Women in Mind Referral Form

Please proceed if you can answer YES to the following questions,

• I have previously struggled with addiction, but have been abstinent for 3 months or more?
• I have been stable for a minimum of 6 months from a psychotic episode
• I have not attempted suicide within the last 6 months
• I have no current suicide ideation or plans to harm myself.
• I want to access support in a group environment and I am willing to engage with peers.

We won’t give up until everyone experiencing a mental health problem gets both support and respect. We want to know a bit more about you, to understand who we are engaging with our work, and who we need to work harder to reach. We also want to make sure we understand the needs of all the communities we work with. Completing these questions is voluntary, and the information you provide will only be shared anonymously. Thanks for your help.