North Cumbria Talking Therapies Self-Referral Form

NHS North Cumbria Talking Therapies Self-Referral Form

NHS North Cumbria Talking Therapies for Anxiety and Depression sees adults who are registered with GP Practices in Carlisle, Eden, Allerdale and Copeland. If you are registered with a practice outside these areas, please contact your GP or NHS Choices for details of similar services in your area. If you feel that your mood is deteriorating, please contact your own GP.  The Samaritans are available 24 hours a day on 116 123.  If you need urgent help with your mental health, you can contact the Trust`s 24-hour helpline on 0800 652 2865.

• If you are seeking help for a problem such as psychosis, bipolar disorder or a personality disorder, NHS North Cumbria Talking Therapies are unable to offer the appropriate treatments, please speak with your GP about the treatment options available.
• Due to the health risks associated with disordered eating NHS 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.
• Due to the impact that some neurological conditions can have on mental health and our need to understand this to best help the patient, there are times when we will not be able to accept self-referrals for some patients. We may need to decline a self-referral and we will write to the GP asking them to make a direct referral including the essential information.

Please complete the following details using block capitals:

Should we need to contact you by phone this would be within working hours (this will show as a withheld number), please let us know which number is best to reach you on during the day.  If this method of communication is not suitable, please let us know       

Consent

I consent to you contacting the relevant GP or other services to obtain further information and to share relevant information if required in line with NHS Confidentiality agreements. I am aware information about my care and treatment will be stored within the Trusts Electronic Patient Record (EPR).

If we think it would be more helpful for your referral to be considered by a different service within CNTW, our NHS Trust, or if you are registered with a Copeland GP, Hope Haven (an integrated neighbourhood service), we will share your referral and associated information with them. Please see the Trust’s Fair Processing Notice at https://www.cntw.nhs.uk/foi/data-protection/

Please return the form to North Cumbria Talking Therapies, Elmwood, 2a Tynefield Drive, Penrith, CA11 8JA or email to nctalkingtherapies@cntw.nhs.uk

Once the form has been sent, please allow 3 working days then ring 0300 123 9122 (Monday-Friday 8:30am–5:30pm) to book a telephone assessment appointment. If you require someone to book your appointment, you 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.