Mental Health Screening Assessment

This is only for employees on the Anglian Water Healthcare Scheme with a Gold or Silver membership. Dependants under the age of 16 will require a GP referral, and then to access the service the policy holder will need to contact Alliance Health Group on the dependant’s behalf.

Prior to completing this form, please ensure that you have checked with Alliance Health Group to verify that you have the necessary membership benefit level to access the service.

Please be aware that this is not an instant response crisis service.

If you are experiencing a crisis, and you feel unable to keep yourself safe, you should call your GP (or your GP out of hours service), visit your local accident and emergency department, call 999 or the Samaritans on 116 123.

If you choose to proceed with this initial screening assessment to determine suitability for the service, please complete the form below.

Thank you for advising us of the current risk that you or other’s around you may face – please be advised that this is not an instant crisis service. We advise you to contact the following services below for immediate support and that you contact your GP to make an appointment to review your current mental health needs and risk.

  • 999: In an emergency you can also go to any A&E department.
  • 116 123: Samaritans
  • 0800 068 41 41: Papyrus HOPElineUK – Support for those dealing with suicide, depression or emotional distress – particularly teenagers and young adults.
  • 0800 58 58 58: The Campaign Against Living Miserably (CALM) works to prevent male suicide and offers support services for any man who is struggling or in crisis. CALM’s helpline and web-chat are for men in the UK who need to talk or find information and support. The services are open 5pm–midnight daily and are free, anonymous and confidential. For access or to find more information visit thecalmzone.net
Personal details

 

Unfortunately, if we are unable to process and store your data, we are unable to proceed with your referral. For further support please contact occupational health.

To be able to progress your referral, IPRS Health needs to share information with relevant people and organisations. Do you agree that IPRS Health can share personal and, where appropriate, medical information with our selected clinical supply chain providers and:

For the purpose of progressing your referral?

Thank you for confirming your consent preferences, one of the team at IPRS Health will be contacting you by telephone to discuss your consent within the next 24 hours.

Please be aware that, under Data Protection legislation, you are able to withdraw this consent at any time by contacting IPRS Health.
IPRS Health respects your privacy and is committed to protecting your personal data in accordance with the General Data Protection Regulation (GDPR) and Data Protection Act 2018 (DPA). Our privacy notice tells you why and how we collect and keep your data, and you can find it here . Please take the time to read this important information.