Request for help (Wirral CAMHS)

If you or the young person is at immediate risk, please call the 24/7 urgent mental health line on 0800 145 6485.

By completing this form you are giving your consent to share this information with partner organisations if we believe it is appropriate to do so*

Request for help (Wirral CAMHS)

Young person's details
Please enter the young person's NHS number. This can usually be found on any correspondence from the hospital
Details of person requesting help/advice
School/College
Details of GP
Other Details
Further information - please provide as much detail as possible
e.g. have they been sleeping too much or too little?
e.g. is it smaller, larger or has it altered recently? If they are displaying eating concerns are they restricting the amount they eat, when and what are they eating, what is their current weight and height? Are they using laxatives or being sick after meals? Has their exercise increased?
It might help to use a rating scale of 0 to 10, (0 unhappy 10 happy). Is this a new presentation? Do they seem more anxious? When and with whom?
If so, what type, when does this happen, how often, is treatment ever required etc.
Please provide as much detail as possible e.g. names/date of birth/relationship to young person
If yes, explore with your young person when these happen and what they think they might plan to do?
Is the young person falling behind, have school raised concerns or offered support?
If yes, what and when was this?
Significant others
Please include name/age/relationship to young person
Other relevant information
This could include some of the following (this is not an exclusive list): family separation, mental health difficulties of the parent / carer, drug or alcohol use by parent / carer or young person, relationship difficulties, physical health problems, witnessed or experienced domestic violence,experienced physical, emotional or sexual abuse, questioning gender identity etc.