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Due to changes in funding, our suicide prevention service is no longer commissioned by the NENC ICB across Durham. Referrals are now managed exclusively via charitable funding.

This affects availability for GP aligned services or any other NHS services. Due to this, referrals are subject of accessibility and suitability processes.

Please email or call 01913875661 for guidance of current availability of service.

Has consent been obtained for referral?

Consent? *

Details of referrer

Details of referred person

Do they use a pro-noun? *

Next of kin details

GP details

* Please provide complete information

Is the supported person currently been seen by any other service?

i.e. crisis team, secondary mental health care, support worker, nurse practitioner, psychiatrist, third sector, family carer… (not definitive list)

Other service? *

Details of suicidal crisis

* Please be a detailed as possible

Are their current difficulties related to any of the following factors?

Relationship breakdown *
Gambling *
Debt *
University *
Work *
Sexuality *
Legal Problems *
Family Problems *
Bereavement *
Drug/Alcohol Misuse *

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