Peer/Counselling/Therapy Support Request

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We understand that many of us may experience mental health struggles at some point in our lives. Sometimes it can be a brief spell, other times it can last a while. It can be frightening and lonely.

HIE, and the effects of an HIE event, can be difficult to come to terms with, and you may find that there are triggers that bring up emotions. We are here to support in any way we can.

This short form is to help us access the best support for you. We can help arrange informal support, signpost to appropriate information, as well as arrange and fund professional counselling/therapies.

If you have any questions at any time, would like this form in a different language, or would like to chat through things, please don't hesitate to get in touch.

First Name

Surname

Contact telephone number

Email address

Postcode (so we know which area you are in)

Please provide a brief summary (only sharing what you feel comfortable with) as to your current concerns / challenges

Have you already sought support from your GP / Health visitor (this won't prevent you from accessing support through Peeps, it's just so we are aware of any counselling/therapy already in place).

Yes - currently receiving counselling/therapy

Yes - have had previously but no longer ongoing

Currently on a waiting list

Clear selection

Are you looking for:

Informal peer support (chat / email / text messages with a fellow HIE parent who "gets it")

Online information and access to resources

Professional support (such as counselling, EMDR* trauma therapy etc,)

Clear selection

Do you give permission for us to share your details with the agreed therapist, so that they can contact you to arrange the initial appointment? (We will let you know before we do this, so that you can expect the contact).

Yes I give permission

No I don't give permission

Clear selection

Thank you for completing the information. A member of the team at Peeps will be in touch with you within 72 hours. If you have immediate mental health concerns please contact The Samaritans for free on 116 123. Further information is available on our website at www.peeps-hie.org.

*EMDR Therapy is Eye Movement Desensitization and Reprocessing Therapy, and can be beneficial where there has been trauma or a stressful event.

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