Table 6

Potential indicators of child MSHT—mental health (non-exhaustive)40 70 77

Presenting concernPossible MSHT-related cause
Mental health
Headaches, back pain, generalised abdominal or body pain, seizure-like events.
Psychosomatic expressions of fear, stress or trauma. Psychogenic nonepileptic seizures in the context of abuse.
Alcohol or substance use, dependency or overdose.Coping strategies during MSHT and/or deliberate cultivation of addiction by perpetrators to enhance dependency and control. Pretrafficking addictions may have been exploited.
Self-harm, suicidal thoughts or suicide attempt.Coping strategies and actions of a child experiencing severe stress, fear, hopelessness, shame and/or trauma responses. May be exacerbated by alcohol or substance abuse and sleep deprivation.
Fatigue or exhaustion.Deliberate sleep deprivation and overwork, poor sleeping conditions, hunger and difficulty sleeping secondary to stress and fear responses (including nightmares) and/or infestation and bites.
Chest pain, palpitations, breathing difficulties, dizziness, sense of choking, weight loss.Anxiety and panic attacks secondary to high-stress situation.
Low mood, hopelessness, lack of energy, self-harm and/or suicidality.Depression secondary to MSHT situation (may have pretrafficking roots).
Day-dreaming, ‘zoning-out’, behavioural regression, different presenting personalities, reporting or appearing to respond to internal voices.Dissociation as an aspect of trauma response.
Flashbacks, anxiety, avoidance of certain people or places or re-enacting traumatic events in play.Potential post-traumatic stress disorder, in conjunction with other mental health symptoms.
  • MSHT, modern slavery and human trafficking.