Completing the following referral form should take 10-15 minutes. We ask a range of questions about various aspects of your mental health and your life in general. We appreciate that it might seem like a lot of questions to answer but the information you provide allows us to offer you the right services for your needs.

If you would like further information please email us on spoe@mindchwf.org.uk.

Due to government guidelines on Covid-19 and social distancing, we have been working alongside our partner organisations to create an alternative offer of online support that can be accessed remotely.

Please complete the referral form and screening questions and you will be given access to these resources. You will be offered free access to a wide of range of online resources that focus on the management of anxiety, low mood and stress.

This new online offer of support will include:

• Access to online self-help modules in the NHS approved Silvercloud programme.
• Access to bespoke online webinars & videos created by experienced therapists and wellbeing practitioners.
• Participation in peer groups

Please note that you will not be contacted for an assessment to access this online support. We’ll send you an email with an access link to each resource as and when they become available.

If you are at immediate risk please contact emergency services or go to A&E. For urgent support or if you are in crisis or distress please contact the City & Hackney Crisis Pathway Service 24 hour helpline on 020 8432 8020.

Please note our mental health and wellbeing services are only available to people who live in the borough of Hackney or the City of London.

Privacy statement:

We want everyone who comes to us for support, to feel confident and comfortable with how any personal information you share with us will be looked after. This Privacy Policy sets out how we collect, use, and store your personal information (this means any information that identifies or could identify you). Our Data Protection Officer makes sure we respect your rights and process your personal information according to the law. If you have any concerns or questions about how we look after your personal information, please contact the Data Protection Officer.

The Privacy Policy may change so please remember to check back from time to time, this is version V1 and was last updated in Jan 2020. Where we have made any changes to this Privacy Policy, we will make this clear on our website or contact you about any changes. We are committed to treating you with respect and openness.

Unfortunately, we are unable to receive your referral without this consent. Please close the page to exit.

During the course of accessing our services, we will need to contact the person you are referring by telephone. If we are unable to get through, please check with them that they are happy for us to: .

During the course of accessing our services, we will need to contact you by telephone. If we are unable to get through, are you happy for us to: .

Address

Below are some statements about feelings and thoughts.

Please enter the number that best describes your experience of each over the last 2 weeks based on the below:

1. = None of the time
2. = Rarely
3. = Some of the time
4. = Often
5. = All of the time