(Only to be used by registered health professionals who have access to sufficient clinical information to fully complete this form, other staff should use the Supported Self-Referral Form)  

North Cumbria Talking Therapies provides short-term talking therapies for adults (18 and over) in North Cumbria with mild to moderate mental health problems including depression, anxiety disorders.  

Exclusion criteria include  

  • individuals presenting with high risk (e.g. plan or intent for suicide, presents a danger to others) 

  • individuals currently open to secondary care mental health services 

  • individuals for whom a brief intervention would increase risk or be detrimental (e.g. individuals requiring input for a personality disorder, bipolar disorder or psychosis). 

Due to the health risks associated with disordered eating North Cumbria Talking Therapies is not able to accept self-referrals for this problem. For safety reasons, we require patients to see their GP and have the appropriate physical health checks completed and then discuss with their GP which service might be the most helpful. The GP is then able to make a direct referral. 

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Please tick the boxes below to indicate any risk considerations. Required

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Thank you for completing this form, please return via email (nctalkingtherapies@cntw.nhs.uk)  

Once the form has been sent, the patient should allow 3 working days then ring 0300 123 9122 (Monday-Friday 8:30am–5:30pm) to book a telephone assessment appointment. If they require someone to book their appointment, they will also need to be present as we collect important personal information during that call. Failure to contact the service within seven days of sending the form will result in the referral being closed. 

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