Parent/Carer Form - Refer Your Child For Mental Health First Aid.

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Parent/Carer Form - Refer Your Child For Mental Health First Aid.

Please complete this form if you have concerns about the mental health of your child and would like a Mental Health First Aider to meet with them in school.

Please note: Our Mental Health First Aiders are trained to triage, support and signpost pupils and parents to relevant resources and services. They are not medically trained to clinically assess or diagnose mental health conditions. If you have significant concerns about your child's mental health, please contact your GP or call 111 for advice.

Email *

What is your full name? *

Your child's name: *

Which tutor group are they in? *

Which of the following is your young person currently experiencing? (Tick all that apply) *

Low Mood

High Levels of Worry

Body Image/Eating Habits

Difficulty Managing Anger

Bereavement

Alcohol Use, Drug Use or Addictive Behaviour

Exam Related Worry

Attendance Related Issues or School Refusal

Other:

Required

How long has this been a problem? *

Less than 3 months

3-6 months

6-12 months

1-2 years

Have you sought advice from your GP or other agencies? If yes, please specify below. *

Has anything helped to improve the issues being experienced? *

Is your child currently demonstrating self-harming behaviour? If so, please give details below. *

Has your child expressed ideas about wanting to end their life? *

No.

Yes, my child has made comments suggesting suicidal thoughts.

Yes, my child has made plans to end their life or made attempts previously.

Please share any other information that you think will help us to identify the most appropriate support for your child.

Would you like a Mental Health First Aider to contact you before speaking to your child? *

Yes

Thank you for completing this form.

A Mental Health First Aider will contact you if requested, or meet with your child as soon as possible. Due to the high demand for mental health support, this may not always be within the same week.

Therefore, if you have significant concerns about your child's mental health please contact your GP or call 111 for advice.

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