17 minute read
Helping street sex workers make healthy life choices
One25 focuses on the specific needs of women trapped in street sex work. The charity's extraordinary service brings food, therapies and medical services to women, and as a result many have left sex work behind, reclaimed their children from care and now lead normal lives. Giving these vulnerable women the support they need to escape and build towards a healthier future.
One25 is a Bristol-based charity that benefits women who are trapped in a chaotic lifestyle of street sex-work, homelessness and addiction. The charity provides four key services: night outreach, a daytime drop-in centre, casework support and a unique 24 hour mother and baby home called Naomi House. Where services are inaccessible or inappropriate, One25 raises awareness of the needs of this group in order to bring about change in provision.
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The charity's mission is to enable these vulnerable women to:
• break free from this abusive lifestyle and achieve their full potential
• make healthy life choices and foster positive relationships with their families and communities.
One25 aspires to the WHO definition of health: ‘Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease of infirmity.’
From its inception in 1995, One25 has been committed to providing long-term, holistic support for each beneficiary at whatever stage she is at and the charity continues to develop its services accordingly. It has built up a good reputation, has support from the Bristol community and trusting relationships with the client group. The charity’s founder, Val Jeal, was awarded an MBE for her work with One25 and in May 2009, the charity won the England Award from the Prince’s Foundation for Integrated Health.
The women supported
Typically, One25 sees around 200 different women every year, all of whom are socially excluded and trapped in a lifestyle of street sexwork, multiple chronic health needs, and addiction to heroin, crack cocaine and/or alcohol. Added to this:
• 65% have reported that they suffered appalling childhood abuse, including cases of rape as young as three years old
• 32% left school aged 14 or younger
• 66% are homeless
• 92% have been the victims of violent crimes including domestic violence, kidnap, GBH, attacks using weapons and gang rape. Only 1% of these incidents have resulted in a conviction
• 68% suffer from chronic traumatic stress disorder on the same level as victims of torture
• 65% have had children, but 79% of these mothers have had their children removed from them.
Many are desperate to escape this lifestyle, but with such complex, deep-rooted problems, achieving change may require several progressions through a cycle of contemplation, change and relapse before finally breaking free.
Case study
‘Melissa’ Melissa grew up in a household of neglect and abuse. From the age of four, her stepfather started sexually abusing her and eventually she was taken into care. She started using drugs at just nine years old to ‘blank it all out’ and by the age of 13 was a heroin addict. By the time One25 met her in her early 20s, Melissa had been selling sex on the streets for six years. Her life was in chaos: she was being beaten by her boyfriend and often got caught up in two-day working/drug-using binges without breaking to sleep or eat unless the One25 van came round. She became pregnant but her baby was taken into care. It was the loss of her child that provided the turning point for her. She says: ‘When my baby was taken away from me I lost it for a bit. I couldn’t stand to think that she might end up with a life like mine. I ended up in hospital. My caseworker sent me cards there and visited. I realised my life could not go on like this – you’ve got to focus on thinking you can do it. She was waiting for me at the gates and helped me get to a detox to do my recovery. I don’t think I would have got there otherwise – before it had just been straight out onto the streets and dealers hunting you down. Even now I’ve escaped the streets, she still meets me and we have coffee and she helps me with the next steps – I want to be a social worker one day and help other women out there. Best of all I’ve got my kids back, got a nice home for us together and I can be a good mum to them. Everything’s changed.’
Brief history
One25 was the first organisation in Bristol to reach out to these women and meet their expressed needs. It was founded in 1995 as a result of concerns from local agencies and churches about the health and wellbeing of female street sex workers in Bristol. There was a total lack of joined-up service provision for this group in Bristol as other relevant services were not going out to meet these women’s needs but expected them to navigate disparate provision. One25 consulted the women and the result was that they created a service that goes out to them, offers a relational service aimed at the whole person not just one aspect of their needs, and offers the possibility of longterm relationship and support.
Founder Val led a small but dedicated group of like-minded people in developing the work of forming supportive relationships with the women. In January 1996, One25 opened a temporary drop-in centre in the basement of 125 Cheltenham Road, which gave the project its enduring name. Around this time a consultative group was formed with representatives from relevant agencies such as Bristol Drugs Project and the Bristol Royal Infirmary’s sexual health clinic.
In 1996, ‘the custard tart’ – a bright yellow van nicknamed by the women it served – started evening outreach on the streets. This greatly increased the opportunity for effective contact with the women and enabled One25 to grow. At this point, One25 was supported by 18 dedicated volunteers and no paid staff.
Today, the charity employs 17 staff and is supported by around 130 volunteers.
The ‘custard tart’ – outreach on the streets
In 1997, One25 became a registered charity and moved to occupy its present site in the St Pauls district. This meant many more women in sex work were able to get support, as the new drop-in was larger and in the heart of the drug dealing and sex working area in Bristol. In 2005 the building, which was previously rented, was given outright to the project by Bristol Christian Fellowship.In January 2009, One25 opened Naomi House. This is an innovative residential family unit providing intensive, therapeutic and practical 24-hour support for up to five pregnant women or mothers with babies where maternal substance misuse and risk from sex work has been a problem. Naomi House is the only supported mother and baby home in England for women with addictions and a history of sex work.
One25’s services
Outreach
One25 provides six sessions of a night outreach service which spans five nights a week. The outreach service offers nutritious food and drinks, condoms, healthcare and information on violent attacks. The women tend to be so caught up in their life-controlling cycle of selling sex to buy and take drugs that they have no chance to take care of their basic needs. One25 sees women who are acutely malnourished, who are so ill that they should be hospitalised, who have just been beaten and raped, and yet are still continuing to sell sex. One25 meets their basic needs in a way that meets their emotional and spiritual needs. As a result, this service has been described by a number of women not only as a ‘lifesaver’ but also as ‘a turning point’. The outreach teams made 4,223 contacts with women in 2008, giving out more than 4,000 food packages, 43,000 condoms, and 1,000 instances of health and housing advice.
Work from a creative art drop-in session
Drop-in
The van teams encourage the women to come to the drop-in centre. This is open four afternoons a week. It is a safe, women-only space where the women can have a cooked meal, get healthcare, and use hygiene and laundry facilities. The drop-in offers women a chance to relax and engage with visiting or in-house clinics, ranging from a no-appointment GP to creative writing classes. One25 recognises that the women need encouragement and emotional support. Therefore staff and volunteers promote feelings of self-worth through words of affirmation and by offering opportunities to take part in therapeutic or educational sessions, have a professional massage, receive homeopathy treatment, take part in arts therapy or take part in cognitive behavioural therapies. Most of the women that One25 meets have rock bottom self-esteem and suffer from deep-seated traumas because of their life experiences. One25 understands that the women require a holistic approach that can take care of their basic needs and simultaneously improve their overall physical, sexual and emotional health. Staff and volunteers encourage the women to become aware of the link between their bodies and their psychological wellbeing and treat the mind and body as an integrated, dynamic whole.
Drop in sessions
Monday
• City of Bristol College basic skills tutor
• Representative of local drug agency helps women with addiction issues
• General health nurse and doctor clinics
Tuesday
• Sexual health nurse and doctor
• Creative writing tutor
• Massage therapist
• Mums and tots group (mornings)
Wednesday
• Representative of local drug agency helps women with addiction issues
• Pottery and ceramics session
Friday
• Therapist offering pedicure and general foot care and massage
Daily
• Homeopathy
• One-to-one counselling
Casework
The relaxed atmosphere gives opportunities for caseworkers to talk in depth with the women, to help them make and attend appointments, or to take steps to arrange detoxification programmes. During One25’s first three years, the charity saw just five or six women make any significant changes in their lives. Over the next 10 years One25 responded to various needs suggested by the women, for example increasing the amount of outreach, campaigning for health visitors to set up clinics at the drop-in and establishing a casework service.
Of the 51 women receiving casework support in 2008, nine (18%) exited sex-work; 28 (55%) saw improvements to their addiction issues; 35 (69%) gained more secure housing; 22 (43%) attended a GP or dental appointment and four (7%) took up formal employment or further education.
The Big Lottery Fund recognised the importance of complementary therapies in March 2009 when it awarded One25 with three years’ funding for a therapeutic caseworker (Dee Parkin), as well as a generic caseworker. Dee is a trained homeopath, mental health worker and counsellor and runs one-to-one and group sessions in each of the four weekly drop-in sessions, giving advice, treatment and consistent intensive casework. She also runs sessions at Naomi House once a week. She has already built up a strong relationship with doctors, nurses and therapeutic practitioners in the city, as she feels that complementary and conventional therapy fit in with each other. She has persuaded the Red Cross to provide massage, medicated camouflage make-up for women with scars and bruising, and first aid training. Dee is planning to take in occupational therapist students who will provide a range of treatments at Naomi House and at the drop-in. Dee uses her skills and extensive experience in counselling and homeopathy to explore the underlying issues behind what she sees as the women’s ‘self-medication’ with heroin, crack cocaine and alcohol.
‘The complementary therapies deal with the issues rather than plaster over them’, says Dee. ‘It is integral to One25’s work that the women have free access to complementary therapies. The therapies enable them to explore the reasons behind their need to blot out all memories or feelings with heroin or give themselves a false sense of joy with crack cocaine. The treatments help them to look at why they put themselves in such high-risk, unhealthy situations on the streets and ignore their own basic needs. Treatments also work wonders with building up their self-esteem and lessening the chance of relapse. Medicine is useful up to a point but it is vital that we offer the biggest possible range of therapies and complementary healthcare if we wish to see real changes in the women’s lives.
‘We have a two tiered health system in this country –the NHS and complementary healthcare. If you are rich enough to pay for complementary therapies then you do it and you see your health improving. The poorer members of our society rarely have the money or the awareness of these treatments to be able to access them and so suffer as a result. One25 makes both levels accessible to the women and we see radical results. Last year, over half of the women saw dramatic improvements to their addiction issues, including going into detox centres and becoming abstinent. One in five of the women exited sex work and street drugs altogether. These women also gained secure housing for themselves and saw real boosts in their self-confidence and self-care.’
Naomi House
Before this service was opened, there was no appropriate support for drug-using pregnant women and mums with babies in Bristol and in fact no supported residential homes in the country for mothers with a history of addiction and sex work. The alternative was that pregnant women were put in potentially risky accommodation that was not supportive to their aspirations to safe, healthy motherhood. In the majority of cases we saw, the situation ended in the woman’s relapse and the removal of her baby.
To respond to this great need, One25 opened Naomi House in January 2009. The home provides 24-hour, intensive support to these new families, with a weekly programme of therapeutic and practical skill sessions
A bedroom in Naomi House
and individual casework, both in-house and out in the community. The sessions range from Shiatsu and art therapy to parenting skills classes and healthy eating. The sessions are practically supported by a range of specialist agencies and professionals. The ultimate aim of Naomi House is to support women who want to change and become equipped with the skills needed to raise their children in a safe, loving environment thus giving the families a better start in life. The project accepts referrals from many different agencies, including the NHS, probation services and drugs projects and has two beds available for women from outside Bristol. Naomi House won a government grant of £187,050 from the Parenting Fund towards two years of salary costs and drugs/alcohol treatment. This has boosted its reputation in the country and ensured its sustainability for the next few years. The new mums at the project are all engaging really well with the programme of support. They give regular feedback on suggested changes or additions to the project, which the staff and volunteers implement when they can. One recent suggestion from ‘Jennie,’ which has been implemented, was for certificates for each month of drug/alcohol abstinence, as she had left school without qualifications and felt her confidence and motivation would be increased by this formal recognition of her achievement. Another recent request was for more art therapy and massage sessions from ‘Sally’, who said: ‘This is amazing! I feel so calm. Why do we need drugs?!’
Events
One25 runs three annual events: a Christmas dinner for women, a Christmas party for mums and their children with circus entertainment, and a summer outing to the beach or to an adventure park. All of these are extremely popular and give these women and their families a sense of ‘normality’. Taking part in an event builds up the trusting relationship with staff and volunteers and gives the women a break from the streets. In 2008, record numbers of women and their children attended these events. All of the women and children received Christmas presents sponsored by local businesses.
The charity also runs a variety of fundraising events for the wider community and always tries to do something unusual and attention-grabbing to attract the attention of the local media. Over the last year, the charity has had a multi-media club night, a fancy dress 10-mile night walk
with more than 100 participants (raising more than £7,000), an auction supported by local and national businesses, and a 100-strong Bristol 10k running team that raised more than £20,000.
A fund-raising fashion show
‘Andrea’s’ story
‘The people at One25 got alongside me for some five years while I was working. They became friends but it took time. I didn’t have the level of self-worth to accept help, I wanted to die. I haven’t been working the streets for about four years now. They turning point came when my health was an issue…I nearly died a few times. My worker at One25 kept visiting me and she helped me get all the agencies together to find accommodation and money to live. It’s a fantastic organisation because they have everything under one roof and they are consistent in their help whether or not you mess up. Knowing someone cares is huge.’
The sexual health doctor’s view
‘The impact One25 has on the local community is unique as there are no other providers. From my own perspective as a sexual health doctor, the One25 clinic is a tremendous asset. Most of the women seen in the drop-in live such chaotic lives that it is impossible for them to access a hospital clinic however much we try to make the clinic acceptable.When I began to work as the doctor at One25, I was soon aware of how the women who sell sex to fund their drug habits wanted to reduce the incidence of sexually transmitted diseases not only for themselves but for these other innocent women who would be caught up in the diseases from no fault of their own. If the facilities were present, most of the sex-working women wanted to take ownership of their health. In order to bring the help to the women numerous other agencies are invited into the One25 drop-in to give advice. This covers drugs and drug dependency, housing, health, benefits and the police. In the healing process that has to go on in these women’s lives, it is essential that as many facilities as possible can be at their disposal.This is why places like One25 need all the support they can get.’ Dr Sue Norman
FAQ
Q Why are One25’s services needed?
A The women One25 work with are some of the most disadvantaged and marginalised people in society and are unable to access services that most people take for granted. They have specific needs and specific histories that don’t fit easily into generic services. Currently One25 is the only service in Bristol that provides an essential outreach service for this client group.
Q Haven’t the women chosen this lifestyle?
A No. Many of the women that One25 support have had an incredibly chaotic and dysfunctional childhood, filled with neglect and abuse. They have turned to drugs as a means of escape from an early age. A large percentage dropped out of school in their early teens, which limits their choices further. Today, many are in violent relationships where they are forced onto the streets in order to support their partners’ drug habits. With the lack of joined-up, specialised services in Bristol to deal with their complex, multiple needs, it can be incredibly difficult for them to exit sex work and addiction.
Q Aren’t the babies better off in care?
A No. There is a lot of evidence to show that children are more likely to thrive when they have a secure attachment to their mother. Naomi House provides expert parenting skills sessions alongside an intensive programme of highly supportive, therapeutic activities and practical skills sessions, maternal recovery and offer mentoring and support in daily childcare routines.
Q What do you think of the current policy of cracking down on kerb crawling?
A We empathise with the problems that street sex work causes for local residents. To pursue an anti kerbcrawling campaign in isolation increases risk of violence for women as activities are displaced to times and places away from support services and these campaigns do not deter the more predatory, dangerous punters. In order to have a positive effect on the women also, anti-kerb crawling actions must be part of a holistic, well resourced strategy that includes help for the women with their problems of drug abuse, homelessness, ill health and violence.
All names have been changed to protect confidentiality.
Written by Josie Hill
Fundraising and Publicity Co-ordinator, One25
Having worked for a range of health-focused charities, I’ve come to recognise that offering an integrated, holistic approach of conventional medicine with complementary therapies is the best way of transforming lives. I strongly believe that we need a new model of health in the UK, one that offers everyone greater choice and empowerment over their health needs. In developing One25’s new therapeutic programme, I anticipate that we will reduce the burden of these vulnerable women’s chronic ill-health and help them reach their full potential.
