Human Trafficking, Mental Illness, and Addiction: Avoiding Diagnostic Overshadowing

This article reviews an emergency department-based clinical vignette of a trafficked patient with co-occurring pregnancy-related, mental health, and substance use disorder issues.The authors, including a survivor of human trafficking, draw on their backgrounds in addiction care, human trafficking, emergency medicine, and psychiatry to review the literature on relevant general health and mental health consequences of trafficking and propose an approach to the clinical complexities this case presents.In their discussion, the authors explicate the deleterious role of implicit bias and diagnostic overshadowing in trafficked patients with cooccurring addiction and mental illness.Finally, the authors propose a trauma-informed, multidisciplinary response to potentially trafficked patients. CaseDr. Shah, an emergency department (ED) resident in New York City, entered the room of a young pregnant patient who was bleeding and visibly frightened.The patient, who only spoke Spanish, was accompanied by her brother, who translated.He explained that the patient suffered from schizophrenia and had been refusing her medications for the last couple of weeks.He added that she'd had a few episodes of aggressive behavior, directed at others and herself.While the patient's brother was talking, Dr. Shah noticed a few bruises and puncture marks with associated ecchymosis (subcutaneous bleeding similar to a bruise) on the patient's arm.The brother saw that Dr. Shah had noticed these marks and explained that the patient sells herself for drugs.Dr. Shah began to suspect that the patient's brother might not be trustworthy, so she requested a certified clinical interpreter.Through the interpreter, the patient conveyed that she was miscarrying and asserted that she does not have schizophrenia, although she admitted feeling depressed sometimes.The patient's tone became increasingly desperate and she explained, through the interpreter, that the man claiming to be her brother was holding her captive.She stated she was brought to the US as his fiancée, Academy of Medicine on issues of human trafficking and testified as an expert witness multiple times before the US Congress.Marti MacGibbon, CADC-II, ACRPS, is an inspirational speaker and author and an expert on trauma resolution and addiction.She uses her personal story to raise awareness of, and strip away stigma from, human trafficking, domestic violence, addiction, PTSD, and homelessness.As a human trafficking survivor leader and advocate, Ms. MacGibbon has lobbied and shared her expertise at the White House, US Department of State, and California State Legislature.