Sally Higgins is a mental health nurse with Forward Leeds. Her pioneering role is at the intersection of addiction, trauma, safeguarding, and outreach work with women involved in street-based sex work.
In a new and almost unique role, Sally provides dedicated mental health support to women alongside the Sex Worker Outreach Team at Forward Leeds. Sally offers a level of consistency, advocacy, and accessibility that many UK services cannot reach.
A Role Built for People Who Fall Between the Gaps
Sally has worked at the city’s alcohol and drug support service, since 2022 within the Co-occurring Mental Health, Alcohol and Drugs (COMHAD) team where she is employed by Leeds and York Partnership NHS Foundation Trust (LYPFT) as part of the Forward Leeds partnership.
It was there that Sally, along with colleagues in the Sex Worker Outreach Team, noticed a persistent problem. Women they supported had extremely high levels of unmet need but current mental health services struggled to meet these women where they were.
Missed appointments, lack of fixed address, chaotic life circumstances, and trauma-related avoidance frequently resulted in women not being able to get the support they need.
Her new role, launched in September 2025 was created to solve that problem. It allows Sally to carry her COMHAD expertise directly into the outreach environment, without waiting for formal assessments or appointments in one of the Forward Leeds hubs.
“Aggressive Outreach”: Meeting People Where They Are
Sally’s work is almost entirely street-based. Most days begin at a Forward Leeds hub, planning the day with Recovery Coordinators in the Sex Worker Outreach Team. Then she’s out in Holbeck, Beeston, Armley, or Harehills, wherever she thinks the women are likely to be that day.
Her support isn’t delivered in therapy rooms or offices, but on pavements, in parks, in cars, and sometimes outside houses known for drug activity. The approach is flexible, patient, and rooted in consistency.
Sally said: “It’s just sort of showing face and being consistent and showing them that I’m someone that is going to keep turning up.
“And then once we’ve built that little bit of rapport and trust, we have some conversations about their mental health, what they’re concerned about, what type of support they think that they need.”
One of the people Sally is working with told her: “I’m not ready for therapy, but I need someone to help me understand what I’m going through. People think drugs cause my mental health to be bad, but I use drugs because of what I’ve been through.”
Too often women find that mental health support services say, ‘come back when the chaos is sorted’, meaning when housing, safety, sobriety, and stability are in place. As Sally points out, some of the women she helps have been in the same circumstances for a decade or more. Waiting for “stability first” can mean they never receive mental health support at all.
Sally’s presence means women who would normally fall out of community services get another chance. She attends meetings, advocates for women who struggle to speak for themselves, and personally brings individuals to assessments if that’s what it takes. The difference is profound: without her, many would simply be discharged for non-attendance.
Supporting the Workforce as Well as the Women
The nature of the work is emotionally heavy. Sex Worker Outreach staff witness relentless sexual violence, exploitation, deprivation, and harm. Winter brings particular strain cold, dark nights spent driving around searching for women shivering on the roadside with nowhere safe to go.
Sally offers reflective sessions and day-to-day emotional support to her colleagues, something that would be impossible without her dedicated role.
A Unique Service with National Significance
Roles like Sally’s barely exist in the UK. Within the NHS this level of specialist, embedded mental health support for sex workers is virtually unheard of.
Yet the impact is unmistakable. Colleagues describe her role as “exceptional,” and the value has already become clear to the outreach team, Forward Leeds leadership, and external partners.
As Sally puts it: “It is niche, but I’m really proud of what I do, and I hope to stick around and keep doing this for some time to come.”