Written submission from One25 (PTN0068)

Executive summary

• Street sex work in Bristol is a last resort for women.
• These women face multiple challenges including poverty, stigma, homelessness, domestic and sexual violence, addiction to drugs and/or alcohol and chronic ill health. There are many barriers which prevent them from engaging with essential services e.g. GP, sexual health, drug treatment etc. However, with the right support, they can and do recover.

The evidence presented focuses on:

• What, if any, harms associated with buying and selling sex? Who is affected? How?
• What local initiatives are you aware of that address these harms? Are they effective? Why?
• What, if any, are the challenges for those facing harm in accessing services (for example, healthcare; support services; advice; exit services)? What needs to change?

An introduction to One25

One25 is the only organisation in Bristol specifically supporting street sex-working women or those who are at risk of entering street sex work. These women are amongst society’s poorest and most vulnerable individuals. Each year we help around 250 women: around 130 of whom are street sex-working. Most of the women we see on the streets are homeless, acutely malnourished and addicted to drugs and/or alcohol, because of this their safety and health is neglected. We see women who are deeply traumatised – from childhood abuse and the violence of life on the streets. Yet these courageous women show tremendous skills and potential: in their supportive peer relationships, their creativity and humour and their survival.

Why we are submitting evidence

One25 welcome this inquiry into prostitution with a focus on inequalities and harm. The women we work with are extremely vulnerable and hidden from view. As a result, they often escape the radar of any services, including safeguarding adults, despite the threat to their lives. One25 is submitting evidence to the Women and Equalities Committee because we have considerable insight into and knowledge about the lives of women trapped in street sex work in Bristol and recognise that they should be considered in this inquiry. We want all services to work together to improve the response to the needs of women who street sex work.

Evidence

What, if any, harms are associated with buying and selling sex? Who is affected? How?

1. Street sex-working women are among society’s most hidden people: “The exclusion of these women is unmatched: even those working with homeless people rarely notice them” (Moss & King, 2012). Twelve times more likely to be murdered and 167 times more exposed to sexual violence (Salfati, 2009), they experience the harshest health and social inequalities of all excluded groups (Luchenski et al, Lancet 2018). The violence that women face is often from multiple perpetrators and they are often not safe within their own community. They are at risk of cuckooing and high levels of coercion. Women become totally isolated and increasingly hidden from public view. The ~130 women street sex-working in Bristol face: addiction (100%); homelessness (79%); chronic mental, physical and/or sexual ill health (92%); domestic and/or sexual violence (100%) (One25’s 2019 stats).

What local initiatives are you aware of that address these harms? Are they effective? Why?

2. All the women One25 works with are survivors of trauma, either from childhood abuse or experiences in their adult lives. We champion working with women in a trauma-informed way, and work to influence our partner services to do the same, so women get the support they need in a way that works for them. We are unique in being without time boundaries or targets, working at a woman’s pace. We tailor activities to each woman, from a 5-minute visit to drop-in, to 6-hour support in court to give evidence against an abuser. Their complex needs mean it can take years to establish the relationships needed to recover. Recovery can also be cyclical, and women know they can return to us whenever they need us. Zena said: “Not having time limitations when working with someone is amazing. It makes it easier for me to build trust and open up. With us girls things change so quickly and we need to have someone we can trust when things go wrong.”

3. Last year One25 helped 53 women to exit street sex work (40% of those who were street sex-working during the year). “One25 is an amazing thing. You supported me after my 2 rapes and during the court appearances. I would still be living in a tent now if it wasn't for all your help when in hospital. I definitely wouldn't be where I am now without the love, care and support you have given me. Thank you all so very much xxx.” SU Survey April 2019. One25’s new Peony service works with women who are moving away from crisis. With peer support and dedicated staff Peony enables women to build their self-esteem and work towards their goals of freedom and independence.

4. One25’s service users have extremely complex needs, so we collaborate with 70+ agencies so they get exactly what they need wherever they are in their recovery journey. We represent them on 30 different strategy groups in and around Bristol, to push for systemic change to take their needs into account. Our model is based around helping them access the support that’s out there for them, in a way that they can understand, and advocating for help to be made available where there’s a gap. Our relationship-building, multi-agency approach is widely evidenced as the most effective way to tackle complex need (Farmer review 2019; Home Office, 2011). Caseworkers build effective relationships with women, agencies and strategy groups, and provide training to other professionals (e.g. police, prison staff, housing officers) to raise awareness, reduce stigma and improve access.

What, if any, are the challenges for those facing harm in accessing services (for example, healthcare; support services; advice; exit services)? What needs to change?

5. Women face multiple barriers to escaping the streets:

• Trauma: usually undiagnosed, from both adverse childhood experiences and as adults
• Co-dependency: many sex work to fund drug use of an abusive ‘partner’
• Dual diagnosis: many addiction agencies won’t help those with poor mental health; many mental health services won’t work with addicts
• Inflexible appointments: chaotic lives block access to mainstream service times and locations
• Entrenched shame stops them seeing professionals
• Loss of tenancy in prison: ‘intentionally homeless’ on release
• Rock-bottom self-esteem: they can’t imagine change is possible

6. Current systems do not cater for these women. One25 trial innovative approaches to provide new ways of offering support which can meet their needs. For example, last year University of Bristol and Bristol Drugs Project completed a ground-breaking NHS treatment trial in our drop-in space, offering parallel support for PTSD and addiction; the results will be published shortly. A major challenge for the researchers was getting trial subjects to attend. Despite offering lunch and vouchers, it was only after One25 staff offered to collect women and bring them to the site that they felt able to engage. “It is only through the committed support of One25 that this pioneering work has been achieved.”  In 2019 we’ve been hugely encouraged by Dr Potter’s research into the gaps in healthcare provision for street sex workers; her early findings show that One25’s healthcare is leading the UK. She’s also facilitating co-production groups with women here, asking how the NHS could work differently. Women have responded brilliantly, collaborating to build feedback and training materials to change the NHS approach for women facing multiple disadvantage. We hope to learn a lot from this new approach, and use it to further develop our service user feedback mechanisms and share women’s voices with more strategic groups.

Recommendations

7. We welcome this look into the issue by ministers and the government because it’s affecting the most vulnerable in our society. One25 recommend the following actions to reduce inequalities and harm for women facing street sex work:

      Provision of more refuge spaces for women facing complex needs.

      Education of professionals across services (e.g. police, prisons, housing) to improve understanding of the specific needs of this vulnerable group and enable greater flexibility to remove barriers so that women can get the support that they need.

      Increased partnership-working, with specialist services like One25, to enable shared local knowledge and more effective interventions.

      Trial and adoption of innovative approaches which are proven to remove barriers to support, such as the model of close partnership with Avon and Somerset Police in Bristol.

October 2019