Self Referral Form

If you feel that your mood is deteriorating, please contact your own GP. If you need urgent help with your mental health, you can contact the Trust's 24 hour helpline on 0800 652 2865. The Samaritans are available 24 hours a day on 116 123

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.

NHS North Cumbria Talking Therapies sees adults who are registered with GP Practices in Carlisle, Eden, Allerdale and Copeland only. If you are registered with a practice outside these areas please contact your GP or NHS Choices (www.nhs.uk) for details of similar services in your area.

If you selected no, please contact the service that covers your area. If you are in South Cumbria (i.e. Furness, South Lakeland) please contact First Step South Cumbria at https://www.lscft.nhs.uk/first-step

It is important to us that we make our service fair and easy to access for all groups within the North Cumbria population. For this reason, we want to collect information on groups that might encounter difficulties in getting the help, so that we can make changes.

Should we need to contact you by phone this would be within working hours (this will show up 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.

If you feel that your mood is deteriorating, please contact your own GP. If you need urgent help with your mental health, you can contact the Trust's 24 hour helpline on 0800 652 2865. The Samaritans are available 24 hours a day on 116 123.

I consent to you contacting the relevant GP or other services for further information if required in line with NHS Confidentiality agreements. I am aware information will be stored on a database.

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.

Please note that referrals are usually reviewed by a clinician within two working days (Monday-Friday)