Supported Housing Referral Form

Supported Housing Referral Form

 Pre-referral Checklist

North Kent Mind has developed the following checklist as a guide to check eligibility and suitability for our Supported Housing Service.

 

 

• They/You are 18+, single with no dependent children.
• Normally resident within the Kent Local Authorities for a minimum of 3 years. Or have a local connection (immediate family member) who has been living in the area for a minimum of 5 years. (Evidence of connection will be required). Unless a different local authority has committed, in writing, to rehouse them/you by the end of their/your 2-year tenancy.
• Has/Have a mental health diagnosis (or are currently seeking a diagnosis). Evidence of this will be required before acceptance.
• Their/Your primary need is mental health.
• Are not in acute or crisis mental health state at the time of referral
• If They/You have a previous history of substance misuse, evidence will be needed to demonstrate management and abstinence, (minimum of 6 months)
• They/You are committed to following a recovery-focused support plan for your/their mental health and working with staff towards independent living within two years.
• They/You do not present a significant risk to others.
• The client/you is/are suitable for low-level support (our service is 2 hours of support per week) they/you must be able to cope with day-to-day living skills
• Our schemes do not have the provision for pets within their tenancy agreement.
• If there is a forensic history (i.e. Admitted for Psychiatric care), Evidence may be required.
• If they/you have a criminal record, information regarding this may be required.

Consent Agreement

If applying on someone else’s behalf this form is to be completed by the referrer for the applicant.

Referrers must obtain the following two types of consent from the applicant prior to completing this form.

Referrals without these consents will not be considered. The referrer may sign /print consent on the applicant’s behalf with their prior permission, which must be confirmed by covering email or indicated in the box below.

North Kent Mind will at times contact the applicants to check consent has been given.

Referrals without these consents will not be considered.

Referrals without these consents will not be considered.

Referral Documentation

Please tick the boxes and attach the following documents at the end of the form.

Applicant Details

(they /them, she/her, he/him etc.)
(this can be found on a medical letter, prescription, NHS app or via contacting your GP)

Next of Kin or Emergency Contact

Referrer Details (please complete if you are making this application on behalf of someone)

(Please complete the below on if applying on behalf of someone)

Reason for application

Medication if applicable

Housing History for a minimum of 3 years

Local Connection

To which of the following boroughs do you/the applicant have a recognised connection?

This normally means you/they have lived there for a minimum of 3 years or have immediate family living in the area for a minimum of 5 years.

Support Needs

Personal statement

(for the applicant to complete in their own words, with referrer support as needed)

Support network

Mental health services currently engaged.

Consultant psychiatrist (or mental health professional responsible for care)

Safeguarding and risk

Safety of self

Safety of others

Safety of others

Mental health – do they/you experience any of the following?

Substance use

Statement by referrer/applicant

Privacy Promise

Where we get your data from: Most data is received from yourself. Where this is not the case, we will have received information from other organisations because you have consented to them referring you or you have consented to us sharing and seeking information from other parties for a specific reason.

The legal basis for using your data: The law sets out that we must have a legal basis for having and using your information. We use “legitimate interests” so we can use your information to provide an effective service which is suitable to your needs and is safe for you and your support worker.

Where we keep your data: Your data will always be recorded in a secure & protected manner. Electronically we maintained our files in our secure databases and servers, which are protected so only people with permission to enter the systems will be able to access your information. In case we keep paper records, they will be stored in our secured cabinets in the office.

How long we keep your data: We keep your data for seven years unless there is a specific reason to keep it longer, such as a legal requirement.

What we share: We are contractually required to keep a record of everyone we support at North Kent Mind. We are required to share information with the organisations that fund our services so that they can see the impact of the work we do and can check the quality of the Housing Services we provide. We will not share what you tell us beyond this without your consent unless we believe you or someone else might be in danger, or if there is a legal requirement for us to share it.

Your rights: You can ask us to see what information we have about you, you can ask us to correct any information that is wrong or, under some conditions, to delete information if you don’t want us to keep it. If you would like to exercise these rights, please speak to your support worker.

Your right to complain: If you have any concerns about our use of your personal information, you can make a complaint to us by writing to our office address or contacting our Data Protection Officer. You can also complain to the Information Commissioner’s Office if you are unhappy with how we have used your data, at: The Information Commissioner’s Office; Wycliffe House; Water Lane; Wilmslow; Cheshire; SK9 5AF

Data Protection Officer: North Kent Mind’s Data Protection Officer may be reached by email at DPO@northkentmind.co.uk or via letter at our office address.

Consent to Sharing Form