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Birmingham & Solihull Community Counselling Service — How to Refer

Please complete this online referral form as fully as possible. Referrals are triaged within 5 working days of receipt. This is not a crisis service. If the client is at immediate risk of harm, please do not use this form. Call 999 in an emergency. For urgent mental health support, call NHS 111 and select the mental health option.

If you have any difficulty completing this form, you can call us on 0800 599 9880 or email Gatewayfs@nhs.net — we are happy to help. Please do not submit referrals by email.

The client can also make a self-referral using the following link: click here

Eligibility Screening

IMPORTANT: Please confirm the following before completing the full referral. If the client does not meet all three criteria, see the signposting information below the screening questions.

Is the client aged 18 or over?
Does the client live in Birmingham or Solihull, or are they registered with a BSOL GP?
Is the client seeking support for emotional distress, low mood, depression, grief and loss, trauma, relationship challenges, self-esteem, adjusting to changes or similar?

Signposting Services

If you answered No to any of the above, this service may not be the right fit. Please consider:

  • Under 18: Forward Think Birmingham (CYP mental health), Kooth online
  • Outside Birmingham and Solihull: Contact the client's local NHS Talking Therapies or community counselling service
  • Not a counselling need: Consider social prescribing, NHS 111 (mental health option), or other Gateway Family Services services.

You are welcome to call us on 0800 599 9880 to discuss a borderline case before referring.

Client Details

Client full name
Date of birth
Address
How would you prefer us to contact the client?
Ethnic Background

Referral Details

Date of referral
Referral source

Presenting Difficulty

Are they currently having thoughts of harming themselves/others?

Risk Information

If you are aware of any current risk factors, please indicate below. This helps us prioritise and ensure client safety.

Current suicidal thoughts
Self-harm (current or recent)
Risk to others
Safeguarding concerns
Domestic abuse
Known diagnosis of Severe Mental Illness (e.g. psychosis, bipolar, personality disorder)

Accessibility and Preferences

Interpreter needed?
Preferred locality

Consent

Client consent to this referral (do not submit without consent)
Date of referral

Data sharing: Information provided will be stored securely on Gateway Family Services' encrypted client management system and shared only with clinicians involved in the client's care. See our Privacy Notice for full details.

Need help with this form?

TEL

Call us

0800 599 9880

EMAIL

Email us

Gatewayfs@nhs.net

For help completing this form only. Please do not submit referrals by email.

Eligibility criteria

✓

Aged 18 or over

✓

Lives in Birmingham or Solihull, or registered with a BSOL GP

✓

Seeking support for emotional wellbeing - not acute crisis

! Crisis contacts

999 - immediate danger

NHS 111 - select the mental health option

Samaritans - 116 123 (free, 24/7)

Is the client able to refer themselves? Send them the self-referral form instead.

Self-referral form →