The NHS Constitution for England establishes the principles and values of the NHS in England. The first principle is that the NHS provides a comprehensive service, available to all.

It is available to all, irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, or marital or civil partnership status.

As we know, the mental health of ethnic minorities continues to be unmet; have you and your team thought about this and reviewed your caseload?

Please know that we particularly welcome referrals of patients from a wide and diverse background to ensure they are representative of the wider population we serve.

Please complete the following fields on the following form in as much detail as possible:

Cassel hospital referral form

Date of referral
Which service do you think would be most appropriate for your patient? (Following screening and discussion we may recommend a different service) Required

It is a requirement that all referrals to the Cassel, need to go through (and be discussed with/approved by) the NHS England Regional Commissioner for the client.

Has this referral been discussed and agreed with your NHS England Regional Commissioner? Required

If 'Yes', please provide further details:


Patient details

Date of birth
Does the patient have a disability?
Address

Referrer details

Address
Required
Required
Required

(For example, housing, probation, social services, voluntary sector) 

(Please describe current difficulties including diagnosis, risk factors etc. as well as the patient’s thoughts about this referral)

(Please provide a summary of the patient’s contact(s) with mental health services, beginning with the first presentation. Please include precipitating factors/risk behaviours and note the patient’s engagement with services if known)

(Please include physical health diagnoses, medications, etc.)

(Please provide a developmental history, including early experiences, significant losses or trauma, quality of family relationships, etc.)

(Please include education, employment, current living arrangements, forensic history, etc.)

(Please describe any safeguarding concerns and any previous safeguarding events)

Would the patient be able to attend a one-to-one assessment? Required
Required