1 R EVIEWING THE OCCUPATIONAL RISKS OF SEX WORKERS IN COMPARISON TO OTHER ‘ RISKY ’ PROFESSIONS . J ULY 2017 Professor Teela Sanders; Stewart Cunningham; Dr Lucy Platt; Pippa Grenfell; Dr PG Macioti Sex Work and Mental health Dr PG Macioti; Pippa Grenfell and Dr Lucy Platt This briefing paper is based on a scoping literature review of existing research on mental health and sex work. It is part of a wider Wellcome Trust Seed Award project, which aims to understand how occupational health and safety differs between sex workers and other professions which are established as ‘risky’ because of the elevated prevalence of violence in the workplace and poor mental health. This document is directed to practitioners and service providers who work with sex workers and to researchers in the fields of sex work and mental health. Whilst this synthesis is by no mean exhaustive, it intends to: • introduce the main discourses and frameworks of analysis on sex work and mental health • identify the main factors that influence sex workers’ mental well being • recommend best practice and policies to improve sex workers’ mental health • suggest new directions for practice-oriented research on sex work and mental health Methods We conducted a literature search in six academic databases (Ovid Medline, Psych Info, Web of Science, Embase, CINAHL Plus, Global Health) and Google Scholar for quantitative and qualitative studies related to mental health and sex work. We also searched grey literature, documents written by sex workers, NGO and government reports. Aiming to critically address dominant discourses, we scoped all relevant literature, regardless of its methodological or ethical flaws. We also included research on mental health and trafficking into the sex industry, to contextualise the sex work literature and because the definition of trafficking is often unclear and/or not clearly differentiated from sex work in research. We anticipated that labour exploitation and coercion along with the overlap between trafficking and sex work would be highly influential on mental health. Overall, we retrieved 160 documents. We conducted similar literature searches to identify research on nursing and police as comparator ‘risky’ professions. Research approaches We identified three main approaches to mental health and sex work in the research literature: 1. Research assuming and assessing the inherent harm of sex work to sex workers’ mental health 2. Research assessing sex workers’ mental health for its wider implications for public health 3. Research studying sex workers’ mental health in order to improve it The mental health of female sex workers Most existing quantitative studies on mental health and sex work are with female sex workers (FSW). Depression, post-traumatic stress disorder (PTSD) and suicide are the most frequently studied mental health issues in FSW. Although generally high, the prevalence of mental health problems among FSW varies considerably (e.g. prevalence of depression varies from 10% to 100%) (Krumrei-Mancuso, 2012). Most of these studies take place among particularly vulnerable sub-groups of FSW, such as street workers, drug users, undocumented migrants, detainees, low- income workers from poorer countries and those who have been trafficked, where the distinction between those who are trafficked and non-trafficked is at times ill-defined. This research tends to use high incidence of mental ill- health among specific samples of FSW to prove the harmfulness of all sex work (e.g. Farley, 1998).