Welcome!

The Sanctuary is here to help people who are experiencing a crisis - we are here for you!

We want to ensure we can support you in the best way possible and by filling in this form, it helps us to make sure we have all the information to do that and helps us make sure we can keep you safe. It will take around 10 minutes to complete and then we can look at how we can support you tonight. If you'd prefer, you can give us a call and we can have a conversation with you, we still need to ask a few standardised questions before support is offered.
 
If you would like to do this over the phone with a member of staff please ring. For:
East Leake, LE12 -  07925584716
Nottingham, NG7 - 07925579516
 
We are unable to accept someone to The Sanctuary without this being completed. But it really is so that we can do our best for you and so that we can agree what we can do to help.
 
This might be that we can support you remotely, by phone or chat, or that we can see you face to face.
 
More information about the Nottinghamshire Crisis Sanctuaries -providing mental health crisis support to the communities of Nottinghamshire.
 
Please note: Harmless host Sanctuary sessions on Monday in Nottingham and Tuesdays & Thursdays in East Leake. For the full timetable, click here https://turning-point.co.uk/services/mental-health/crisis-support/nottingham-crisis-sanctuaries
 
What you can expect of us and what we will expect of you: Our Charter
 
  • The Sanctuaries are provided by Framework, Harmless, Mind and Turning Point, they offer a relaxed environment for those in mental health crisis to work alongside staff to develop solutions and positive outcomes to their current distress. Tonight's support will be offered by Harmless - and you can find out more about us here.
  • The Sanctuary spaces aim to provide a sense of hope and safety ensuring that you receive appropriate advice and guidance to best meet your needs.
  • Whilst in The Sanctuary we ask that you treat others and the environment with respect.
  • We will work alongside you to develop solutions and play an active part in your crisis management planning.
  • During attendance, we want to reduce the risk of COVID-19 transmission. As such everyone will be required to wear a mask, wash their hands and sanitise **unless exempt.
  • You will confirm that you and those you live with are Covid free.
  • Anyone found to be, or suspected of being excessively intoxicated will be asked to leave or be declined a face to face offer of support.
  • Whilst in The Sanctuary space we ask that visitors refrain from self-harm. We are a place to come to move forwards and it is important that you use the time with us to get the best possible support. Any self-harm on-site would require a review and it may be considered that the service can no longer support you at this time.
  • Anyone using or threatening violent/intimidating behaviour will be asked to leave the Sanctuary.
  • The Police may be informed of any criminal activity and will carry out their own investigation.
  • To ensure a safe space for everyone, no animals/pets are allowed in the cafes with the exception of assistance animals.
  • Carers are welcome to attend the Sanctuaries with you, however, during the COVID-19 pandemic we will need to be mindful of social distancing requirements.
 

Question Title

* 1. Today's date

Date
Time

Question Title

* 2. Is this an agency referral

Question Title

* 3. Name and contact details of referrer

Question Title

* 4. Personal details of the person needing help

Question Title

* 5. Is the person at their place of residence at present?

Question Title

* 6. Date of Birth of person needing help

Date

Question Title

* 7. Gender

Question Title

* 8. Ethnicity

Question Title

* 9. Next of kin details

Question Title

* 10. Do we have permission to make contact with them? **We will only breach confidentiality without your consent if there is imminent risk to you or someone else. For more details, please ask.

Question Title

* 11. Has the person needing help been using alcohol in the last three hours?

Question Title

* 12. Has the person needing help been using substances in the last three hours?

Question Title

* 13. Does the person needing help have any history of violence towards others?

Question Title

* 14. Please answer the following questions on a scale of 0 to 10 where 0 is not at all and 10 is a lot. If the question is not relevant to you then the answer will be '0'.

  0 1 2 3 4 5 6 7 8 9 10
1. I am thinking about hurting myself?
2. I am planning on hurting myself?
3. I am thinking about ending my life
4. I am making a plan to end my life
5. I am able to tolerate my distress
6. I am able to tolerate my thoughts
7. I feel positive about my relationships with your friends and family
8. I feel positive about my daily activities (e.g. school or work)
9. I feel positive about the future
10. I am in a mental health crisis
11. I am in a suicide crisis
12. I am likely to harm myself (without intervention)
13. I am likely to harm someone else (without intervention)
14. I am in distress
15. I am likely to consume alcohol
16. I am likely to consume substances
17. I am likely to behave recklessly
18. I feel safe
19. I am unable to cope
20. I feel hopeless

Question Title

* 15. Do you receive support from any other services?

Question Title

* 16. Details of your main source of professional support (if in receipt of support, please leave blank if not applicable)

Question Title

* 17. Do we have your consent to make contact with them? **We will only breach confidentiality without your consent if there is imminent risk to you or someone else. For more details, please ask.

Question Title

* 18. What is the employment status of the person needing help?

Question Title

* 19. If you are unable to get help from The Sanctuary, what do you think will happen?

Question Title

* 20. If you are unable to get help from The Sanctuary where else will you look for support, or what services will you use?

Question Title

* 21. Has the person needing help used a Sanctuary before?

Question Title

* 22. Where is the person needing help right now?

Question Title

* 23. We offer remote support with some face to face availability, what is your preference?

Question Title

* 24. Do you have any dependents at home?

T