Sex Work and Mental Health

Meet the pioneers working to improve mental health support for adult industry professionals

Mental health is a hot topic.  However, discussions about sex work and mental health feel muted.  To follow on from our article on Sex work, body image and mental health and the support of Mental Health Week 2019 which took place in May last year, we asked writer Rose Crompton to delve deeper into this subject as people are now starting to feel like they can speak about mental health more freely.     

While researching this article, both therapists and sex workers share their concerns that fear and stigma are getting in the way of much-needed support for sex workers.  

Online searches return news channels reporting performer suicides and a smattering of articles from a handful of sex-positive news outlets.  There’s significantly less information compared to, let’s say, workplace stress and effects on mental health. Or young people and mental health.

While these topics are important, the whispered discussion going on around sex work and mental health shines a light on the subtle undercurrent of the stigma.  It appears to exist between the adult industry and the availability of mental health support. 

Raising the topic of mental health and sex work

Research into sex work and mental health

The 2018-19 planned NHS spending on mental health services was £12.2 billion.  The NHS argues that investing in mental health services can reduce subsequent health problems and save the wider economy money.  But are the services that this investment is supporting open and accessible to everyone who needs it?

If an official industry body or institution invests time into research, they recognise the subjects worthy of further investigation.  Any findings help propel the discussion forward.  A lack of studies, research or discussion into a particular subject can be a cause for concern. 

I found further evidenced while spending hours and hours looking for factual information.  But finding reliable, useful, current research into sex work and mental health for this article was difficult.

 A 2017 collaborative paper written by Leicester University and the Wellcome Trust titled, Reviewing the occupational risks of sex workers in comparison to other ‘risky’ professions sums up the two main problems. 

  1. Many existing studies into sex work and mental health focus predominately on female sex workers (FSW).  The paper noted the scarcity of research into male and trans sex worker mental health, saying the latter is ‘practically non-existent.’
  2. Consensual sex work and sex trafficking are often lumped into the same basket.  Trauma faced by each group may be problematic and very different.  As identified by the paper, ‘This [existing] research tends to use the high incidence of mental ill-health among specific samples of FSW to prove the harmfulness of all sex work.’

A lack of research is worrying.  The notion that existing studies and data relating to sex work and mental health are being used to reinforce negative stereotypes and stigmas is more distressing. 

Battling stigma and stereotypes

Quoting the University of Leicester and Wellcome Trust paper, the authors write: 

‘According to several empirical studies, stigma is strongly correlated with sex workers’ mental health problems (eg Benoit, 2015).  Stigma has also been found to prevent sex workers from accessing care and support, because of fears and experiences of being judged or reported to the authorities.’

Conservatism continues to outweigh progression, despite reports of more people with healthcare backgrounds, education and retail choosing to work in the sex industry to boost their income. Stereotypes remain ingrained, bringing stigma with them which only causes additional stress and trauma when it’s care and compassion that’s being sought out. 

Importantly, the wider adult and therapy communities are recognising these issues.  “In my opinion, stigma is the biggest issue faced by many performers in the adult industry” explains Leya Tanit, Founder and President of Pineapple Support, a non-profit mental health care organisation for adult industry performers. 

“Performers are less able than civilians to talk openly about any issues they face or seek professional support when needed.  When they do, they often face therapists who don’t understand or are hostile to sex work.” 

During a podcast recording, the late August Ames highlighted such feelings, explaining, “I would get in contact with some people and then I would feel bad because they’d be like, ‘What’s your profession?’ and I’d be like, ‘Oh, I’m in the adult industry’ and then I’d feel like they’re like, ‘Oh, that’s the whole reason that you are the way you are’ and then I’d get turned off.” 

Counsellor Simone Ayers best described the danger of the stigma.  “Not feeling free to share what they do for a living, or pretending to live a different life, can impact individuals working in the sex industry if they don’t have close and supportive relationships in their lives.” 

Can this be applied to many (or any) other industries, where someone feels it’s necessary to hide part of who they are to get the support they need? Dive a little deeper into the challenges sex workers are reportedly bringing to therapy and it gets even more frustrating that some can’t see beyond the job title. 

Every profession comes with stress

Sex work, like most jobs, has its challenges.  London-based counsellor Katie Evans explains the problems sex workers bring to sessions are often no different to the stresses other solo business owners experience.  “The most common reasons are financial stress and concern about the future — much like many self-employed people I see.” member, performer, producer and therapist Lacey Starr, echoes these sentiments and highlights some of the industry-specific challenges.  “Adult work can be extremely tough; it’s physically and emotionally challenging and can be exhausting,” says Lacey.  “The industry is full of individuals who find themselves challenged emotionally all the time, with daily issues such as keeping safe, isolation, financial stress and bookkeeping.  Looking after your sexual health, and slut-shaming are all common occurrences.”

The everyday stuff does a good job of keeping most people awake at night, not just sex workers.  By the time industry-specific challenges are added in — isolation, body issues, stigma, anxiety, addiction, sexual assault — the difference between professional sex work and other industries is clear.  

Louder voices calling for improved support services, specifically for sex workers, are gathering.  These are the people seeking large-scale change so finding a stigma-free therapist will soon be a simple task.

Pioneers seeking to change attitudes

Breaking stereotypes and stigma starts with awareness and education.  Currently, there’s no recognised accreditation or kitemark to indicate that someone has experience working with adult industry professionals, but change may not be far away. 

There’s a growing number of therapists and councillors who proactively highlight the fact that they work with adult industry professionals.  One such example is Pineapple Support

“Pineapple Support was launched in 2018 in response to a string of losses in the adult industry from depression and other mental illness,” explains Leya Tanit. “The Pineapple Support therapists provide sex worker-positive and stigma-free therapy to adult performers.  Some of the top therapists across the globe have chosen to work with Pineapple Support, sharing a vision of improved mental health for the adult industry.”

In the UK, Pink Therapy is an independent therapy organisation with a focus on working with gender and sexually diverse clients.  They are challenging stigmas held by the therapy industry though their annual events.  Most notably, their 2018 Pink Therapy event titled, ‘Sex Works!’ which looked at the crossover between the mental health industry and the adult industry profession. 

The appearance of Pineapple Support and the ‘Sex Works!’ event shows adult workers that non-judgemental support is out there and discussion is taking place.  When a therapist says they’re a ‘sex worker’ friendly service, what does this mean?

Defining sex worker-friendly mental health support

In the case of Pineapple Support, SW-friendly services include individuals who have worked in the adult industry.  They have lived SW experience and become volunteers in their team of ‘listeners’, working alongside trained therapists. Other counsellors and therapists take the time to educate themselves on the industry rather than working in it.  They may then refer to themselves as a ‘sex worker aware’ therapist.

Being sex worker aware means I have knowledge and understanding of sex work and, most importantly, I won’t see sex work as an issue itself to be ‘fixed’,” explains Katie Evans. 

Counsellor and psychotherapist Karen Pollock expands on this, explaining, “For me, I understand the “aware” coming from kink.  Phrases like “kink affirmative”, “kink aware” and “kink knowledgeable” may be more familiar.  Whether it’s kink or sex work, the idea is that I’ve sought out training and education.  This involves connecting with sex workers on social media, reading books or articles written by sex workers and so on.  As such, sex workers can be confident they don’t have to educate me when it comes to industry-related phrases or practices if that’s what they want to discuss. 

“If you work with a certain group, you have to know about a group.  If I were to work with lesbians, I know what a “butch” is, what a top is or what a “femme” is. Someone’s not having to stop mid-flow to teach me about their world.” 

A lot has been said about stigma.  This may cause therapists to jump to the conclusion that sex work is the reason you need help.  The reverse is also true. Being a “sex worker aware therapist” doesn’t mean someone is thinking the industry is all roses. 

“I’ve had people come to me who hate it,” says Karen Pollock. “Being a “sex worker aware therapist” doesn’t mean I think there’s one universal experience of sex work.  It doesn’t mean I’ll say I think it’s empowering or wonderful or feminist.  What I’m saying is that I start with a blank sheet.  At the top of that sheet is my knowledge about a certain area of life, which I’ve taken the time to look into.”  

Successful therapy

For therapy to be successful, you need someone who won’t judge your circumstances based on your profession.  It will need to be someone you’re comfortable being open with. 

“It’s OK to ask your therapist if they’ve ever worked with sex workers,” suggests Karen Pollock.  “You don’t even have to say that you are one — though they might guess — you can ask! ‘Have you ever worked with sex workers and what stance do you take on SW?’ The response you get will be very revealing,” says Karen Pollock.

You should also research their background.  “People can be fully qualified, be a member of every professional body, and still carry internal prejudices.  Before you start working with a therapist, check out their blogs, their social media and what they talk about.  You can out how they talk about sex generally.  Can you see if they take a sex-positive stance?” asks Karen Pollock.

Finding support

If you feel you need mental health support, it’s available.  Whether it’s something you want to talk about, with your job or not, there are professionals who can help. 

You can find support in our Support Service section and many of the therapists we spoke to for this article are part of the Adult Industry Services network. 

COVID-19 and your mental health

It’s even more important to look after your mental health during these challenging times.  As well as the implications of distancing yourself from people, financial complications have a huge effect on your mental health too.

We’ve published an article titled COVID-19 286K Bonus for Escorts which provides all the information you need to know about a bonus is offering for Escorts, further information on where you can get financial support or aid and information on Hardship funds which may prove to be a lifeline in these troublesome times. have recently become a Pineapple Support Partner.  Mental health and wellness services dedicated to adult industry performers are vital and we wholly support Pineapple for providing these.


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