Make a Referral

We are dedicated to providing the best possible support for those in need.

Please share some information about the individual you are referring and the type of support they require. Their wellbeing is our top priority, and all information will be treated confidentially.

You can refer someone to the Sanctuary using this online form or by calling us on 0300 330 9492.

Once you have submitted the online form, or referred the individual by calling us, our team will contact them on the number provided within 24 hours. Please note, the call will come from a private number.

Whether the person you are referring is experiencing a mental health crisis or needs support to stay well, we can provide them with a safe, supportive space. Our service is available 7 days a week, 365 days a year.

Please note—We can only support individuals over the age of 18.

Referrer Information

Full name

Position Organisation

Contact Number Email Address

Has the person you are referring given consent for you to submit this referral? (If no, then consent must be obtained prior to a referral being made)

YesNo

Client Information

Full name Date of Birth

Address

Postcode

Contact Number Email Address

Emergency Contact Name Emergency Contact Number

Emergency contact information will only be used if there are concerns about the individual's safety.

How Can We Help?

What kind of support do you think the individual needs from our service? What challenges or issues is the individual currently struggling with? How are these challenges affecting the individual’s daily life?

Support Needs

What support does the individual currently have in place? (tick all that apply): Friends or FamilyCommunity OrganisationsMental Health ServicesSocial Care ServicesOther (please describe): Is the current support helpful to the individual?

Mobility Needs

Does the individual have any mobility needs or require assistance?

YesNo

If yes, please describe:

Keeping Safe

Has the individual expressed thoughts of self-harm or suicide recently?

YesNo

If yes, please tell us more:

Has the individual made a plan to act on these thoughts or intend to do so?

YesNo

If yes, please tell us more - If the individual is at immediate risk, please contact 999 or 111 option 2 for urgent help.

Coping Strategies