Young person's MHST referral form

Three teenagers sitting on the ground laughing with each other

There are 7 sections to complete on this form.

In sections 1 to 5 we ask for information about you, including consent and contact details.

In sections 6 and 7 you can tell us about your reason for making this referral.

This form may take around 15 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 you have these thoughts, but only if you do not have any plans to act on them.

I confirm I am not planning to act on my thoughts of self-harm

I confirm I am not thinking about attempting to end my life

If you do have plans to hurt yourself and feel you can’t keep yourself 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
speak with a trusted adult (such as a parent) so they can help you stay safe and find the right support. This may include contacting your GP for support

If you do have plans to hurt yourself but feel you can keep yourself 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 self-referral form

I confirm I am 13 years or older

I understand that if MHST does not cover my school, the referral will be sent directly to YOUnited

Cambridgeshire and Peterborough

Cambridgeshire

Peterborough

Young person's MHST referral form

You must log in to save content

You must log in to save content