Model of care

Who this is for

People who are pregnant, postpartum, or planning pregnancy and are experiencing mental health difficulties such as postpartum depression, postpartum psychosis, or pregnancy-related anxiety. This includes pregnancy mental health support for those experiencing distress after a difficult pregnancy, birth experience, perinatal loss, miscarriage, or infertility.

What this can look like (postpartum)

Pregnancy and postpartum mental health symptoms vary from person to person. They often cluster into a few common patterns:

• Low mood and loss of enjoyment: feeling sad, crying more than usual, feeling hopeless or lonely, losing interest in things that normally matter, feeling very tired, or feeling weighed down by guilt.

• Anxiety and panic: excessive worry, restlessness, feeling on edge, panic attacks, or a strong fear that something bad will happen to the baby. Anxiety can sometimes come with physical symptoms such as headache, chest tightness or pain, a racing heart, or feeling short of breath.

• Fear related to pregnancy or birth (tokophobia): ongoing distressing fear about pregnancy or childbirth, including after a difficult or traumatic birth experience, which can lead to panic, avoidance, or persistent worry about future pregnancies or medical care.

• Intrusive thoughts and compulsive behaviours: unwanted, upsetting thoughts or images (often about harm coming to the baby), and feeling driven to check, seek reassurance, or repeat certain behaviours, even when there is no intention to act on the thoughts.

• Changes in bonding and day-to-day functioning: feeling disconnected, not enjoying time with the baby, feeling either “too little” or “too much” focus on the baby, difficulty with self-care, withdrawing from others, trouble concentrating, feeling agitated or slowed down, or more conflict at home.

• Safety concerns: thoughts about harming yourself, or fears about harming yourself or the baby. If there is immediate risk, seek urgent help.

What happens in appointments

• Time to understand the full history, including mental health, physical health, medications, and perinatal context

• A structured management plan, which may include a Mental Health Care Plan when appropriate and Sensitive Birth Plan

• Perinatal counselling and practical strategies when appropriate (for example PREPP: Practical Resources for Effective Postpartum Parenting)

• Medication review and options within scope, with consideration of perinatal safety and breastfeeding where relevant

• Coordinating care with the existing team when indicated (for example GP, midwife, obstetric team, psychologist)

• Planning investigations where relevant (for example blood tests)

• Follow-up planning

Boundaries and urgent support

• This is not a crisis or emergency service.

• If there is immediate risk of harm to self or others, call 000 or attend an emergency department.

• If you are concerned about immediate safety for a baby or child, seek urgent support.

• No formal report assessments for medico-legal, court, or compensation-related matters.

FOR HEALTH PROFESSIONALS 🩺

When to involve Sabrina

• EPDS high, ANRQ high

• Perinatal depression or anxiety that is persistent, severe, or functionally impairing

• Significant intrusive thoughts, panic symptoms, or sleep disruption with safety or functional concerns

• Comorbidity (BPAD, ASD, ADHD), complexity, or partial response to first-line primary care support

• Risk concerns where additional assessment and care coordination would help

• Preconception medication review, medication review while pregnant

Who this is for

People seeking ADHD assessment, ADHD diagnosis, or support for longstanding attention, organisation, or impulsivity difficulties. This often overlaps with anxiety, low mood, sleep disruption, burnout, trauma history, or personality disorder, and it is not always clear what is primary. This service also provides youth mental health support for children and adolescents with neurodivergence or emerging mental health concerns.

What this can look like

• Difficulty sustaining attention, planning, or completing tasks

• Chronic disorganisation, forgetfulness, or losing track of time

• Overwhelm, burnout, or “all-or-nothing” productivity patterns

• Emotional dysregulation, irritability, or feeling easily stressed

• School, study, or work functioning difficulties

• Sleep problems in children and adults that worsen ADHD symptoms, attention, and mood

• A mixed picture where anxiety, depression, trauma, or substance use may be contributing

• In younger people: school refusal, declining school performance, or social difficulties can be part of the presentation

• In younger people: family stress, conflict, or significant life changes can worsen attention, mood, and behaviour

What happens in appointments

• Time to understand the full impact, including developmental history, mental health, physical health, sleep, and functioning

• Comprehensive assessment where relevant, including family, school, and developmental context

• Clarifying priorities and mapping contributing factors (including overlap with anxiety, mood, sleep, trauma, substance misuse)

• A structured plan, which may include a Mental Health Care Plan or coordination with other services when appropriate

• ADHD medication review and options within scope when clinically appropriate

• Coordinating referrals, investigations, or supports where indicated

• Referral pathways and liaison with other clinicians where appropriate

• Follow-up planning

Boundaries and urgent support

• This is not a crisis or emergency service.

• If there is immediate risk of harm, call 000 or attend an emergency department.

• If urgent child and adolescent mental health intervention is required, appropriate urgent pathways are needed.

• If a service requires specialist-only diagnosis or treatment, the pathway is explained and appropriate referrals may be recommended.

• No formal report assessments for medico-legal, court, or compensation-related matters.

FOR HEALTH PROFESSIONALS 🩺

When to involve Sabrina

• ADHD complexity, comorbidity, or diagnostic uncertainty

• Significant functional impairment (work, study, relationships)

• Partial response to first-line support, or difficulty tolerating standard approaches

• Medication complexity or need for careful review within scope

• Functional impairment at school or home (where relevant)

• Risk concerns where additional assessment and care coordination would help

Who this is for

Women experiencing mood, anxiety, sleep, or cognitive changes that may relate to menstrual cycle changes, perimenopause, or menopause. This includes support for perimenopause symptoms, menopause symptoms, PMDD diagnosis and management, and PMS-related mental health concerns. Symptoms can overlap with physical health concerns and other mental health conditions. Sabrina provides a women's health GP perspective that integrates hormonal and psychological wellbeing.

What this can look like

• Mood and anxiety changes that come in waves: irritability, mood swings, feeling low or flat, anxiety, panic symptoms, “rage” that can fluctuate with the cycle.

• Sleep and energy changes: sleep problems during menopause or perimenopause, unusual tiredness, fatigue, and reduced concentration or "brain fog".

• Body symptoms that can travel together: hot flushes, headaches, light-headed feelings, muscle and joint pain, and backache.

• Weight and metabolic changes: perimenopause weight gain, changes in body composition, or difficulty managing weight alongside mood and energy changes.

• Skin and sensory changes: dry skin, itchiness, or crawling sensations under the skin.

• Bladder symptoms: recurrent urinary discomfort or UTIs.

• Sexual and vaginal symptoms: less sexual interest, vaginal dryness, or uncomfortable intercourse.

• Changes you might notice in the body: new facial hair.

• A mixed picture: symptoms can be hard to separate into “hormonal” versus “mental health”, especially with a history of perinatal mental health challenges, trauma, or long-standing anxiety or depression.

What happens in appointments

• Comprehensive history, including mental health, physical health, menstruation, medications, and symptom pattern over time

• Clarifying likely contributing factors and priorities for support

• A structured plan, which may include lifestyle management, education, and perimenopause treatment or menopause treatment options (hormonal or non-hormonal) when appropriate

• Medication review within scope when clinically appropriate

• Coordination with other clinicians when indicated (for example regular GP, gynaecology, endocrinology, rheumatology)

• Planning investigations where relevant (for example blood tests, US vaginal, CST, mammogram, DEXA scan)

• Follow-up planning

Boundaries and urgent support

• This is not a crisis or emergency service.

• If there is immediate risk of harm, call 000 or attend an emergency department.

• No formal report assessments for medico-legal, court, or compensation-related matters.

FOR HEALTH PROFESSIONALS 🩺

When to involve Sabrina

• Complex presentations with mixed mood, anxiety, sleep, and physical symptoms

• Significant impairment, treatment resistance, or diagnostic uncertainty

• Need for careful medication review within scope alongside physical health considerations

Who this is for

People experiencing anxiety symptoms, depression symptoms, or stress-related presentations. This also includes assessment and management of bipolar disorder, OCD, PTSD, ADHD, schizophrenia, personality disorder, and older adult mental health concerns including dementia symptoms and dementia support.

What this can look like

• Ongoing worry, rumination, panic symptoms, or physical anxiety symptoms, including anxiety attacks

• Persistent low mood, tearfulness, irritability, or loss of motivation, common depressive symptoms

• Reduced functioning at work, study, or home

• Avoidance, social withdrawal, or difficulty leaving the house

• Sleep disturbance and fatigue

• Symptoms in the context of significant life stressors, grief, or long-standing patterns

• OCD symptoms such as obsessions, compulsions, intrusive thoughts, reassurance seeking, or checking behaviours

• Mood episodes (for example periods of elevated mood/energy, reduced need for sleep, or marked mood swings)

• Longstanding interpersonal, emotional regulation, or behavioural patterns causing functional impairment, including personality disorder presentations

• PTSD symptoms such as flashbacks, hypervigilance, avoidance, or emotional numbing following trauma

• Cognitive changes, behavioural changes, distress, or carer/family concerns in later life (including dementia-related mental health concerns)

• Mixed presentations where physical health, medications, alcohol/drug use, or trauma may contribute

What happens in appointments

• Comprehensive history and assessment of mental and physical health factors

• Clarifying priorities, risk, and what support is most appropriate

• A structured management plan, which may include a Mental Health Care Plan when appropriate

• Focused Psychological Strategies (FPS) treatment and counselling

• Anxiety medication, depression medication, OCD medication, or PTSD medication review and options within scope when clinically appropriate

• PTSD treatment, personality disorder treatment, and dementia support planning where relevant

• Coordination of investigations and referrals where indicated (outpatient support, inpatient referral, liaison with support worker)

• Follow-up planning

Boundaries and urgent support

• This is not a crisis or emergency service.

• If there is immediate risk of harm, call 000 or attend an emergency department.

• No formal report assessments for medico-legal, court, or compensation-related matters.

FOR HEALTH PROFESSIONALS 🩺

When to involve Sabrina

• Persistent or severe symptoms, functional impairment, or comorbidity

• Risk concerns, complexity, or partial response to first-line primary care support

• Diagnostic uncertainty (including bipolar disorder, OCD, PTSD, personality disorder, or dementia-related mental health concerns)

• Need for careful medication review within scope

Who this is for

People seeking support for weight-related concerns or disordered eating patterns, particularly when mood, anxiety, sleep, trauma history, medical conditions, or medications may be contributing. This can include people who are unsure whether their eating disorder symptoms meet criteria for a formal diagnosis, or who need a structured eating disorder care plan.

What this can look like

• Preoccupation with weight, shape, food rules, or body image distress

• Restrictive eating, loss of appetite, or avoiding food groups

• Binge eating, loss of control with eating, or eating in response to stress

• Purging behaviours (vomiting, laxative misuse) or compulsive exercise

• Weight changes with low mood, anxiety, sleep disruption, or medication effects

• Fatigue, irritability, poor concentration, or physical symptoms related to nutrition

• Health anxiety or shame that makes it hard to seek help

What happens in appointments

• A comprehensive history, including eating pattern, weight history, body image concerns, exercise, and triggers

• Screening for eating disorder risk and medical red flags

• Review of mental health contributors (anxiety, low mood, trauma, sleep) and physical health factors

• A structured plan, which may include an Eating Disorder Plan when appropriate

• Medication review within scope when clinically appropriate

• Coordinating referrals and supports where indicated (dietitian, psychologist, specialist eating disorder services)

• Planning investigations where relevant (for example blood tests, ECG) and follow-up planning

• GLP-1 indication

Boundaries and urgent support

• This is not a crisis or emergency service.

• If there is immediate risk of harm, call 000 or attend an emergency department.

• If there are signs of medical instability or high eating disorder risk, urgent medical assessment and specialist pathways are needed.

• No formal report assessments for medico-legal, court, or compensation-related matters.

FOR HEALTH PROFESSIONALS 🩺

When to involve Sabrina

• Disordered eating with significant distress or functional impairment

• Medical risk concerns, rapid weight change, or diagnostic uncertainty

• Comorbidity (anxiety, depression, trauma, ADHD, ASD, ARFID) complicating management

• Medication review needs within scope

Who this is for

People whose alcohol or drug use is causing distress, health concerns, relationship or work impacts, or is complicating anxiety, depression, sleep problems, ADHD, or trauma-related symptoms. This includes support for alcohol misuse disorder and related mental health presentations.

What this can look like

• Increasing use over time or difficulty cutting down, common alcohol misuse symptoms

• Using substances to cope with stress, sleep problems, anxiety, or low mood

• Cravings, loss of control, or risky use (driving, unsafe situations)

• Withdrawal symptoms, tolerance, or morning use

• Blackouts, memory gaps, or poor decision making when using

• Functional impacts (work/study, parenting, relationships, finances)

• Worsening mood, anxiety, irritability, or sleep disruption related to use

What happens in appointments

• A non-judgemental substance use history (type, amount, frequency, pattern, triggers)

• Review of mental health and physical health contributors, and current safety risks

• Clarifying goals (reduction, safer use, or abstinence) and mapping supports

• A structured plan, which may include a Mental Health Care Plan when appropriate

• Medication review within scope when clinically appropriate

• Referral pathways and coordination where indicated (GP, counselling, AOD services, detox/withdrawal services)

• Follow-up planning and relapse prevention supports where relevant

Boundaries and urgent support

• This is not a crisis or emergency service.

• If there is immediate risk of harm, call 000 or attend an emergency department.

• Acute intoxication, severe withdrawal, or medical instability needs urgent care.

• No formal report assessments for medico-legal, court, or compensation-related matters.

FOR HEALTH PROFESSIONALS 🩺

When to involve Sabrina

• Substance use complicating mental health presentations or treatment response

• Safety concerns, diagnostic uncertainty, or significant functional impairment

• Complex comorbidity (anxiety, depression, trauma, ADHD) alongside use

• Medication review needs within scope

Who this is for

People experiencing insomnia symptoms or persistent sleep disruption that is distressing or affecting daytime function. Sleep issues often overlap with anxiety, depression, ADHD, perimenopause, menopause, and physical health concerns.

What this can look like

• Difficulty falling asleep, staying asleep, or waking too early, common insomnia symptoms

• Non-restorative sleep with fatigue, irritability, or low mood

• Racing thoughts, anxiety at night, or fear of not sleeping

• Sleep problems during menopause or perimenopause

• Sleep disruption alongside shift work, parenting demands, pain, or health conditions (sleep apnea, OSA)

• Daytime concentration difficulties and reduced functioning

• Reliance on alcohol, sedatives, or over-the-counter sleep aids

What happens in appointments

• Comprehensive sleep history, including routines, triggers, and contributing factors

• Review of mental and physical health factors that may affect sleep

• A structured insomnia treatment plan, which may include a Mental Health Care Plan when appropriate

• Medication review within scope when clinically appropriate

• Planning investigations where relevant (for example blood tests), and referral pathways if indicated (for example sleep physician)

• Follow-up planning

Boundaries and urgent support

• This is not a crisis or emergency service.

• No Benzodiazepines prescription on first consultation or over the phone.

• If there is immediate risk of harm, call 000 or attend an emergency department.

• No formal report assessments for medico-legal, court, or compensation-related matters.

FOR HEALTH PROFESSIONALS 🩺

When to involve Sabrina

• Persistent insomnia with significant distress or functional impairment

• Sleep issues with comorbid anxiety, depression, ADHD, PTSD, PND or perimenopausal symptoms

• Medication complexity, dependence concerns, or need for careful review within scope

• Diagnostic uncertainty or complexity requiring coordinated approach