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Listening Ear Referral Form

Referrer

Your Contact Details

Your contact details will be held on Manchester Mind's database, which can only be accessed by current Manchester Mind staff.. We will not share these with any other organisation. We will use these details if there is an issue with the referral (e.g. we cannot make contact with the young person, or we need further details about their situation), a member of Manchester Mind staff may contact you for more information. For more details of how we hold personal data please see our Data Privacy Notice.

Referring Organisation

We will use the details in this form to contact the  person and arrange an assessment meeting with them. Please make sure they are aware this will happen before proceeding with this referral.

Is this person aware that a referral is being made on their behalf, and that their details are being shared with Manchester Mind's Peer Support Service?

Please make sure the person is aware Manchester Mind will be in contact with then before continuing with this referral.

Eligibility

The Listening Ear Service is open to people who:

  • Are aged 18 or over
  • Are residents of Manchester City Council
  • Have a current mental health problem

Please answer the following questions to confirm the eligibility of the person you are referring.

Are this person (or their family) a Manchester Resident
Not sure of their local council? Find out using this postcode search.
Do they have a current mental health problem?
Person you are referring
Address and Contact Details

Please leave at least one phone number or an email address for this person. We will use these details to contact them about their referral.

How do they prefer to be contacted?
Are they happy for voicemail messages to be left? Should we leave a message if someone else answers the phone? Is there anyone we should not speak to? Please give as much detail as possible.
About the person's situation
Please give as much detail about their situation as you feel able.
Do they get any support from other agencies?
Please share details of other services working with this person, where appropriate.
Listening Ear Preferences

The Listening Ear Service

A Manchester Mind staff member or volunteer will call the person you have referred once a week, on an agreed date and time.   The call provides a confidential space where they can talk about anything that’s on their mind. 

They will be listened to without judgement or any pressure.  The call will last for up to an hour and will usually be with the same listener.  We can offer a maximum of 6 calls. 

We will email the persn you have referred a listening ear agreement with further details for them to read through and confirm if they are happy to proceed.

The following questions will help us to determine the kind of support we can offer them.

Do they have a preference for a maloe or female listener?
Can they converse in English?
Can they commit to a weekly call?
Can they be available at the same time and day each week?
Availability for phone calls. (If known)
How you heard about us.
Have you used Manchester Mind Services before?
How did you hear about us?