Bolton Community CAMHS Referral Form

All referrals are processed and screened within 24 hours on working days – Monday to Friday, 9am until 5pm (excluding bank holidays).

If you have any concerns regarding immediate risk to life outside of these working hours, please contact one of the below:

• GMMH Helpline – 0800 051 3253
• NHS 111 Service
• A&E Department

If the referral is for emotional health and wellbeing support
Please consider if it would be more appropriate to refer to Bolton Together:  IThrive 2 – 19 years Referral Form - Bolton Together (bolton-together.org.uk)

Other Agencies and Self-Help Tools can be found on:  www.bekindtomymind.co.uk

If the referral is for an assessment of Autistic Spectrum Disorder (ASD) or Regarding ASD
School needs to initiate an Early Help process and refer to the Bolton Social Communication Interaction Panel (BSCIP).

If the referral is for Attention Deficit Hyperactivity Disorder (ADHD)
The Early Help process needs to be initiated by school and it needs to be accompanied by an assessment report from Behaviour Support team (or independent equivalent e.g., Aspire and/or Education Psychology).

If you are referring for an ADHD assessment, please complete the external ADHD form alongside this referral form in order for the referral to be processed:  ADHD pathway referral form.docx

If the referral is for bereavement support
There is a great deal of self-help information available and some of the most popular are detailed below.

Bereavement:

• http://www.winstonswish.org.uk/ 
• www.hopeagain.org.uk
• www.onceuponasmile.org.uk

Adjustment problems:

• http://www.understandingchildhood.net/our-leaflets/
• http://www.rcpsych.ac.uk/expertadvice/youthinfo.aspx
• http://www.youngminds.org.uk/

If the referral is for Behaviour issues with no parenting intervention
Locally, there are arrangements for children’s’ social, emotional and behavioural needs to be addressed via the early help process.  If there is not an early help form already in place we would recommend that you complete a form or advise parents to talk with school about early help.

 

All of the information marked * below is mandatory and needs to be completed before a referral can be processed.

This is to comply with NHS Mental Health Data Set requirements, and also to fulfil safeguarding responsibilities

 

Referral Details

Note: Questions marked by * are mandatory

Referral Date

Referral Priority

Urgent
Routine

*This is a mandatory field. Referrer Name

*This is a mandatory field. Designation

*This is a mandatory field. Organisation

*This is a mandatory field. Contact Number

*This is a mandatory field. Email Address

*This is a mandatory field. Address

	Yes	No
*This is a mandatory field. Is there risk to self?
*This is a mandatory field. Is there risk to others?
*This is a mandatory field. Is there risk from others?

*This is a mandatory field. If yes to any of the above, please detail:

*This is a mandatory field. Reason for referral: (Any assessment should contain information about the symptoms of mental health difficulties, including the duration, severity, impact on day-to-day functioning and the presence of any risk issues such as self-harming behaviour or risk to others. Please include details of any concerns around risk through self-harm, suicidality, the child or young person’s physical condition, aggression, vulnerability to exploitation, substance misuse etc.)

*This is a mandatory field. Please state if this referral is for a LAC consultation: