Exploring available knowledge and evidence on prostitution in Scotland via practitioner-based interviews

2. Support For Those Involved in Prostitution

Specialist support organisations are located in each of the four cities, providing a range of services to women involved in prostitution in terms of harm reduction (to minimise risk whilst working), and assistance to exit. Although each organisation is distinctive and has developed in response to the particular challenges of the local area, policy priorities and available resources, there are a number of commonalities across areas. Indeed, all organisations recognise the importance of partnership working with police, social work, health and other key agencies and the importance of providing an holistic support service to meet the (often complex) needs of women involved in prostitution. The majority of services are aimed at supporting women, with the exception of Roam in Edinburgh and the Steve Retson project in Glasgow which provides support and assistance to men involved in prostitution (who sell sex). The mainstay of support is provided to those currently involved in prostitution, although some organisations also aim to support those who are at risk of becoming involved, or have managed to move out of prostitution and require continued support. In addition, while all provide a harm reduction service and provide support to exit, there was some variation on the degree of emphasis placed on the latter across certain areas, with some organisations' support provided as part of a coordinated plan shared with other organisations, and some services' provision intentionally having less coordination than this ^[92] .

While they do not provide direct support services to those involved in prostitution, the Women's Support Project ( WSP) is important to mention in this context as the role of national development lead is funded by the Scottish Government's Violence against Women ( VAW) fund to focus on commercial sexual exploitation. The role of development lead has been in place since 2008 and involves capacity building and delivery of training via the VAW networks at local levels to improve knowledge and understanding of CSE within mainstream services ^[93] . As part of this work the Encompass Network, involving projects that either receive VAW money or use a VAW approach in relation to prostitution ^[94] , was established to enable better links and share learning across the specialist services offering support. Activities to date have involved capacity building exercises for staff and scoping exercises to assess the needs and concerns of service users.

The following section first sets out the overall context by highlighting some of the ways in which service providers are responding to the shift from on-street to indoor prostitution. It then considers some of the key issues raised in relation to supporting women involved in prostitution and barriers to exit/reasons why some women stay. Finally it touches on perceptions of gaps and additional services needed and challenges in providing services.

Reaching those involved in indoor prostitution

The shift from on-street to indoor prostitution has posed a number of challenges for service delivery and precipitated recent changes in approach to engaging with those involved in prostitution. For specialist support services this has, in Aberdeen and Dundee involved re-assessment of service provision and resulted in the closure or reduction of night-time drop in services (due to decreased demand), and different ways of working. Alcohol and Drugs Action and Vice Versa previously ran night-time drop in services, which were closed due to reductions in the numbers of women accessing this support. Instead more targeted approaches were adopted, in the case of Aberdeen this involves support workers driving around the traditional harbour area to make contact with women alongside recent attempts to engage with the indoor market by contacting those advertising online. Alcohol and Drugs Action had also developed day time one to one support services and recovery groups and activities within integrated treatment services. In Dundee a more proactive approach to raise awareness of the service was being adopted with key agencies to improve referrals, as well as a widening of access to vulnerable women more generally via their daytime drop-in service. However Dundee had again recently (September 2016) introduced a weekly, early evening outreach service in response to recent developments.

Services in Glasgow were also recently changed after a review of trends and now includes extended opening hours. A standalone website to reach women involved indoors has also been introduced, as well as safety surgeries fortnightly at emergency accommodation projects for women across Glasgow and inputs to partner agencies.

In Edinburgh Sacro are able to engage with women working indoors within the sauna environment through a harm reduction initiative in partnership with the NHS. This involves short interventions (due to the working environment), with women encouraged to attend the Women's clinic or the Sacro office for a more appropriate setting. Otherwise agencies generally highlighted the difficulty of identifying and engaging with those involved in indoor prostitution. To this end attempts were also being made to promote available support services across key agencies, to increase the number of referrals, as well as to reach those involved in indoor prostitution who advertise online, to promote available support and services ^[95] .

In line with current Police Scotland priorities, a recent initiative, established and co-ordinated by the National Human Trafficking Unit ( NHTU), to provide support and assess the safety and wellbeing of those involved in indoor prostitution, involving close partnership between police, sexual health services and key agencies, is currently operating in Glasgow and Edinburgh with a view to wider roll out in Aberdeen and Dundee, once results of the on-going evaluation have been taken into account. The SHaW ^[96] initiative involves health professionals and police visiting flats where police intelligence has been provided ^[97] and has a range of objectives, including: to improve the multi-agency response to prostitution; ensure the safety and wellbeing of persons involved; provide advice and guidance where required to those wishing to exit; provide details of support services available, and utilise the outcomes of these visits to enhance policies and procedures and improve understanding of the scale of prostitution in Scotland. It also aims to help identify victims of trafficking and sexual exploitation as well as other criminality and information in respect of organised crime groups. The initiative is in the early stages of development and implementation and therefore monitoring and evaluation data is currently unavailable.

Crucially however, the majority of respondents identified the importance of developing better knowledge and understanding of the current scale of indoor prostitution and the support needs of those within it. Indeed because many working within the off-street environment receive no assistance, they are particularly vulnerable and at risk of harm. It was also suggested that the more hidden nature of prostitution currently made it more difficult to raise awareness of the support available and to encourage people to engage with services. This was encapsulated by one respondent who highlighted how: 'if you've got somebody that's physically in front of you, you can say look there's these services if you want them'. (Third sector support). The additional difficulty of engaging in those who may be isolated within flats, and particularly those where English is not a first language was also stressed.

Key issues in the provision of support

All organisations recognise that the type and level of assistance required will vary from individual to individual, although an holistic approach is generally adopted in the provision of support. Assistance to move on from prostitution in the first instance usually involves a needs assessment, engaging with women to look at various aspects of their life, including housing, finance, physical health, mental health and sexual health and the subsequent identification of key support needs. Organisations provide direct assistance as well as support and advocacy to access a range of services as appropriate ( i.e. in terms of housing, employability etc.).

A number of respondents highlighted that the level of support required could vary depending on a number of factors, including the length of involvement and the underlying reasons for becoming involved in prostitution. It was therefore suggested by several respondents who provide specialist support that exiting could be a lengthy process. Indeed one respondent suggested that 'exiting' prostitution at a fixed point does not reflect the reality that some women may stop selling sex and then re-commence involvement at times of hardship/relapse into drug dependency (Third sector support).

In terms of support to move out of prostitution, the importance of building good relationships with women and engendering a high degree of trust was cited as key, alongside a non-judgemental approach to women who struggle to exit. Developing this trust was described by one respondent as sometimes difficult given some of the women's personal circumstances and backgrounds: 'the majority of their lives is about folk taking things from them for something, and survival. So for us to come along and say, we don't want anything from you, we just want to be here for you, that's very hard for women to believe so… It can take a long time to develop that trust.' (Third sector support).

This was echoed by another respondent who highlighted the process of building trust and relationships and raising awareness of the support available (developed through outreach work) as being key in encouraging women to seek support: 'A lot of these women don't engage with any services let alone a service that openly says we help women involved in sex work. So you really have to build those relationships and let women know we're here to help. We…..also bang the drum about confidentiality…. We're actually here because we want to help you and that's what we're going to deliver'. (Third sector support). In this respect word of mouth was also considered important, in terms of women who have been positively supported spreading the word about the service and encouraging others to access support.

It was frequently acknowledged by respondents that women may be reluctant to access services due to the stigma associated with prostitution and feelings of shame and guilt, and that many are concerned that seeking support may lead to disclosure. Therefore reassurance of confidentiality was also highlighted by a number of respondents as being crucial.

Many respondents highlighted how, key to providing support, is the understanding that there is no quick fix, that while immediate needs can often be addressed quite quickly ( i.e. by assisting with benefits or a food parcel), helping to change women's situations and to get them to a safer, more stable base takes time. This may entail linking in with substance misuse services to address addiction issues, but also addressing harm that has happened as a result of their involvement in prostitution: 'how they feel about themselves, how they've been treated, how they've been… feel degraded…' (Third sector support). Overall it was suggested that the process of fully exiting and being able to move on takes time. This was reiterated by another support provider with experience of assisting women with complex needs: 'It's not all about fixing people and suddenly their lives are going to be great, you know? It's a kind of a lifelong process' (Third sector support).

In terms of measuring success in the provision of support, it was highlighted by a few respondents that there are degrees of success and benefits. First and foremost this was highlighted as giving women the opportunity to make informed choices and increase their options. Key benefits in terms of harm reduction support are described as increased safety, the provision of sexual health services and personal safety equipment, as well as information and advice and having someone to talk to. Other indicators of positive change more generally were identified as improvements in quality of life, sense of belonging and having a sense of purpose.

Reflecting on women who have been assisted to exit, one support worker again highlighted how this can be a lengthy process, with women exiting at different times. The importance of understanding the different stages and levels of need women present with was therefore highlighted as key. Also it was suggested that some women access the service with different aims, for example some prioritised having a safe place to live, while others appreciated just having someone to talk to. Recognising the complexity of women's lives and the wishes of the individual was highlighted as key by one respondent: 'It's about what does that woman want? I might want her to get a job, go into training and see all this potential, but actually she might just want to feel safe, which means having her own house and access to some sort of income' (Third sector support).

A similar point was made by another support worker, who described an important measure of success as being the reduction of involvement in prostitution, given the difficulties some women experience when attempting to exit, and their dependence on the income. For example, assistance with finding part-time work could lead to decreases in hours worked in prostitution and was identified as a positive milestone in the process of exiting. However, it was also acknowledged by a few respondents that it can be difficult to ascertain whether or not women have exited. For example, while women with previous involvement in prostitution may not have been seen working on the street or in saunas, they may still be working from home ^[98] . Given complexities in measuring success in the provision of support ( i.e. that the process of exiting for some women can be lengthy and it is often difficult to ascertain whether or not women have fully exited), formal assessment of programmes aimed at assisting women to exit was generally considered difficult. Therefore there seems to be limited evaluation of service delivery available. However, some support agencies cited degrees of success and benefits, including giving women the opportunity to make informed choices and increase options, to enable them to eventually move out of prostitution.

In terms of success in assisting women to move out of prostitution, the Women's Clinic working in partnership with the Another Way Project and other key agencies report that on average, of those women who engage in these services, one in four manage to move into volunteering training or other work. This estimate also includes some of the most vulnerable women, i.e. particularly those involved in street work ^[99] .

While for some women, the provision of support was identified as key in helping them to move out of involvement in prostitution, for others specific events were highlighted as a catalyst for exiting and 'turning points' in people's lives. Indeed, a number of NHS and third sector support respondents described how either positive or negative life events could lead to women exiting (often after several unsuccessful attempts). Some of these were identified as:

• Rape or sexual assault or other traumatic event
• General poor health and exhaustion, for women with complex needs
• Seeing peers moving on and having a positive example
• Meeting a partner and settling in a relationship
• Pregnancy and/or child protection issues

Barriers to exit for those who want to leave/reasons why people stay working within prostitution

In terms of the main reasons that people remain working within the sex industry, among the women that support services encounter, a lack of choice and financial reasons were cited as key, with poverty as a key driver. For many there are few alternatives which offer the earnings that prostitution can provide and it is therefore often difficult for women to break the cycle. This is particularly pronounced in relation to women with complex, multiple needs and often chaotic lives for who would find it difficult to hold down a job and require money to fund a drug addiction. For those off-street who are earning more, it was suggested that the pressure to maintain a certain lifestyle is key.

Prolonged involvement in prostitution over many years was highlighted by many as making it more difficult to exit, particularly because of leaving behind friendships/networks developed within it, with possible feelings of isolation and loneliness upon leaving. A few respondents also identified coercion as an issue, they often saw women with controlling partners who had made or encouraged them get involved in prostitution: 'there's 101 reasons why women won't leave an abusive relationship in general but when there's prostitution on top of that, you're talking of a really difficult situation and even where we can provide all the support in the world, we'll do whatever we can, it's a really difficult one' (Third sector support). It was also added that because many women have suffered trauma (often linked to gender-based abuse) and have past involvement in the criminal justice system: 'actually they've had a life of this experience and it almost doesn't seem that bad for them.' Indeed another respondent with years of experience providing support to women on-street described how women were often 'desensitised' to the day to day reality of prostitution after prolonged involvement.

Mental health problems (often pre-existing) were also highlighted as being exacerbated by involvement in prostitution, leading many women to 'self-medicate' with drugs or alcohol, often leading to higher levels of chaotic substance use and riskier sexual arrangements. This was identified as often resulting in more trauma and poorer mental wellbeing and a 'spiral of escalating problems which can be very difficult to exit/recover from' (Third sector support).

A few respondents also identified how previous convictions and a criminal record (for often relatively minor offences), could be a barrier to alternative employment, with some women unable to find a job and concerned about disclosure. Other reasons cited were fear of exposure and how to explain gaps employment as well as lack of knowledge of services in the area, or how to access them. However, even where services were made available, and women had been enabled to leave, one respondent described how crisis points in people's lives ( i.e. in terms of financial strain) could lead to women recommencing involvement and re-enacting previous patterns of coping.

Perceptions of gaps and additional services needed

Specialist services

In terms of perceptions of the sufficiency of current support to women involved in prostitution, this varied by area. For example a few Local Authority contacts in different areas cited specific gaps in service provision including mental health services and having specialist psychological support for women who have experienced trauma, while another suggested that more could be done in terms of employability services to help overcome barriers to employability ( i.e. by addressing gaps in education etc.). Another highlighted that more could be done in terms of the extension and greater use of diversionary criminal justice approaches. In general terms however a number of respondents also felt that more could be done with regards to prevention to stop women from becoming involved in prostitution in the first instance, as well as to halt the escalation of problems ^[100] .

Even where respondents perceived a comprehensive service, it was recognised that a higher staff ratio would enable a higher number of women to be supported: 'we can always do more, we can always do it better, we can always do more hours'. Although it was highlighted that providing a holistic service that addresses a range of needs is: 'a huge, huge piece of work for each woman who comes through the door' ( NHS).

At a strategic level it was suggested by one respondent that while existing specialist support providers are providing valuable support to exit and developing good practice around this, a key overall gap was felt to be in terms of longer-term support that offers services over a longer period and assists in dealing with crisis points ( i.e. financial crises such as Christmas, unexpected bills etc. as well as relapses in drug and alcohol addiction). The importance of having trauma-based, comprehensive services which engage with individual needs at different stages was highlighted as key.

Mainstream and wider services

In terms of gaps identified within wider mainstream support services, it was often suggested that for women who are in crisis and have chaotic lifestyles the flexibility of support is crucial ( i.e. in terms of the provision of after-hours services and weekend support), rather than expecting women to 'fit' with existing services. In addition, in relation to supporting women involved in prostitution, an important aspect of this was identified as having trauma informed services to provide an empathetic approach: 'so when you refer somebody to a service they need to understand that these women might be 5 minutes late for an appointment. They might find it difficult to open up or they might find it difficult to build a relationship so actually understanding that there's a lot of trauma and how best to approach that'. (Third sector support)

Indeed, a number of respondents suggested that in terms of the more mainstream services, there is a gap in terms of fully understanding the issues faced by women and the complexity of the issues and the circumstances that lead them to become involved in prostitution. It was felt that better partnership working and understanding of commercial sexual exploitation ( CSE) would enable key services such as maternity and accident and emergency, as well as housing and homelessness services to work together to identify and address the specific needs of women involved. Although it was recognised that this is reliant on sufficient resources being available, in terms of services which are secure and sufficiently well-funded.

In relation to this, a few respondents highlighted that often women access other services first, presenting with other issues, such as domestic abuse and alcohol problems and involvement in prostitution only becomes apparent afterwards. It was therefore suggested that better opportunities could be made in terms of identifying women involved in prostitution who are accessing other key services. Indeed a commonly voiced concern is that women are not being offered the support they need, often because of non-disclosure ( i.e. within social work and GP services). One respondent suggested that currently the question is not being asked of those accessing key mainstream services: 'it's almost like domestic abuse. People were scared to talk about it 10 years ago and people are kind of like the same….Are they actually asking about prostitution?'. (Third sector support).

The lack of enquiry and knowledge sharing it was suggested, also makes it difficult to get a true sense of the scale of the issue, and estimating the numbers of women and men involved in different areas particularly difficult. One respondent highlighted how information and knowledge tends to be found in pockets within various different services (drugs, mental health, GP practices).

An attempt to address this gap was supported by the Women's Support Project. This entailed a pilot in Glasgow linked with homelessness services and drugs and alcohol services around 'routine enquiry' into prostitution ^[101] . Indeed while this is often done in terms of other types of violence against women such as domestic abuse, the aim was to train staff in how to ask the question in relation to commercial sexual exploitation (and how to respond appropriately to ensure the right support is provided). While some useful insights were gleaned from this exercise the results were not considered representative of the service user population (due to limitations in the recording system and the lack of consistency in recording of staff).

However, a few respondents felt that a more consistent approach to asking the question (where appropriate) across services and along these lines would allow better provision of support as well as a better understanding of the scale and nature of prostitution in Scotland. It was also suggested that, to deal appropriately with the response and service needs of those involved, appropriate support would have to be made available within all local areas (not just the cities).

In terms of wider gaps in service provision, another gap was highlighted as support for concerned parents of those involved in and affected by prostitution. One organisation raised this in relation to having received a number of calls from parents whose daughters had become involved in prostitution (some of whom were students who had become involved in escorting). In relation to the indoor market, it was also suggested that it would be useful to engage with landlords to inform them about what their responsibilities are in relation to this, and to raise awareness of key issues.

Service user involvement in the design of services

One organisation highlighted the importance of including women and men involved in prostitution as key partners in the design of services and around key decisions affecting them. In relation to this it was also suggested that services should be non-judgemental and non-ideologically based to reach as many people as possible.

Societal attitudes towards prostitution

More generally it was suggested by a few respondents that within society, more could be done to change societal attitudes around prostitution, in terms of better understanding of the inequalities in society, the circumstances that drive many women into prostitution and the vulnerabilities that they face, that for many women it is 'just a way to survive'.

Women's voices

There was a consensus among respondents that listening to women involved is crucial in understanding gaps in support and how to address them. It was highlighted that this is particularly important in relation to more vulnerable women 'giving women a voice and helping them share their experience of what they've been through, because of the stigma, and often their family don't know. Or they're trying to get a job and so it means that the real lived experiences are never known. Because women stay in the shadows a bit around this." (Third sector support).

Another gap identified was in terms of speaking to those who have exited from prostitution. Crucially it was felt that this would provide a better understanding of the overall process of moving out, what support was required and overall perspectives looking back on involvement.

Black and Minority ethnic communities

Finally, one respondent suggested that commercial sexual exploitation within black and minority ethnic communities is also an issue, but that it's more hidden than within the general population: 'It's very hidden, and not spoken about at all. But it's there'. (Local authority)

Challenges in providing services and support

A number of organisations raised the issue of short-term funding cycles as being problematic as the (often lengthy) process of applying for funding and uncertainty around this could make it difficult to conduct longer-term planning to develop better services. In addition, due to the complex, often long-term issues involved, women involved in prostitution who have complex needs can require a great deal of time and support. Consequently, it was suggested by one service provider that while improvements/outcomes demonstrated may appear small, they are nonetheless hugely significant for those involved. It was suggested that this could make attracting funding difficult. For example, Alcohol and Drugs Action had recently received notification that the Violence Against Women funding which have received for over ten years had recently been stopped as the fund was over-subscribed, leaving a gap in support for some of the most vulnerable women in Aberdeen.

Insecure and short-term funding was also raised as an issue particularly in relation to developing strategies to support those advertising online and reaching those working off-street. In addition, short-term funding was highlighted as making it difficult to provide reassurance to women that they are going to be supported in the longer term. This uncertainty was highlighted as undermining organisations strong commitment to provide support and one to one assistance. Indeed, the security of providing resources was highlighted as being particularly crucial in this context with women who are vulnerable: 'because often they're not valued in any other part of their life. And so if you put something in place and then take it away, that's hugely damaging, because it goes back to this "I'm not important enough for them to value me". To continue that service.' ( NHS). Uncertainty around resourcing was described by another respondent as also posing difficulties in staff retention, with often well trained, trauma informed staff looking for alternative employment because of job insecurity.

Finally, in general terms, one local authority respondent described how services were being stretched within the context of a constrained budget. However, close partnership working was identified as positive and helped to alleviate some of this pressure. Furthermore, in terms of funding it was suggested by one organisation that there is a need for specialist services that aren't just funded on a local level, so that referrals can extend outwith city council boundaries.