State of Sandwell - Consent Form
Please fill in this form if you are interested in speaking to us for State of Sandwell. Please include at least one way for us to contact you.
You can read more about the State of Sandwell in the info below. If you need any more information please email Holly at
or call 07534 000831.
You can ask us for this information in Easy Read or in another language.
Questions with a red star mean they must be answered.
WHO ARE CHANGING OUR LIVES?
Changing Our Lives is a rights based organisation. We work in partnership with disabled people and people with experience of mental health difficulties to find solutions to social injustice and health inequality.
WHAT THIS WORK IS ABOUT
Every year our Sandwell Mental Health People’s Parliament speaks to 100 people in Sandwell about what mental health means to them, how they keep mentally healthy and what happens when they experience mental health difficulties. We call this the ‘State of Sandwell’. Anonymised findings from the State of Sandwell are presented to Sandwell Metropolitan Borough Council, local NHS services and other relevant people to improve the mental health support available to Sandwell residents.
Just like everyone has times of good physical health and poor physical health, everyone has times of good mental health and we can all have mental health difficulties at times in our lives. For State of Sandwell, we don’t just want to speak to people who identify as having mental health difficulties. We will speak to a varied group of people across gender, age groups, employment status and class. As with all our work we will include disabled people.
In 2020 we are talking to people from minority ethnic communities about the impact of COVID-19 on mental health. This is because studies have shown that some minority ethnic communities in the UK are less able to access mental health support and some minority ethnic communities in the UK have been hit hardest by COVID-19 and the effects of the national lockdown.
If you consent to being part of State of Sandwell we will arrange to have a conversation with you. All conversations are held in complete confidence over phone or video chat at a time to suit you, and should take no longer than 60 minutes to complete. After the conversation, a member of staff from Changing Our Lives will make a written record of what was said.
After 100 people have taken part, a group will be formed of members of the Mental Health People’s Parliament, staff from Changing Our Lives, and a small number of people selected from the 100 people we speak to. This group will look at anonymous information from the 100 conversations and analyse it to identify themes. A report will be written based on the conversations and this will be presented to Sandwell’s Health and Wellbeing Board and other relevant bodies. The findings in the report will be used to steer the future work of the Mental Health People’s Parliament.
WHY WE HAVE A CONSENT FORM
This consent form lets you choose if you want to give us some of your personal data and if you agree to us using your personal data in different ways.
OUR PRIVACY STATEMENT
Our Privacy statement tells you about how we collect and look after your personal data. You can find this at the bottom of this form.
To be a part of the project, you must live in Sandwell, be over the age of 16 and identify as being from a minority ethnicity community. If you are not sure, please email Holly at
I describe my nationality as:
I describe my ethnicity as:
The area of Sandwell I live in is:
Do you have a disability?
Prefer not to say
If you do have a disability, please detail below.
All information collected will be treated anonymously and confidentially.
We will never share personal information unless you or someone else is at risk of harm.
Information you give us may be used for the project and report, but will not include your name or identifying details.
Changing Our Lives can use quotes that I give them during my work with them. All quotes will be anonymised and my name will not appear in the report.
Changing Our Lives can store my name, date of birth or age, address, email address and telephone number and any support needs I have for the purposes of this project.
Changing Our Lives can keep a record of my ethnicity, disability and mental health needs. I will tell them only as much information as I feel comfortable with. Changing Our Lives will keep this information on a secure server.
Changing Our Lives can keep a record of any other personal information I choose to give them which is necessary for the project.
I understand that I can stop taking part at any time and can ask for my information to be removed from the project.
Changing Our Lives Privacy Statement
1. Changing Our Lives is a rights based organisation. We work with disabled people and people with lived experience of mental health difficulties to find solutions to social injustice and health inequalities.
2. Changing Our Lives fully understands the responsibility we have to protect and respect your privacy and look after your data; both personal and otherwise. Please be advised that this policy is subject to change, so please do return regularly to ensure you are aware of the latest details.
3. The Data Protection Law changed on the 25th of May 2018. This privacy notice explains clearly your rights under the new law as well as how your information is used.
4. How do we collect personal data from you?
We receive information about you when we work with you. This might be information you give us when we meet with you or information you give us over the phone or in a written form such as by email or letter.
5. What type of personal information do we collect?
We ask you for your name, address, telephone number and e-mail address so we know how to contact you. We may also ask for your ethnicity and disability so we can monitor the number of people from Black and Minority Ethnic Communities and disabled people we work with for each project. You do not have to give us this type of information if you don’t want to.
We also ask you for information about yourself in order to carry out our work. For example, if we are facilitating a person centred plan with a person, we need to know about their interests, hopes for the future, their needs and a range of other important factors which will help make their plan a reality.
Sometimes a social worker or healthcare professional or a similar individual may
give us personal information about you, but this can only be with your consent. If you are not able to consent this should be via a best interests meeting or via a parent if you are under 18.
6. Where do we store your personal data?
All information you provide to us is stored on secured servers within the UK. This secure server is commissioned by Changing Our Lives and provided by a third party.
7. Consent and how we use your personal data?
We will always gain your explicit consent to gather and store any personal data about you. This means that we will ask for your permission to process your personal data and explain why we need to do this.
We will also make it clear to you how you can withdraw your consent if you so wish.
We will use your personal data in different ways dependent on the project we are working on with you. You will have information about the project and a consent form which will tell you what personal data we need to process and where you can state whether you consent or don’t consent.
The ways we might use your personal data include (but are not limited to):
• Changing Our Lives website
• social media
• publicity materials such as leaflets, banners, brochures and posters, newsletters, books, newspapers, magazine articles
• personal stories showcasing best practice and ordinary lives
8. Who can give consent
• Young people from 18 years old can consent.
• A signature of the parent/legal guardian must be obtained where the child is under 18 years old.
• People with insufficient understanding of the consent process – staff should refer to Information Governance procedures: Consent and people who may at times lack capacity
9. Data Retention
Your personal data will be kept as long as is required for the project. Some projects may operate over a short period of time and other projects can progress over years.
Once a project is no longer active, your personal information will be marked as inactive and then kept for up to 12 months after the project’s end date.
The reason personal information may be kept this long is due to our legal and/or accountancy requirements. We may also keep it for research or statistical purposes. Please be rest assured that your personal data will only ever be kept for necessary reasons and specific purposes as informed to you.
10. Who has access to your personal data?
Your data is used internally by Changing Our Lives staff and systems for the purpose of our work. Changing Our Lives will never sell your personal data to third parties for any advertising or marketing activity.
11. Your Rights
You have full control and decision on what, if any, personal data you provide to Changing Our Lives. In choosing not to provide certain information, this may limit or restrict the way we are able to work with you.
You have the right to withdraw consent at any time. Let us know you no longer consent in writing by email, letter or let us know by speaking to us. We will make a record of this and note your withdrawal of consent and take action to withdraw consent within 30 working days.
You have the right to be forgotten. You have the right to object to our usage or processing of your personal information as well as delete, remove or stop using it if there is no need for us to do so. Any request submitted will be taken seriously and reviewed; there are accounting and legal reasons why we would need to retain your personal data, however if you believe your personal data to be retained on an incorrect basis, please do inform us.
You have the right to access all the information we hold about you. To request this at any point, please
• call us on 0300 302 0770 or,
• email us at
• write to us at 34B The Old Woodyard, Hall Drive, Hagley, West Midlands DY9 9LQ.
12. Data Breaches
In the event of a data breach, we will ensure that our obligations are met within required timeframes in accordance with the applicable data protection laws.
13. Your right to make a complaint
If you have any concerns about the way we handle or process your personal data, please do ensure you contact us in the first instance; we’re always on-hand to listen to your concerns and address and review our data processing procedures.
You also have the right to make a complaint about how we process your personal data to the Information Commissioners Office:
Information Commissioner's Office
Tel: 0303 123 1113
Changing Our Lives Privacy Statement
I have read and agree to Changing Our Lives privacy statement
I have read and do not agree to Changing Our Lives privacy statement
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