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Self-Referral form Tower Hamlets CAMHS

Self-Referral form Tower Hamlets CAMHS

Childrem

Self-Referral form Tower Hamlets CAMHS

If you have difficulties reading or writing please call 0207 426 2375/2400 and a clinician will call you between Monday and Friday between 09:00 – 17:00hrs.  If anything changes once you have completed the form and sent it to us, please call us on the above numbers.

If it is an emergency please go to A&E or tell a responsible adult or someone you trust. In non-emergencies please contact NHS 111 which is an out-of-hours service. Take a look at our list of services here that can help.

If this form relates to someone where there are immediate concerns about their health and safety, do not use this form. Please call us on 0207 426 2375/2400 and out of hours crisis contact numbers. 

Relationship to the young person being referred
Please enter the details of the young person being referred.
Please specify whose number it is (e.g 07xxx xxxx - parent).
A copy of your referral will be sent to this email address.
Can we contact your parents or carers regarding this referral?
Do you receive Special Educational Needs and Disabilities support (SEND support) at school?
Do you have an Educational, Health and Care Plan (EHCP)?
Do you give consent for CAMHS to make contact with the agencies / professionals or social care involved in your child’s care?
Are you in contact with other agencies / professionals (e.g Other Healthcare professionals or Social Care)?
(How are you feeling?)

The following section is for our monitoring purposes. We would appreciate if you could please complete it as much as you are able to. Don’t worry if you do not wish to provide some or all of the details. This will not affect the support we are able to offer you.

Do you need an interpreter?
What is your ethnic origin? Please tick below.
What is your gender?
What is your sexual orientation?
What is your pronoun(s)
By referring yourself to Tower Hamlets, you are agreeing that the service may contact and share relevant information with your GP to facilitate your care. We work with other community partners to ensure we can offer assessments/treatments to residents as soon as possible. It could be that your assessment/treatment is delivered by one of the partners and by referring you are agreeing to your data being shared with them in order to deliver your assessment/treatment. Our partners follow our own data protection and confidentiality policies.

What happens to your referral?

  • East London Foundation Trust (ELFT) provides specialist CAMHS services in five boroughs; City & Hackney, Tower Hamlets, Newham, Bedfordshire and Luton.
  • Each service offers the same process for safe consistency in the management of referrals; this is via a local Single Point of Entry (SPOE).
  • All referrals are discussed with the young person, their family, and/or the referrer in order for the specialist clinical triage team to gather all relevant information, this helps inform the team to make a detailed clinical decision regarding the most appropriate treatment pathway for your presenting need based on risk to ensure your referral receives the right help at the right time.
  • Once a decision has been made you will receive confirmation from the team to inform you of the outcome of your referral, this may include offering an episode of care within CAMHS or signposting to local services who are better suited to meet your needs.
  • A copy of the clinical decision-making will be sent to you and copied to your GP for continuity of care.
  • If anything changes once you have completed the form and sent it to us, please call us on T: 01525 638 613.