Mental Health Pathways

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Pathways to Support

Thanks for contacting our support services. Our self-referral form is designed to help you access non-academic support for issues which are impacting on your wellbeing, mental health or student life. Our aim is to work alongside you to ensure you receive the most appropriate and timely support, advice and guidance for your particular needs.

Please follow the link below and complete the referral form as accurately as possible. Once the form has been assessed by a practitioner you will be offered one or more of the following:

A telephone call or enquiry to gather further information
The offer of a one-to-one appointment.
The offer of a place in a group course or workshop
Referral to or exchange of information about services outside of the university
Referral to or exchange of information about people or services within the university or Students Union
Suggestions of online resources or other relevant advice or guidance

You will be contacted either by telephone or via the portal within a maximum of 5 working days. Student support are available between 9am & 5pm Monday to Friday.

Other help and support:

For academic support please speak to your personal supervisor. You can also access academic guidance from our Study Skills Team who offer a wide range of articles, guidance, workshops and one-to-one appointments. If you are struggling with academic study in general, please take a look at this fantastic Skills for Study | University of Hull course. Canvas

Our student assistance programme is available 24/7 and can offer immediate support with any mental health or wellbeing needs you have - Call 0800 028 3766 see our website for more information.

On myJourney you will find a wide range of useful information on a range of topics including how to apply for an extension, money management and hardship funds, emotional wellbeing, pregnancy and a whole host of other helpful advice and guidance

Student Space offers phone, text, email, and webchat support for students who need advice and guidance around mental health, your studies, money worries, or relationships. They also have dedicated, tailored services to support specific student groups.

For queries related to your course or if you are unsure who can best help you, please contact the central student hub on 01482 462222, use the live chat function in MyHull portal or visit on 1st floor of student central building.

In an emergency:

If you have an urgent medical or mental health need outside of these hours, please contact one of the following services:

For a medical emergency, a mental health crisis or if you ae been a victim of crime please call the emergency services on 999. If the incident has happened on campus, please call security on 01482 465555.

Please check that you have read the above information...*

I have read the above inforation

Your Details

Name*

First Name

Last Name

Preferred name/pronouns

Student Number*

This is the 9 digit ID on the front of your student card, e.g. 200890876.

Contact Phone Number*

Current Address (the address where you are living now)*

Address Line 1

Address Line 2

City

ZIP / Postal

We may contact you through myHull Portal or by telephone, so please enusure this number is correct.

Please provide the name of your GP practice

Please provide your GP's address

Address Line 1

Address Line 2

City

Postcode

If you have not registered with a GP, we recommend you do so as soon as possible. Please find your closest GP surgery and register.

I have a mental health or wellbeing concern I have experienced sexual misconduct, violence or harassment

Please describe the challenges or problems you are currently experiencing which you would like help and support with*

What changes are you hoping to make by accessing support?*

Please describe your experience in more detail including when and where the incident (s) happened*

I would describe my experience as...*

Sexual harassment – e.g. verbal/social media comments, being sent unwanted sexual content Sexual violence – e.g. unwanted sexual touching without consent including kissing, touching of the body and/or penetration Stalking Not sure

Further Questions

Thinking about your current situation, which best describes your situation: *

I am doing well but have a diagnosed disability or mental illness and would like to talk to someone about individual learning support. I am coping OK, but have one or two things that I am a bit worried about. These worries affect me some of the time but are not stopping me engaging in student life and my studies. I am struggling in a few different areas and feel worried a lot of the time. Sometimes these worries stop me from engaging in my studies and engaging with other areas of student life. I am overwhelmed. I have things going wrong in lots of areas or one. I feel stressed or worried most of the time. My problems make it almost impossible to engage with my studies and other aspects of my life. I am in crisis. I need urgent help to stay safe or prevent harm to myself or someone else. I am homeless or at immediate risk of homelessness. I have recently experienced a sexual assault or being a victim of domestic abuse or a violent crime.

Over the past two weeks, I have been having thoughts about ending my life*

Not at all Sometimes Often Most or all of the time

Over the past two weeks, I have made plans or taken actions to try and end my life*

Not at all Sometimes Often Most or all of the time

Do you want to tell us anything else about your suicidal thoughts or plans?*

Yes No

Please provide details

If you feel unsafe, you deserve to feel hope and help is available 24/7.

Get medical advice quickly

Call the NHS on 111, or use their online services

Get help now, over the phone

Call Samaritans on 116 123

Get help now, over text

Text Shout to 852 58

Mental health condition (please tick all that apply) *

I have a diagnosed mental health condition I haven’t yet told Student Support Services about I have a diagnosed mental health condition I have already told Student Support Services about I am currently receiving support from the NHS for my mental health diagnosis None of the above

Please provide details*

To what extent are you considering leaving University because of your difficulties? *

Not at all Sometimes Often Most or all of the time

To what extent would you say your difficulties are affecting your study (e.g. attendance, assessment)? *

Not at all Sometimes Often Most or all of the time

To what extent would you say your difficulties are affecting your overall experience at University (e.g. managing daily life, socialising)? *

Not at all Sometimes Often Most or all of the time

Please let us know your availability to ensure we contact you promptly.*

Please let us know your availability to ensure we contact you promptly.
	9am - 1pm	1pm - 6pm
Monday	Please let us know your availability to ensure we contact you promptly.: Monday (9am - 1pm)	Monday (1pm - 6pm)
Tuesday	Tuesday (9am - 1pm)	Tuesday (1pm - 6pm)
Wednesday	Wednesday (9am - 1pm)	Wednesday (1pm - 6pm)
Thursday	Thursday (9am - 1pm)	Thursday (1pm - 6pm)
Friday	Friday (9am - 1pm)	Friday (1pm - 6pm)

I would prefer my appointment to take place via:*

Face to face on campus Telephone (call will come from a withheld number) Teams (camera on) Teams (camera off)

You may select more than one type of appointment

Have you chosen a face to face appointment because of a disability or accessibility need, for example a hearing impairment?*

Yes No

Please provide details

We will always try our best to give you your first choice of contact preference however we have limited numbers of some appointment types so you may be offered an alternative.

Information Sharing

We will only share information with third parties with your consent. The only time we would share information without consent is where we have concerns that you or somebody else is at risk.

When sharing any information, we will only share those details which are relevant to ensure you receive the most appropriate support.

Please select all that apply...

I am happy for you to share information with Health Assured for the purposes of accessing the Student Assistance Services I am happy for you to share information with my GP or other relevant health services I’m happy for you to share information with other areas of the university – for example my personal supervisor

Declaration

I have read the GDPR policy and accept that the information provided will be used in accordance with GDPR regulations.

Signature*

[clear]

Use your mouse or finger to draw your signature above

We are always trying to improve our service, so we would appreciate your feedback. These questions are optional and your answers will have no bearing on the outcome of this form.

How would you rate your experience completing this form?

How could we improve this process?

Student Life Team

SLT Actions*

Send Resources Advisor appointment Officer appointment

Other:

Notes*

Name*

First Name

Last Name

Pathways to Support

Your Details

Further Questions

Information Sharing

Declaration

MHST

Student Life Team