Angus Mental Health and Wellbeing ECS Hub Self Referral Form

Angus Mental Health and Wellbeing ECS Hub 

 

REFERRAL FORM  

 

Who is the Hub For? 

 

Anyone aged 16 or older living in Angus who needs support with mental health, wellbeing or substance use. 

 

About the Hub 

 

The Mental Health and Wellbeing Hub is a service that reviews referrals for individuals needing support with mental health, wellbeing, self-harm, or substance use. Staff from the following services will review your referral, Community Mental Health Teams (CMHT), Angus Integrated Drug and Alcohol Recovery Service (AIDARS), Psychological Therapies, Peer Support, and Community Link Workers. You will be contacted or offered an appointment with one of these services. 

 

Important Information 

 

By submitting this form, you consent to the sharing of your information within the Hub team. 

 

This form is not for urgent or emergency support. If you need immediate help, please contact your GP or emergency services. 

 

 

Signed  

Date 

Please sign to confirm you understand the above  

 

 

 

 

 

 

 

 

 

 

NEXT STEPS  

 

Complete and Submit the Referral Form either by: 

 

  • Emailing it to your local Hub (email addresses are at the end of this form). 

  • Hand it in at your GP practice reception. 

 

Screening Process: 

 

  • Your referral will be reviewed within one working day. 

  • You’ll receive a phone call or letter within 10 working days about the outcome.  

 

 

Type of Referral 

 

 

DATE: 

Self-Referral  

(Please tick YES or NO) 

YES 

NO 

Completed on your behalf (with consent) 

(Please tick YES or NO) 

YES 

NO 

 

Have you read the Service Information leaflet 

YES 

NO 

If this is completed on your behalf please provide further details 

Name of person 

completing referral: 

 

 

 

 

Relationship: 

 

 

Team/Service: 

 

 

PERSONAL DETAILS 

Name: 

 

DOB: 

 

Address: 

 

 

 

Postcode: 

 

Contact Number: 

 

Email Address: 

 

GP Practice: 

 

 

 

Why do you want support? 

 

 

 

Please tick all that apply 

Anxiety 

 

Low Mood 

 

Depression 

 

Stress 

 

Loneliness/Isolation 

 

Alcohol use 

 

Drug use 

 

Bereavement 

 

Housing issues 

 

Debt/Financial Worries 

 

Relationship difficulties 

 

Relapsing mental health disorder 

 

Self-harm 

 

Suicidal thinking 

 

Other (please advise why you want support) 

 

 

 

For the boxes you have ticked.  How does this affect you? 

 

 

 

 

 

 

 

 

What type of support are you looking for? 

 

 

Please tick all that apply 

Advice and information 

 

To talk to someone 

 

Help with problem solving 

 

Help in a crisis 

 

Relapse prevention 

 

Risk management 

 

Group work 

 

Online support 

 

Identifying goals and how to reach these 

 

Supporting behaviour change 

 

Self-Directed Support 

 

Carers Support 

 

Other (please advise of support wanted) 

 

Any other information you would like us to know about the support you are looking for? 

 

 

 

 

 

Has anyone helped you in the past or is helping you now?  What help have they given you?  

E.g. Family of Mental Health Support organisations, Community Mental Health Team, Penumbra, Angus Integrated Drug and Alcohol Recovery Service, Tayside Council on Alcohol, Mental Health and Wellbeing Peer Support, Psychology, Community Link Worker, Listening Service, Counselling, Carers Centre, Family, Friends. 

 

 

 

 

 

 

 

 

 

 

 

 

 

Any other information you would like the hub to be aware of?   

 

 

 

 

 

 

 

 

 

 

 

 

Thank you for completing this referral form with as much detail as you can, to help us to provide you with the right support to meet your needs. 

 

What Happens Next? 

 

The outcome of your referral might include: 

 

A Phone Call - You may be contacted to discuss your needs and learn about available support. Please note that calls may come from an NHS blocked number. 

 

Pre-Appointment Tasks - You might be asked to complete tasks such as: 

 

  • Gathering information relevant to your appointment. 

  • Reading helpful articles. 

  • Keeping a mood diary or answering questions. 

 

Completing these tasks will help us understand your needs better and ensure you get the right support. Please bring any completed tasks to your appointment. 

 

Please email the completed referral form to the Hub where you live: 

 

North East (Brechin, Edzell, Montrose and surrounds) - tay.angusmhwhub@nhs.scot    

North West (Forfar, Kirriemuir, Letham and surrounds) - tay.angusnwhub@nhs.scot   

South East (Arbroath/Friockheim and surrounds) - tay.southeastangushub@nhs.scot   

South West (Carnoustie/Monifieth and surrounds) - tay.southangushub@nhs.scot   

Last Updated: 20/12/2024

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