For the past five years, Alice has been making a living as a sex worker. She is also disabled; she has bipolar type II, which leads to hypomania, depression and a severe lack of physical energy.

For Alice, these two sides of her life – disability and sex work – are inexorably linked. Alice (not her real name) started this line of work when she was at university – it was a way to make some extra cash to top up her student loan. She had always intended to quit sex work after graduating. “That was three years ago,” she says.

Upon leaving university, she struggled to retain a job. Traditional employment – with a boss and set working hours – proved impossible during depressive episodes and her job came to an end for that reason. She started a postgraduate degree, but her mental health meant she kept missing lectures and the university eventually recommended she take a year off. “I’ve to all intents and purposes [had to] drop out,” she says.

The disability benefit system is supposed to be there to catch people such as Alice; a safety net for when ill health means she cannot have a job to pay the bills. But she is in a catch-22: she cannot claim the out-of-work sickness benefit, employment support allowance (ESA), because she is still registered as a student, despite the fact that her mental health meant she had to leave her course. “On the one hand, I’ve got someone saying: ‘You’re too unwell to study or work.’ On the other, I’ve got [the government] saying: ‘You’re not unwell enough to get support, and go away.’”

On top of this, she was turned down for the other key disability benefit, personal independence payment (PIP). In the middle of a depressive episode, she could not fill in the extensive paperwork. “Ironically, I wasn’t well enough to chase them,” she says. After reapplying and being rejected again, she had to appeal against the decision, which constitutes a mound of paperwork and then a tribunal in court. Besides, Alice worries that mental health problems are rarely seen by the benefit system as being as debilitating as, say, being a wheelchair user. It is a concern backed up by evidence: in 2018, the high court ruled that the PIP system was “blatantly discriminatory” against people with mental health problems, even going as far as to order the government to review 1.6m disability benefit claims. It all adds up to a situation where Alice could not pay the bills with either a wage or social security. As she put it to me: “I’ve got no income to speak of and the government doesn’t care.”

Instead, she has had to rely on sex work to get by. When I first speak to Alice, she is working. I have accidentally called her early and her client is still in her home. This is an intimate set-up but it generally works for her health. Being her own boss, she has a flexible working pattern and can control the use of her own flat. “When I’m having my down days, I don’t have an employer to answer to, and then, when I’m elated or if I’m actually well, I can sort my own bookings out and organise my own working pattern to cover the days that I can’t work,” she says.

When I'm having my down days, I don't have an employer to answer to. Then, when I'm well, I can organise my working pattern

Arranging her working hours around fluctuating health is especially easy with sex work, she explains, as she is able to earn a lot quickly on her good days, “if you put the time and energy in”. However, her health means she has often not got enough energy to take bookings. Alice uses what she calls “standard rates”: £130 for an hour at her place, £150 at someone else’s, £50 for 15 minutes and £750 for overnight. Most clients tend to go for half an hour or an hour, she says. She describes her working hours as “binge and starve”: she goes several weeks without a client and then sees several men a day, for a few days. “Then I recover,” she says.

There is a pressure to take on as many clients as possible when she is well. Without her disability benefits or a regular income, Alice is thousands of pounds in debt: £10,000 to friends she has borrowed from over the years; her student loan; a £3,000 overdraft; and maxed-out credit cards. Rare periods of hypomania can lead her to shop excessively. But for the past five years, it is simply her lack of income that has seen her finances spiral. She is getting into more and more debt every month, as her outgoings exceed her earnings. The stress of the debts is taking a further toll on her mental health, “only making the situation a vicious cycle”. Finding clients has become a way to alleviate the debt and keep her head above water. “I wouldn’t have been able to survive without sex work,” she says. “It’s quite literally saved my life.”

As we talk, Alice repeatedly tells me there are times she really enjoys sex work, but she admits her choices are heavily controlled by circumstance. She says: “I’m definitely being failed by the system right now – being financially coerced into it by the government.”

As the UK recession and the subsequent austerity measures kicked in, I began to speak to a number of disabled women who had turned to sex work in order to get by. The methods of work varied. Some met men in person who paid them in exchange for sex. Others began sex-cam work; half an hour stripping on Skype for a stranger across the internet. Women with pain- or fatigue-related disabilities were particularly prevalent in the latter. Sex work was the one job they could do from their beds. But if the disabilities varied, the reasons for taking on this work often came back the same: like Alice, without access to benefits or traditional employment, sex work was the only way they could survive.

Alice’s best friend, Sarah, is also disabled and has chronic pain. Unlike Alice, Sarah has been granted disability benefits but does sex work to top up her low payments. The government gives her “some, but not enough to live off as a human being”, Alice says. Many of her friends with disabilities and chronic illnesses started sex work for the ease and flexibility it offered to those who are too unwell for traditional employment – or, as she puts it, whose energy levels are sometimes too low to function properly but “who need money to survive in the world”. “It is what it is,” she says. “If the state won’t support vulnerable people, they have to find work. And if they can’t, they’ll find options.” .

One survey of 'survival' sex work found women to be selling penetrative sex for as little as £10 for a place to stay

This use of sex work as a last option for marginalised women is not a new phenomenon, but as benefit cuts have been rolled out, austerity measures are exacerbating it. In 2018, Frank Field MP, chair of the work and pensions committee, reported that some women in his Birkenhead constituency had been pushed into prostitution because of the local roll-out of universal credit. The union Aslef suggests that on-street prostitution increased by 60% between 2010 and 2017, which has, in particular, been linked to an increase in women having their benefits sanctioned.

Women’s organisations and outreach workers across the country repeatedly point to this pattern. Changing Lives, a charity that provides women’s services across the north of England and the Midlands, conducted research in 2016 into what it termed “survival sex work”. It found women to be selling penetrative sex for as little as £10 for a place to stay or even in exchange for clean clothes, with “punters” approaching them to offer as little as a fiver at times when the women are perceived as being particularly vulnerable. Staff at the organisation’s women’s outreach centre tell me that a growing number of women are being pushed into sex work because they have their benefits stopped for things such as missing JobCentre appointments or failing to attend interviews.

“We noticed a big increase in women selling sex after the introduction of benefit sanctions, not just to make ends meet but, in some cases, to provide the basics for their family,” says Laura Seebohm, the director of operations at Changing Lives. “Some of the women were so desperate that they were selling sex for the first time while others had successfully got themselves out of the world of survival sex only for the sanctions to come along and force them back into it.” Another staff member at the service, Laura McIntyre, told me that women with learning disabilities and those with multiple and complex needs have been particularly at risk.

At the same time, Sheffield Working Women’s Opportunities Project in 2016 warned that austerity measures, including benefit rejections and sanctions, were behind an estimated 400% rise in women using their service who had entered prostitution. Some were new to sex work, they noted, but many were women who had previously managed to leave prostitution only to have to return as much as a decade later because of losing their social security. “We know that some women come out just so they can buy food, and once they’ve raised enough they go home again,” the manager of the centre went on. “Quite a lot of women might only intend to come out for five or six weeks to make some money while they wait for payments to come through but once they’re in it again, it can be very difficult to leave.”

Alice is, in many ways, in a much safer environment than the women resorting to on-street sex work. She finds her clients through the internet and coordinates them through a work phone and email address. “Ninety per cent of sex work is admin,” she laughs. But she admits that, even working in this safer environment, she is sometimes more vulnerable because of her mental health. If she is hypomanic, she doesn’t just take on more work but forgoes safety checks: during those periods, she is active, creative, energised, “and everything seems a good idea”. “It’s not necessarily safe. I make riskier decisions – like driving two hours to somewhere I don’t know at 3am,” she says.

The government is making it deliberately as confusing, intimidating and difficult as possible

Alice is doing this at a time when women generally, let alone those contending with health problems, are facing an increasingly arduous labour market. The push to insecure, low-paid work in recent years has disproportionately affected women, who are already more likely than men to be in part-time or low-waged roles. Since the start of the global crash in 2008, 826,000 extra women have moved into low-paid and insecure work in the UK, according to the Fawcett Society. At the same time, the number of female part-time workers who would like to be working full-time has nearly doubled, to 789,000.

This shift to precarious work will likely exacerbate what are already poorer working opportunities for those women with disabilities. Research by Comic Relief in 2017 found that as much as 50% of the work disabled people perform is in low-paid, short-term and part-time roles, meaning female disabled workers are contending with the impact of both sex and disability. Even cuts to disability benefits are, in some ways, gendered. Women are more likely to be disabled – there are around 6.4 million disabled women in the UK compared to 5.5 million disabled men – and the Women’s Budget Group in 2018 found that almost six in 10 individuals claiming PIP are women.

When we next talk, Alice has just received a large pack of documents from the Department for Work and Pensions: 100 A4 pages front and back. She needs to read and understand all of them before her tribunal appeal of her PIP rejection; a process that has, overall, taken the best part of a year so far. “The government is making it deliberately as confusing, intimidating and difficult as possible,” she says. A local disability charity has been helping her navigate the appeal, but lottery funding – its only source of income – is due to run out in a few months’ time and Alice is worried she will be left to take on officials at the tribunal alone. “It’s all very overwhelming and distressing,” she says. “I really need the government to recognise that I have next to no income and it is a direct result of being disabled.”

Her mental health is deteriorating as a result and she has been put under the care of her local crisis team for suicide prevention after developing suicidal feelings. Despite sending out multiple CVs each day she is, more than ever, “not in a place where I can manage a traditional job”. Alice is trying to formally withdraw from her degree so she is eligible for ESA, and with it she might finally get a bit of support from the benefit system. In the meantime, it is a case of borrowing money from friends, credit cards and her growing bank overdraft. “I don’t know what to do at this point,” she admits. “I’m treading water. Or at least delaying my drowning through … sex work.”

Names have been changed.

This is an edited extract from Crippled: Austerity and the Demonization of Disabled People, by Frances Ryan, published by Verso on 11 June. To order a copy for £8.99 (RRP £12.99) go to guardianbookshop.com . Free UK p&p over £15, online orders only.