There is a welcome change in how we address mental health today. Yet, gaps remain in mental health services for the most marginalised communities, like women in sex work. One million women in sex work struggle to live a life of safety and well-being in India. One of them is Sunita.
Sunita’s story is similar to many others in her community. Lured into sex work under the garb of employment while still a teenager, she lived most of her adult life disallowed from going out, and today, is able to finally speak about her stress and anxiety. She credits her moments of respite to being a member of a community organisation.
Sex Workers Face Higher Risk Of Mental Health Illness
Studies worldwide have indicated that sex workers are at higher risk of mental health issues than most other members of the general populace. Correlations have been drawn with violence, substance use, food insecurity, financial struggles, etc.
A 2008 study titled ‘Mental Disposition of Commercial Sex Workers (CSWs) with HIV/AIDS’ shows that the majority of women in sex work suffer from depression. Yet another 2009 study (by Bhatt et al) reported the prevalence of neurotic disorders in commercial sex workers to be 45 percent, and 94 percent of them had depressive disorders.
A 2012 study titled ‘Psychological Morbidity Among Female Commercial Sex Workers with Alcohol and Drug Abuse’ by Pandiyan et al, found anxiety, alcohol abuse and psychological morbidity (depression and adjustment disorder) to be especially prevalent among women sex workers.
Personal Financial Crisis & Violence — Causes of Suicide Attempts by Sex Workers
A 2016 study by Reny Rajan of NIMHANS, on suicidal behaviour among women in sex work (who were members of Swathi Mahila Sangha, a community organisation) found that 73.3 percent had suicidal tendencies. The study highlighted financial trouble as the major cause for a suicide attempt, followed by facing violence.
This is only the contours of what women sex workers are dealing with. But there are barely any mental health services for them.
As Shama Karkal, Chair of the Asia Pacific Alliance for Sexual and Reproductive Health and Rights and CEO, Swasti, a global non-profit working in the area of public health puts it, “Mental health is not well understood in society, and seeking care for mental health is stigmatised. This is true for the population in general, but more so for marginalised communities such as women in sex work and others; they face additional stigma. Within mental health professionals also there is often more curiosity than empathy for women who have lived through what few can even imagine.”
For a woman sex worker, the options of accessing safe and affordable quality mental health services are limited.
She can at best reach out to the counselor with the Targeted Interventions programme.
Like Sunita, she can reach out to a community organisation whose members undertake basic counseling and facilitate access to psychiatrists, de-addiction centres and safety, security, justice pathways.
What Sex Workers’ Community Needs
Sex workers dealing with mental health issue can also reach out to some social development organisations that have established systems to offer help. Like Durbar Mahila Samanwaya Committee (DMSC) and its NGO partners, who earlier this year put together a team of six sex workers in Sonagachi (in Kolkata), trained by psychiatrists to look for symptoms of mental distress among sex workers and initiate early stages of counselling.
If she is offered the space to overcome fear of stigma and discrimination, a woman sex worker can access the nearest state-run mental health institute or general hospital.
What this community needs is a nuanced, proactive, dignified, agile and flexible array of mental health services, that are available to them at various touch points — through technology-supported mediums such as phones, in-person interactions in safe spaces like community organisations, or drop-in centers of targeted intervention programmes or navigation support in mental health institutes and district hospitals.
The National Mental Health survey says 150 million people in India need mental health care, and reveals that 70-92 percent fail to receive treatment. We are possibly staring into the abyss of a mental health and well-being crisis, and marginalised communities such as women sex workers, who cannot afford nor access services, are the ones left behind. The time to act is now.
(Shrirupa Sengupta has been working in programmes for and with Women in Sex Work across India since a decade now. She serves as Associate Director at Swasti, a global public health non-profit. This is an opinion piece, and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)