Youth in Mind

Support for someone else

 

To make a referral for someone else for support from Youth in Mind, please read the service member privacy notice then complete the online form below. 

If you need any help completing the form then please contact us by email youthinmind@mindinbradford.org.uk or call us on 01274 730815.

Please enable JavaScript in your browser to complete this form.

Select your first choice of Service Provider:

Is the Young Person aware of and do they consent to this referral?
If you do not have the express consent of the child or young person, please obtain consent from them before making a referral.

Your details:

Young person you are referring details:

If the child or young person is in temporary accommodation, please include their current address and original address.
Is their gender identity the same as they were assigned at birth?
Do they consider themselves to have a disability or additional needs?
Does the individual have a statement of Special Educational Needs (SEN)?
Does the individual have an Educational Healthcare Plan (EHCP)?
Are they an asylum seeker/refugee?
Are they a young carer?
Are they a looked after child?
This means they are currently being cared for by their local authority.
Is the child at risk of exploitation?
Please include information about the problem they are experiencing, any support they have from family/friends/professionals, how long they have felt like this, if they are aware of or have been using any coping strategies to support these feelings. Include details on how you have supported the young person to identify and understand barriers to their mental health and what interventions have already taken place.
Are they pregnant?
Are they currently in education?
Are they working with social care?

Understanding risk

Is the Young Person currently in any risk of danger or harm?
Is the Young Person a risk to themselves?
Is the Young Person a risk to others?

What to expect next

Someone will be in touch in the next 5 working days to confirm receiving your referral and explain what happens next.

Full details on how we use your data and keep it safe can be found in our Privacy Policy.

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