Professional MHST referral form

There are 8 sections to complete on this form.

In sections 1 to 7 we ask for information about consent and contact details.

In section 8 you can tell us about the reason for making this referral.

This form may take around 10 to 20 minutes to complete.

Sometimes, when people feel sad or worried, they might have thoughts about hurting themselves. You can still make a referral to our service if the child or young person is having these thoughts, but only if they do not have any plans to act on them.

I confirm the child or young person is not planning to act on their thoughts of self-harm

I confirm the child or young person is not thinking about attempting to end their life

If the child or young person does have plans to hurt themselves and you feel they/parent/carer can’t keep them safe, it’s very important to get help straight away.

You can:

contact First Response Service by calling 111 and selecting the mental health option
attend an A&E department

If the child or young person does have plans to hurt themselves but you feel they can keep safe, you can make a referral to YOUnited. Please be aware your referral may not be reviewed by YOUnited immediately.

MHST does not provide an emergency response or crisis support.

I confirm I understand the above to proceed with the referral

I understand that if the MHST does not cover the child or young person's school, the referral will be sent directly to YOUnited

Cambridgeshire and Peterborough

Cambridgeshire

Peterborough

Professional MHST referral form

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