Mental Health Support Team Referral Form

Introduction

Please note that we are an early intervention Mental Health Support Team and do not offer urgent care. Our service hours are Monday to Friday 9am to 5pm.
If you think there is significant risk please contact the Child and Adolescent Mental Health Service (CAMHS) directly on 0300 365 1234 or Children’s Services on 0118 937 3641.
If there is an immediate danger call 999.
Support and advice is also available from Childline 0800 1111, Samaritans 116 123, or your GP surgery.
This service is currently available to children and young people who attend the following schools: Blessed Hugh Faringdon, Prospect, The Wren, Cranbury College, Battle Primary, Churchend Primary, English Martyrs, Manor Primary, Meadow Park Primary, Moorlands, Oxford Road, Park Lane, Ranikhet, St Michael's Primary, and Wilson.
Please complete this form in full. If the form is not completed fully, we reserve the right not to accept the referral.

Consent

If the child or young person is below 16 years old consent is required from a parent or carer with parental responsibility.
Statement of Consent from parent/carer: I give permission for my child to be considered for Mental Health Support Team (MHST) involvement. I understand that this request will be considered and I will be notified of the outcome. If an assessment and/or intervention is agreed then, I understand that I will be informed of the date(s) when this work will take place and that I will be invited to meet with the practitioner. I understand and agree that information may be shared with other professionals involved with my child if/when appropriate.
Your child's data is subject to our data protection policy (website link below) and information will be held on a secure computer system / filing system at Brighter Futures for Children to support this work. Information about your child’s involvement with the MHST may be entered to a secure data base and shared anonymously with the Department of Health for data reporting purposes. For further information about Brighter Futures for Children’s Data Protection Policy, please see website: https://brighterfuturesforchildren.org/privacy-policy/ (for security please copy and paste the URL into a new browser)

Details of person completing this form

About the child or young person being referred

About the request for support from MHST