Rights organizations can avoid further harming victims

By Madeline Kennedy (Reuters Health) - Lawyers interview victims of human rights violations to document their stories and seek justice, but victims who have to relive the violence during a single interview may be traumatized anew, researchers argue. In the journal BMJ Global Health, psychiatrists and human rights advocates jointly propose a research agenda to find the best ways to protect both the legal rights and mental health of these victims. Led by psychiatrist Susan Meffert of the University of California, San Francisco, the proposal authors point out that “debriefing” a victim in a single interview session used to be a mode of therapy. But the practice was abandoned 20 years ago when research suggested that debriefing can worsen mental health and may double rates of post-traumatic stress disorder (PTSD). “With traumatic events, we know that gradually increasing exposure to the memories over multiple psychotherapy sessions can lead to de-sensitization and fewer trauma-related symptoms when recalling the events,” Meffert told Reuters Health by email. Having to go through all the events in one sitting can make symptoms worse, she added. In their proposal, Meffert and her colleagues offer the International Criminal Court (ICC) at the Hague in the Netherlands as an example of a legal organization that uses the testimony of survivors of genocide, war crimes and other human rights violations. Whereas the ICC offers mental health support to victims who travel to the Netherlands office to provide testimony, it is unclear if any resources are offered to people who participate in interviews in their own countries. There are options to offer help to victims, however, and trauma treatments that have been shown to work and can be used in places with little money or infrastructure, the researchers argue. The team proposes a study that would assess survivors for PTSD before and after their interviews with the ICC. This would give an idea of the mental health impact of providing testimony. The researchers also provide several recommendations for an improved human rights legal model. To start, they propose screening potential witnesses for their risk of PTSD or other mental health issues before interviews. This could give the organization a chance to refer more vulnerable participants to mental health trauma care prior to being interviewed. Survivors could also identify a support person from their community to help them through the process. In addition, victims could be given more choice about how long their stories can be used and how they are stored. Lastly, the ICC could monitor past interviewees with a follow-up mental health screen and refer them for further care if needed. If this new model works, it could then be evaluated to see if it can be applied to other organizations. “While we are making good progress internationally in terms of documenting and processing reports of human rights violations, we need to be sensitive to the long-term mental health of the survivors who form much of the backbone of these cases,” said Steven Thorp, a fellow of the American Academy of Clinical Psychology and assistant professor at the University of California, San Diego. Thorp, who was not involved in the study, noted that it is important to give interviewees information about the process. “Legal organizations can first describe the legal process to all survivors so that they are not surprised by any components of the interviews or paperwork,” he said. Thorp added that organizations can also let participants know about the risks of interviewing, including the symptoms of PTSD, depression, and anxiety. “Now is the time that we must begin working together to develop collaborative models of caring for survivors of human rights violations, such that they do not have to chose between justice and mental health, but can have both,” Meffert said. SOURCE: bit.ly/2bPjZ3U BMJ Global Health, online July 21, 2016.