Case number:
(Let’s Talk use only)
Date received:
(Let’s Talk use only)
Referral source:
(Let’s Talk use only)

Referral Form

The following information along with a referral letter (see below for details) is essential for a referral to be processed by Let’s Talk-Wellbeing. Missing data will result in a delay in us contacting your patient as we will return incomplete documents.

If any of the following 4 criteria are met, please refer direct to step 4 services as the patient falls outside our referral remit;

1)  Currently under the care of secondary Mental Health Services YES / NO

2)  Experiencing symptoms of Psychosis YES / NO

3)  Current suicidal or self harm intent YES / NO

4)  Primary problem is drug or alcohol misuse YES / NO

Does the patient fit the following criteria; if so continue with referral;

1)  Experiencing a mild to moderate common mental health problem YES / NO

2)  Have they consented to this referral YES / NO

Patient Details
Name
Address
Town
DOB
NHS number
GP Details
Name

3)  Have you considered 2 weeks watchful waiting YES / NO

Initial contact will be made by telephone please provide the following 4 pieces of information:

1) Is the patient able to communicate in spoken English YES / NO If no preferred language ......

2) Is patient happy for us to leave a message YES / NO

3) Contact telephone number:......

4) Preferred day/time of contact (please circle): MON TUE WED THU FRI 8-12 12-4 4-8

Give details of the following on a separate sheet / letter:

1)  Current presenting problem including: onset and current treatment

2)  Previous similar episodes

3)  Any previous contact with Mental Health Services

4)  Your current assessment of risk to self or others

For prompt response please fax this referral to Fax Number - 01623 884221

For information about our service please contact us on 01623 884500 or email

PRIMARY CARE GUIDELINES: ASSESSMENT AND REFERRAL FOR IAPT

LET’S TALK-WELLBEING (ADULTS AGED 16 YEARS and older)

Psychological therapy within Let’s Talk-Wellbeing should be routinely considered as a treatment option for people with MILD to MODERATE common psychological difficulties

GP ASSESSMENT should cover characteristics of the patient’s problems, aspects of functioning and the patient’s views of the problem and preferred treatment.

Consider

·  Severity If: Mild, consider two weeks WATCHFUL WAITING

If: Mild to moderate, consider referral to Let’s Talk-wellbeing

If: Moderate to severe, consider secondary care Psychological Therapy

·  Problem Type/ Complexity If: Reaction to life event, consider Let’s Talk-wellbeing

If: More severe/complex difficulty, consider Psychological Therapies in

secondary services

Risk If: High risk, consider referral to CR/HT or Psychiatric Services.

(see note 3)

·  Patient’s Preference Consider patient’s preference for drug and/or talking therapy

& Characteristics and type of talking therapy, in order to maximise motivation

and commitment to therapy.

â â â

CONSIDER
Let’s Talk-Wellbeing
IF: / SECONDARY CARE Psychological Therapies (step 4) and Mental Health Teams in NHCT.
North Localities / SECONDARY CARE Psychological Therapies (step 4) and Mental Health Teams in NHCT.
South Localities
Type of problem: Suitable for brief interventions.
eg. Step 2. Guided self help, supported CCBT, psycho educational groups and
Step 3. Brief CBT, Counselling or Interpersonal Psychotherapy
(see note 1 for examples)
Chronicity: Recent onset
Severity: Mild to moderate.
Complexity:
·  Not complex
·  No comorbidity
·  No significant previous psychiatric history or currently receiving a package of care within the secondary services
·  May be social, practical or relationship difficulties or life events (may or may not have had previous episodes of care within secondary services)
·  (see note 2).
Do not refer:
·  Severe or complex cases
·  Primary severe and complex mental health conditions.
·  If psychiatric treatment is indicated
·  Suicide risk or any risk of self harm or harm to others
Fax appropriate cases to Let’s Talk –wellbeing
Fax: 01623 884 221
Tel :01623 884 500 / Refer to the single point of access.
Newark and Sherwood
Use the ‘Choose and Book’ system.
Newark address:
Single point of Access
65 Northgate
NG24 1HD
Tel: 01636 670600
Fax: 01636 610861
Urgent cases can be sent to Crisis Team
Tel: 01636 670614
Fax: 01636 610717
Mansfield and Ashfield
Send a referral to:
Single Point of Access
Millbrook Mental Health Unit
Kingsmill Hospital
Mansfield Rd
Sutton-in-Ashfield
NG17 4JL
Reception Tel:
01623 784793
Mansfield and Ashfield cont.
Urgent cases can be sent to Crisis Team
Tel: 01623 636029
Fax: 01623 785700 / Refer to the locality mental health team.
Manor Rd Gedling CMHT
Manor Rd
Carlton
NG4 3AY
0115 952 4098
Broxtowe & Hucknall Hope Centre
Dovecote House
NHCT
38 Wollaton Rd
Beeston
Nottingham NG9 2NR
0115 845 1271
Rushcliffe Mental Health Team
93 Musters Rd
West Bridgford
Nottingham NG2 7PG
0115 945 5990
Urgent cases refer to Crisis Team as usual.

Note: In additional to NICE guidelines, Patient’s preference should inform treatment choice particularly where the research evidence does not indicate a clear choice of therapy

Refer to Let’s Talk- Wellbeing additional notes

Note 1: Examples of conditions likely to respond to brief psychological therapies of 6-14 sessions at Let’s Talk wellbeing:

Adjustment to life events (e.g. illness, bereavement, disability)

Stress or mild to moderate anxiety as a normal response to current circumstances.

Low mood or mild to moderate depression.

Problems with anger.

Health anxiety/hypochondriasis.

Relationship problems

Note 2 Stressful life events impacting on Psychological wellbeing might include:

Physical health problems

Carer stress

Relationship difficulties

Family relationships

Financial problems

Poor housing

Social isolation

Bereavement

Early diagnosis of neurological conditions

DO NOT refer to Let’s Talk wellbeing- additional notes

Note: If any risk of suicide, self harm or harm to others, brief psychological therapies at Let’s Talk wellbeing are not appropriate as treatments of first choice.

Note 3: Lets talk wellbeing is not suitable for people with primary severe and complex mental health conditions including, psychosis, pure dementia diagnosis, severe and complex anxiety disorders, severe and complex depressive disorders and those who are at serious risk of self harm and suicide. If serious alcohol or drug abuse is a difficulty, consider referral to specialist services (see Substance Dependence Protocol) Also see NICE Guidelines for:

PTSD Guideline 26

Depression Guideline 23 amended

Anxiety Guideline 22 amended

Eating Disorders Guideline 9

Antenatal and postnatal

mental health Guideline 45

Personality Disorders

Somatic Presentation