vicarious Trauma Effect on emotions Effect on behavior Effect on values and worldview Interaction with burnout Survivors of Torture, International
28. Managing Vicarious Trauma Awareness Balance Connection Survivors of Torture, International
29. California Consortium San Diego- Survivors of Torture, International, www.notorture.org Los Angeles- Program for Torture Victims, www.ptvla.org San Francisco- Survivors International, Trauma Recovery Centerwww.survivorsintl.org San Francisco- Center for Justice and Accountability, www.cja.org San Jose- Center for Survivors of Torture, www.aaci.org/center-for-survivors-of-torture.htm Palo Alto - Institute for the Study of Psychosocial Trauma, (650) 424-1314 Survivors of Torture, International
30. Publications TORTURE, Quarterly Journal on the Rehabilitation of Torture Victims and the Prevention of Torture. Published by the IRCT, subscription information: www.irct.org REFUGEES, Quarterly Magazine. Published by the UNHCR, subscription information: www.unhcr.org Survivors of Politically Motivated Torture: A Large, Growing and Invisible Population of Crime Victims. Published by the US department of Justice, Office of Victims of Crime, available by calling the OVC Resource Center, 1-800-627-6872. Survivors of Torture, International