Family Support Referral Form

Family Referral Form

In a EMERGENCY please contact your own GP. The Cumbria Health On Call team (CHOC) are also available out of hours on 111. The Samaritans are available 24 hours a day on 116 123.

SAFA is GDPR compliant. Once the below form is submitted to us, the forms data is encrypted and automatically password protected. Only a team member from SAFA can access the data provided.

We provide wrap around support to families and also offer education around self-harming. Families can be offered up to 6-8 sessions on a one to one basis. These sessions are about being listened to in a confidential, non-judgemental space. Family Support is about being heard and learning new ways of dealing with problems and problem solving, by exploring new methods. Seeing a loved one struggling and not knowing what to do or say can be overwhelming. Once the family are communicating, solutions can be found so that the family can start to thrive.
We hold a weekly drop-in on a Wednesday morning from 9:30 – 10:30am, in Barrow. Any families that are struggling and would like some support are welcome to come along and have a brew in a safe space to talk about any concerns. It’s also an opportunity to meet other people.
We offer support in North Lancashire on various platforms. These sessions can be one to one over zoom or teams. We are also offering virtual monthly drop-ins on the last Thursday of every month. Various topics will be discussed for e.g. self-harming/suicidal thoughts. This is an opportunity to get involved and learn new skills that can support greater well-being.

Please note we are only currently accepting family support referrals from South Cumbria and North Lancashire. After filling out the Family Referral form below, you will initially be contacted by our family support worker, by text, when you get to the top of the waiting list. If you prefer to be contacted another way please specify.

You will receive an automated email to acknowledge the form has been submitted, please check your spam folder. If no email has been received please contact info@safa-selfharm.com

Person Details

First Name

Last Name

Date of Birth

Gender Identity

MaleFemaleOther

Other

Address Line 1

Address Line 2

Town or City

County

Post Code

Email Address

Home Phone Number

Can we contact you on this phone number?

YesNo

Mobile Number

Can we contact you on this mobile number?

YesNo

Family Referral Reason

Characters Remaining: 500

By submitting this form I accept the information provided will be held by SAFA. This information will be kept confidential, however there are some extreme situations where SAFA may be obliged to share information. Please note that referrals are usually reviewed by a counsellor within two working days (Monday-Friday).

By ticking this box, I confirm my consent as stated above

Yes, I consent

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We work with clients aged 11+. There is no upper age limit.

We recognise that alcohol or substance misuse is a form of self-harm. We recommend that you have not been dependant on alcohol or drugs for 6 months prior to referring to SAFA.

We offer counselling in Barrow in Furness, Kendal and several other locations around the county.

The first place to start is your GP. We recognize that it takes courage to speak openly about your worries and concerns, perhaps take a family member or a trusted friend along for support.

This can feel incredibly overwhelming and makes the way you are feeling very real, often when we are in the grips of an Eating Disorder we are in denial that there is a problem. It’s everyone around us who doesn’t like it or is jealous of you being thin. When we are able to move out of denial we can see that we have a problem which needs help. Often we feel weak for asking for help but in fact it’s a strength.

All of our counsellors are registered with the BACP (British Association of Counselling and Psychotherapy).

The sooner someone is treated for an Eating Disorder, the better the chance of making a full recovery. We know that gaining access to treatment isn’t always as straight forward as we would like it to be. SAFA is not a crisis service which can also be very frustrating for you. Because it takes courage to ask for help. What SAFA does offer is a professional 1:1 counselling to work with the core issues which are affecting you.