The experiences of people who sell or exchange sex and their interaction with support services: lived experience engagement

3 Mapping Survey Findings

The following section outlines the findings of the mapping survey, conducted with the aim of understanding current provision of services for those who sell or exchange sex in Scotland and identifying any gaps.

3.1 Specialist Service Provision

The research has identified 16 services which consider themselves to provide support for people who sell or exchange sex in Scotland, including services that deliver broader support but have a specialist worker or team. This is not considered to be an exhaustive list of services, but rather to form the basis of a map of provision, which can be considered a living document to be updated as services are identified, and as provision continues to evolve. The focus of mapping is direct support provision, therefore services which primarily focus on campaigning have not been included here.

The identified services include 14 services with a physical base in Scotland, and also two services which provide online or remote support which is accessible to, and has been used by, people in Scotland. Two of the identified services are partnerships which deliver outreach in collaboration with Police Scotland. Identified services have been listed in Table 5.

These services have been added to an interactive map of specialist provision for people who sell or exchange sex in Scotland. This map also includes details of services provided and eligibility for services. Still images from the map have been included as Figure 2. The interactive map can be viewed here. Detailed service information provided has also been included as Appendix I, and is briefly summarised below.

Table 5: Specialist Services identified in the Mapping Survey

Type of Service	Service Names
Services with a base in Scotland	Ending Violence and Abuse Aberdeen (EVAA) FedCap (Pilot Programme) Quay Services – Alcohol and Drugs Action RASAC Perth and Kinross Remploy South Lanarkshire (Pilot Programme) Roam Routes Out Sacro – Another Way The Street Project – The Salvation Army The TARA service Vice Versa WISHES Leith Partnership* Operation Begonia – Aberdeen*
UK-wide Services	National Ugly Mugs You My Sister

*Police-led outreach

Service Offer

• The largest group of identified services (n=7) offer holistic support which is tailored to the individual. Typically this involves emotional support, referrals and advocacy, with advice available around safety planning, addictions, benefits, accommodation and other practical requirements. Where particular support or expertise was not available from the service directly, it is made available through onward referrals.
• The TARA service also offers holistic support, although the work they do is distinct due to the needs of the trafficked individuals they are supporting. Whilst the same holistic tailored support is available, they take a large role in co-ordinating legal advice, and navigating the particulars of asylum claims, including the National Referral Mechanism.
• Three of the identified services operate primarily through outreach: this is The Salvation Army Street Project, and the two police-led partnerships Leith, and Operation Begonia. Primarily these services offer harm reduction measures such as condoms, safer injecting equipment and personal alarms, as well as advice and onwards referrals. Strong partnership working in all these projects assists them in making onwards referrals to additional support services. The Street Project in particular offers refreshments and a place to take a break for women selling or exchanging sex on the street, and as such is well placed to build trust, offer referrals and advice.
• Two services, Roam and WISHES are primarily sexual health services and operate from NHS premises. They do however, both offer emotional and practical support in addition to their central remit.
• The pilot project at Remploy and FedCap provides targeted employment and employability support as their sole focus.
• You My Sister is for women who are no longer selling or exchanging sex, and offers support in the form of courses. These courses provide education around elements such as trauma and self-management of mental health, as well as an opportunity to connect with peers. They are delivered by people with lived experience who receive training and payment as facilitators.
• National Ugly Mugs is currently undertaking consultation work to inform how their new service in Scotland, in conjunction with Umbrella Lane will operate. As such, no information on the specifics of this service is available at the time of writing. On a UK-level they offer case work support, and provide an alerts service warning about potentially dangerous people buying sex and ongoing incidents, and third party reporting of incidents.

Eligibility and Access

• All of the services offer support to adults (18+). The Roam Team support people who are 16+, and RASAC indicated additional services for young people.
• All but one service (n=16) provide support to women, and of these 6 services also support men. Roam offers support to men who have sex with men only.
• 11 services explicitly stated they offered support to trans and non-binary individuals, however eligibility based on gender identity was often unclear.
• Of the identified services (n=16), 3 currently have a waiting list, and the rest are able to immediately take referrals. In the case of You My Sister, the courses they offer start at fixed times, and this waiting list represents the numbers waiting for the next course.

Source: ONS Geography Open Data

The geographic area covered by the identified services is highlighted in

Figure 3. The data reveals large areas without any specialist service provision. Participants noted that people seeking support from outwith these areas where they would be able to access face to face support did have two opportunities for seeking support; online support was available from two services, and one was able to reimburse travel, or the costs of relocation where necessary. However, these two services have a distinct service offer: the TARA service is for people who have been trafficked, and You My Sister offer courses to those who are no longer selling or exchanging sex. For people not meeting these criteria, accessing support is likely to involve travel, potentially at their own expense. Two participants in areas without specialist services shared that they were aware of this happening, and knew of individuals from their area travelling to access specialist services in other areas. For many this is likely to represent a substantial barrier to engaging with specialist services.The respondent from one area with a specialist service, however noted that travel is not always a barrier. They shared that some people in their local authority area preferred to travel to a service rather tan use the local, as they felt more secure in their anonymity and had less concerns about being seen accessing services which may reveal their involvement in selling or exchanging sex.

It is important to note that for some larger regions, the presence of a static service in their area may still necessitate travel to access, even where drop-in and outreach is offered in fixed locations, although some services are able to offer home vists or to meet people in the community where capacity allows. Overall, the specialist service mapping indicates substantial gaps in coverage which are likely to prohibit those unable to easily travel from accessing support.

3.2 Mainstream Service Provision

In addition to mapping specialist service provision, practitioners were asked to give a rating for the level of understanding of the needs of people selling or exchanging sex they believed mainstream services in their area had. Figure 4 illustrates the perceived expertise in mainstream services across local authority areas.

Source: ONS Geography Open Data

As Figure 4 illustrates, the majority of local authority areas estimated that mainstream services in their area had a basic understanding of the needs of people who sell sex (n=24). Three regions reported poor understanding, and four rated their levels of understanding as very good. By these estimations, people who sell sex are most likely to meet someone with only a basic level of understanding when accessing mainstream services. Although some regions noted that there were individuals with expertise within the area, none considered the general level of understanding to be of an expert level.

Participants were asked to provide an explanation of the ratings they had given for the level of understanding of the needs of people who sell or exchange sex in mainstream services in their area. All provided a brief description of the activities in the area that had lead them to their chosen rating. These responses were analysed, and a list of challenges and of positive practice for improving understanding compiled.

3.2.1 Challenges

Inconsistent approaches

Nearly all areas reported that the response people would receive from mainstream services if they were to present needing support around selling or exchanging sex would be inconsistent. They noted that there may be individuals with particular expertise, but this knowledge was not universal. This may result in people receiving varied and even contradictory information depending on which service they first presented to. This is likely to negatively impact engagement with people much less likely to engage with support where the response is unpredictable.

Lack of joined up or partnership work

Related to inconsistency was the lack of joined up or partnership working. This mainfested, in poor communication and a lack of information sharing. A number of participants shared that there was some good practice, for example a clear Commercial Sexual Exploitation (CSE) position statement had been established, but that many support practitioners would not be aware of this. Some respondents noted that they themselves, had only found out about services and other initiatives having done some research in order to participate in this survey. This lack of joined up work, is likely to mean that in some circumstances people who seek support are not receiving all that is available, even within their own area.

'It doesn't happen here' attitude

A number of participants reported that practitioners in mainstream services services did not think that people were selling or exchanging sex within their area. This is likely to mean that they do not proactively seek out training, and additionally that if someone presents looking for support around selling or exchanging sex they are unable to signpost them to appropriate services and resources. In some areas, practitioners were aware that people sold sex, but were unclear on the numbers or the needs that people may have related to this within their community. One practitioner said:

'our pattern is very unclear, with many people not accepting it happens in our small community' [MS21]

Many areas spoke to the need for scoping studies, and further research to get a picture of who is selling or exchanging sex in their area, and how best to support them. This was particularly the case for areas which were more rural, or constituted a mix or rural and urban areas, with them noting the lack of understanding of the presentations of people selling sex within these specific geographies. In a number of areas scoping studies were planned to improve clarity.

In some areas, scoping had revealed that the perception of very low numbers of people selling or exchanging sex was accurate. In these areas, practitioners noted that mainstream services are likely to have very little experience dealing with people presenting for support around selling and exchanging sex. It should be noted however, that this lack of scale was not reported to preclude good practice where communication and partnership working was strong, an one area reported excellent practice even when the number of individuals involved was very small.

Lack of training options

Many participants were unaware of any training going on in their area around supporting people selling or exchanging sex. The result is a reliance on individuals being proactive and seeking appropriate information and resources themselves. For many services who are feeling stretched financially and in terms of time, this is not happening consistently. Reliance on people being proactive is especially problematic in areas with a prominent 'it doesn't happen here' attitude, as well as in areas where numbers of people selling sex are known to be low. In contrast, in some areas training providers reported that uptake of the provided training was low even when communicated through established multi-agency channels.

Practitioners noted that this leaves mainstream services without the skills to identify when people may be needing support around selling or exchanging sex, and therefore not proactively offering support. In some areas this was reported to be reflected in professionals holding strong beliefs around choice and personal responsibility across all presentations of selling or exchanging sex.

Stigmatised views

Related to a lack of training and knowledge, were the prevalance of stigmatised views and judgements. Whilst none of the respondents expressed these views themselves, they did share the opinion that these views still exist within some mainstream services in their areas. One practitioner shared:

'there is still stigma, and women involved are seen to be an underclass' [MS29]

The prevalance of these views is likely to be a substantial barrier to people who sell or exchange sex being able to engage with services.

3.2.2 Positive Practice

Joined up and partnership working

In some areas, joined up and partnership working took the form of a CSE Working Group, which sat within the VAWG Partnership, and included representatives from mainstream and specialist services. These groups were considered most effective where other services were invited to join meetings if they needed additional guidance on supporting an individual within their service, or a point of contact for any identified training needs. Some of the benefits of partnership working were identified as clear referral processes and knowledge of where to signpost to receive particular support. Additionally, the groups were reported as providing proactive and regular communication meaning that other good practice and resources were shared widely. Finally, CSE working groups were identifed as being able to lead on awareness raising activities and initiatives and use their collective resource and networks to improve practice across the local authority area.

In other areas partnerships were formed between two, or a smaller number of services rather than being a formal working group. This gave the ability to pool resources, including staff time and expertise and to share good practice to provide a consistent reponse. As with the CSE working groups, smaller partnerships were able to lead on awareness raising activity, and provide a point of contact for practitioners in mainstream services seeking additional guidance. This was especially noted in areas where a dedicated specialist service was not available to fulfil this role.

Position statement

Some areas noted they found it helpful to have a clear position statement on selling or exchanging sex, or CSE more broadly. This was considered most effective when communicated effectively to mainstream services. Clear position statements allowed for a more consistent response across different services, and provided individual workers an approved framework to work within, rather than responding based on their own personal politics.

Related to a position statement, was the development of clear policies around selling and exchanging sex, and the agreed response on a local authority level. In some areas they found it helpful to join up these discussions to ongoing policy discussions for example around the licensing of sexual entertainment venues. This allowed for local authority areas to give a cohesive response across different business areas, and also meant that additional teams or practitioners working on related policy areas were connected into discussions around broader issues on prostitution and CSE.

Training

The existence and provision of specialist training was considered to be essential in raising understanding, reducing stigma and judgement and in providing a consistent response. One practitioner said of training delivered by a specialist service in their area:

'It was a complete eye-opener for most of the services' [MS17]

Areas that had good access to and uptake of training also reported improved communication, partnerships and signposting as a result in engaging intraining sessions together, and creating those links.

3.3 Lived Experience: Mainstream Service Access

To augment the information provided by the professional participants, all participants with lived experience were asked to share information about the types of mainstream services they had been involved with, whether or not they had chosen to disclose their selling or exchanging sex to these services, and their rationale for this.

Information collected about the types of mainstream support services participants had engaged with was intended to indicate the range of support needs people who sell or exchange sex in Scotland may have, as well as indicating areas where increased training for staff around supporting people who sell or exchange sex may be particularly beneficial, and where it might be particularly important to have well established referral routes into specialist support for those who wish to engage.

As Figure 5 illustrates, the most common type of service for participants to have accessed was NHS services (n=63) followed by housing (n=55), mental health including counselling (n=48) and addictions (n=45). Participants were also given the option of selecting 'Other' and specifying additional services. Of the 20 who specified engagement with another service, 9 were re-categorised (for example Needle Exchange was included under addictions, and creative groups under faith and community groups). Of the remaining, all 11 were for legal advice. Additional types of service which were mentioned during the engagement, but not raised here include specialist support for autism and learning difficulties, support with physical disabilities and eating disorder services.

Most notable is that every participant had some involvement with mainstream services. Whilst assumptions cannot be made about the wider population of people who sell or exchange sex these results suggest that most mainstream services may be regularly accessed by people with this lived experience. These findings gain new significance in line with the findings from the mapping survey that mainstream services report they do not believe that people who sell or exchange sex access services in their area. This disconnect strongly suggests the value in scoping studies to gain an accurate picture of where people are selling or exchanging sex across Scotland and may be accessing services, to ensure services are able to respond appropriately as necessary.

The results shown in Figure 6 demonstrate the range and number of services that many individuals may need to access. Just three participants had only engaged with one type of service, and the average number was 7. 12 participants reported having accessed over 10 different types of service. As these results represent categories of services, the number of individual services each person has engaged with is likely to be higher. For example, participants often reported engaging with a number of different support services for addictions, such as needle exchange, support groups and recovery hubs. In this circumstance multiple services are recorded as one service type – in this example, addictions.

These findings add to the call from the mapping survey for increased joined-up and partnership working to streamline the processes for both workers and the person accessing the service when individuals are receiving support from a number of different places at once. The impacts of siloed working, where joined up working does not occur, are explored in more detail in the section on accessing services. Noted impacts include participants feeling they constantly have to repeat their story, and also a number of concerns expressed about being unable to seek support from one service for fear of losing their support from another.

3.3.1 Disclosure of selling sex to mainstream services

Having shared which mainstream services they had been engaged with, participants were asked whether they had disclosed their involvement in selling or exchanging sex to these services. The responses to this are shown in Figure 7.

Responses to this question were provided by 70 participants (1 participant chose not to answer). The majority (n=40) had disclosed their involvement in selling or exchanging sex to some mainstream services they had been in contact with. 24 participants had not told any services they had been engaged with about selling or exchanging sex, and the smallest group (n=6) had told all services. These results indicate that where conditions were right the majority of participants would talk to mainstream services about selling or exchanging sex. However, a substantial number of participants (n=64) had accessed at least some support services who were not aware of their involvement, and potentially of any additional support they may be able to provide as a result.

In order to better understand the conditions that facilitate or restrict disclosure of selling or exchanging of sex to mainstream services, participants were asked to explain why they had taken the decision to tell services or not. The most common factor was whether the service asked them directly. Explanations given have been summarised in Table 6. Many of the issues raised reflect broader themes around challenges and barriers in accessing services and have been discussed in detail in section 4.

Table 6: Rationale for choices to disclosure the selling or exchanging of sex to mainstream services

Motivators to disclose to services

• Service asked
• Specialist services were able to facilitate contact
• They felt they would not be judged
• There were clear tangible benefits to disclosure e.g. for asylum claims, sexual health
• To share with others or help others through group work/peer support
• They were having a good day
• They were at crisis point or felt they had to out of desperation

Barriers to disclosing to services

• Service didn't ask
• Having a tough day
• They felt there was nothing to gain by sharing with that service or felt it not relevant
• They feared stigma and judgement
• They were accompanied by someone who does not know about their involvement
• Negative experiences of disclosure in the past have put them off
• They don't trust the service
• There were concerns about the impact on other service provision e.g. social work
• They never talk about it with anyone and don't want anyone to know