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Crisis services
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Introduction
What is a crisis?
An opportunity for change
What are crisis services?
Services for acute mental health crisis
Introduction
GPs
Hospital care
Community-based alternatives to hospital care
Crisis Resolution Teams
Other community-based services
Crisis houses
Day services
Telephone helplines
Making decisions before a crisis occurs
Care Programme Approach (CPA)
Advance Directives
Crisis cards and joint crisis plans
Services for other mental health crises
GPs
Secondary services
Telephone helplines
Online support
Voluntary organisations
Social, personal financial services
Further reading
Useful contacts
Introduction
This factsheet is for anyone with experience of mental distress, their families, friends and carers. It is especially relevant for people who have experienced a mental health crisis in the past and want to know about the options available to them if a crisis should occur in the future.
Information is given on the range of crisis services that may exist in your area. This should help you to decide which services are likely to work best for you and how to make contact with then when you are experiencing a crisis. The standards you have a right to expect from crisis services and the ways you can make decisions about service use before a crisis occurs are also described.
This factsheet is aimed at adults aged 18 or over. Children and young people are not eligible for some of the services described. However, people aged under 18 do experience mental health crises. If you are under 18, this factsheet may help you to understand the nature of your crisis and direct you towards sources of help and support.
What is a crisis?
Most definitions of a mental health 'crisis' emphasise a sudden deterioration in a person's mental state that could lead to self-injury, suicide or (very rarely) harming others. The person experiencing this kind of crisis has a severe mental health problem and he or she likely to be in contact with secondary mental health services or to have used these services in the past. Many of the 'crisis services' provided by the NHS and social services have been designed to respond to this kind of crisis. For the purposes of this factsheet, this will be referred to as an 'acute mental health crisis.'
Many people who do not meet the criteria for an 'acute mental health crisis' do experience one or more episodes of mental distress in their lifetime that they would identify as a crisis.
Any mental state that results in emotions or behaviours that are painful, out of control or unmanageable should be seen as a crisis. Someone in this state may not require the 'crisis services' provided by the NHS or Social Services but may need to access services that they do not need at any other time, to help them resolve the crisis, or to support them until it has passed.
An opportunity for change
Crises, especially acute mental health crises, can have catastrophic consequences if they are not managed well. However, a crisis can have beneficial outcomes. It can be a transition point and an opportunity for change or growth. It may compel a person to look at their life as a whole and not only their mental health problem in isolation. They may gain new insights and take positive steps for the future.
It may be that a crisis is linked to forms of care or treatment that have not proved helpful and must now be reassessed and changed. It can also provide valuable lessons as to how a similar episode may be prevented or resolved in the future.
What are crisis services?
Any service that helps a person to resolve a crisis, or that supports them while it is happening, can be seen as a crisis service. These services can range from telephone helplines and online discussion forums to Crisis Resolution Teams (CRTs) (see p6) and hospital wards. Crisis services can be provided by the public sector (NHS or Social Services) or the voluntary sector (charities or non-profit making organisations involved in health, social care or other forms of support). Within the NHS, crisis services may be provided by primary as well as secondary care.
Sometimes, a crisis may be caused by a specific issue such as financial difficulties, work-related stress or physical illness. If this is the case, you might find it helpful to contact an organisation specialising in that particular issue.
Services for acute mental health crises
Introduction
The aim of this section is to describe the services that exist to assess, treat and care for people experiencing an acute mental health crisis. It covers recent developments in government policy and frontline practice to ensure people are kept informed about the range of services available and the standards they have a right to expect.
All the services should take a person's needs and choices into account at every stage. The only time they can be treated against their express wishes is if they are sectioned under certain parts of the Mental Health Act 1983. For more information about this, see Mind rights guide 3: Consent to treatment.
Because people may be unable to make decisions or express their views about treatment in an acute mental health crisis, it may be a good idea to do this before the crisis occurs. See 'Making decisions before a crisis occurs'.
GPs
General Practitioners (GPs) play an important role in the early recognition of mental health problems. A GP is more likely to be familiar with a person's history and may monitor his or her condition through regular appointments. This makes it easier to identify and address any deterioration in a person's condition at an early stage, before a problem becomes an acute mental health crisis.
For many people, the GP is the first point of contact with medical or support services at the onset of a crisis. A GP can be a valuable source of support and can help put into practice self-management techniques that have worked in the past. Research shows that people who experience an acute mental health crisis value having someone to talk to, the ability to remain as independent as possible, and recognition and respect for their personal coping strategies. A patient's relationship with their GP can sometimes meet these requirements.
If doctor and patient decide that other services are needed, the GP can give information and advice and make the necessary referrals.
Hospital care
For some people facing an acute mental health crisis, the first point of contact with medical or support services will be the Accident and Emergency (A&E) department of a local hospital. A&E is sometimes the best place to go, especially if a person has physically harmed themselves. However, standards of care in A&E departments are not always adequate to meet the needs of a person experiencing an acute mental health crisis.
Once in A&E, the person in crisis should be referred to the on-call psychiatrist or other mental health staff attached to the hospital. These staff members should assess their condition and arrange appropriate care and treatment as quickly as possible.
After assessment, a referral may be made to a inpatient psychiatric ward. As recently as ten years ago, this was the usual response to an acute mental health crisis. While this is not the case today, many people in a crisis find the inpatient experience necessary. The inpatient setting may be needed for further assessment or to start treatment. It may prevent someone from harming themselves or the symptoms of the crisis from getting worse. It may also helpful in giving the person a break from their usual surroundings.
Both the English and Welsh National Service Frameworks for Mental Health, which set out the standards all health services should reach, state that inpatient provision should be available to anyone who needs it. Hospital wards should be safe and secure with the minimum restriction necessary, offer appropriate care and treatment, and be located as close to the patient's home as possible.
If you are admitted to hospital because of an acute mental health crisis, you should be consulted on the contents of the written care plan that outlines your care and treatment and names one person to be your care co-ordinator. On discharge from hospital, you should be involved with your Care Programme Approach (CPA) which should include ways of preventing and resolving any crises that could happen in the future. See 'Care Programme Approach (CPA)'.
Community-based alternatives to hospital care
Research has repeatedly shown that hospital care is not always necessary or helpful to people experiencing an acute mental health crisis. For years, mental health service users have called for community-based crisis services as an alternative to hospital care. The National Service Frameworks for Mental Health in England and Wales support this position. They both state that people experiencing a crisis should have access to 24 hour care and support and that this should be available from community as well as from hospital services.
Some people are able to manage their crisis in the community with support from their Community Mental Health Team (CMHT) and others such as their GP, family members and carers. Most CMHTs now provide coverage outside traditional 'office hours.' In addition, service users at risk of an acute mental health crisis should have a named contact and/or a helpline number to call, 24 hours a day, if they need help outside the CMHT's hours.
Crisis Resolution Teams
Crisis Resolution Teams (sometimes called Home Treatment Teams) are now provided for adults (aged 18 to 65) experiencing an acute mental health crisis which, without the involvement of the Team, would be likely to result in hospitalisation. The aim of this service is to treat people in the least restrictive environment, with the minimum of disruption to their lives, and in their own home. The majority of mental health service users find this preferable to hospital treatment. Evidence shows that outcomes achieved by CRTs are at least as good as those achieved in hospital.
Crisis Resolution Teams should provide immediate, community-based treatment 24 hours a day, seven days a week. This includes a rapid response following referral, intensive intervention and support in the early stages of the crisis and continuity throughout its management. The CRTs should work with family, friends and carers. They have a good knowledge of local services and can help the person in crisis to learn from the experience, in terms of crisis prevention and crisis management.
If admission to hospital should prove necessary, the CRT should be involved in planning the discharge from hospital and providing intensive care to enable an early discharge.
CRTs contain staff from all disciplines that may be needed to resolve an acute mental health crisis medicine, psychology and social work, as well as support staff that may include people with life experience of mental health problems and services.
The National Service Frameworks for Mental Health state that this kind of service should be available for adults with a severe mental health problem who experience a crisis. Unfortunately, provision is still patchy across England and Wales and many CRTs do not offer the full range of services or 24 hour coverage. Workloads have proved too heavy for many large, sparsely populated rural areas. Different methods of crisis intervention are being considered for people in isolated settlements.
However, the overall picture has improved considerably over the past five years. Crisis services continue to be a high priority for both the Department of Health and the Welsh Assembly Government, so CRTs are likley to play an important part in crisis provision for the foreseeable future.
Other community-based services
In recent years, practitioners have developed and evaluated different ways of delivering crisis services. The results from these research projects, and continuing development work at local level, have led to a range of community-based crisis services across England and Wales. Some of these services are provided by the public, some by the voluntary sector and others are provided by partnership working between the two. The best services draw on the experiences of people who have had acute mental health crises, and there are some user-run crisis services in existence.
Due to the range of services and their varying availability across England and Wales, specific examples are not listed in this factsheet. To find out what is available in your area, ask your GP, CMHT, local NHS trust, NHS Direct or MindinfoLine. The are main types of community-based crisis services are described below.
Crisis houses
Crisis houses offer short-term, intensive support so that people can manage and resolve their crisis in a residential rather than hospital setting. Many crisis houses have been set up in direct response to demand from mental health service users as a preferred alternative to hospital treatment.
Crisis houses usually provide a small number of beds, often for a group with specific needs; for example women, people from a Black or minority ethnic (BME) group or people facing a particular kind of mental health crisis. Overnight accommodation is provided, usually for a specific period of time. Day services are often provided which give opportunities for contact with other residents and staff. Staff who work in crisis houses should be in contact with community mental health workers and have a good knowledge of local services.
People are usually referred to crisis houses by their CMHT. Some crisis houses give the opportunity to self-refer, especially to returning residents. All new residents should be assessed on arrival. If residents are taking medication, they are normally expected to be able to take the medication themselves, without staff supervision. The criteria for admission, length of stay and terms and conditions of residence vary between crisis houses.
Day services
Day services can help someone who doesn't need residential care but who does need support during the day, to manage their crisis. A person experiencing an acute mental health crisis may wish to use these services daily or very frequently. They may use services for the full duration of opening hours or at certain times of the day. Day services may be used in combination with care provided by an unpaid carer (for example, a family member) and contact with a GP or CMHT. Day services can help a person to resolve their crisis and learn self-management techniques that may be helpful in the future.
The term 'day services' covers a range of activities and settings, from 'drop-ins' provided by local, voluntary organisations (such as local Mind associations) to units in hospitals. Some crisis houses also have a 'guesting' service for users who visit during the day but do not stay overnight as residents.
Day services can include counselling, other therapies such as art therapy, or activities such as gardening. They may also provide opportunities to talk to others or opportunities for peace and quiet. Day service staff should have a good knowledge of local services and the day service should be known to CMHT staff.
Telephone helplines
Telephone helplines can provide essential support to people in an acute mental health crisis. This is especially true of helplines that operate outside 'office hours' or give 24 hour a day cover.
Some helplines are 'stand alone' services provided by voluntary organisations, such as Samaritans. These are helplines that allow the caller to talk through his or her emotions and explore options with the aid of confidential and non-judgemental support. Sometimes the caller may ask for information. The helpline operator will either provide it directly or will direct the caller to an appropriate organisation.
Helpline operators should not influence callers in their beliefs or attitudes, or direct callers towards particular courses of action. The operator will allow the caller to make sense of his or her situation and work out possible solutions. If the caller is at risk of suicide or in despair, some helplines (such as Samaritans) offer follow-up calls.
Several national charities for specific mental health problems operate telephone helplines out of office hours. Examples of charities offering this service are No Panic (for panic and anxiety-related problems), Rethink (for severe mental health problems) and the Eating Disorders Association. People with these specific mental health problems can call the helplines in times of crisis. See 'Useful contacts' for details.
Other telephone helplines are not 'stand alone' services but operate as part of the public sector's mental health provision. They may operate in CRTs or CMHTs. These helplines are to be used only by people at risk of an acute mental health crisis. In these cases, the service user will be given the helpline number by a member of their CMHT.
A person who calls their designated helpline number may be able to manage and resolve their crisis by talking to the helpline operator, either once or at scheduled times over a period of days or weeks. If the caller needs more support or treatment, the helpline operator should make immediate referrals to appropriate local services.
Although this section has focused on the telephone, most of the organisations that provide helplines now do so through other media, such as email and textphone. This will be important if you are deaf or have a hearing impairment, or if you simply prefer to use one of these alternative formats.
Making decisions about treatment before a crisis occurs
Sometimes people in an acute mental health crisis may be unable to make or communicate choices about their treatment and care. If you think you are at risk of this occurring, it is a good idea to state your preferences in advance. The ways in which you can do this are described below.
Care Programme Approach (CPA)
The Care Programme Approach is a statutory requirement in England and Wales. It is an individualised care programme to be delivered by health and social care services. It is applies to anyone who is in contact with secondary mental health services.
It is a good idea for people with severe mental health problems to have a crisis plan written into their CPA. Crisis plans should cover what action needs to be taken when the person's mental health is deteriorating, the services that have worked well in the past and the name an individual responds to well in times of crisis. It will also cover contingency plans if the first choice of treatment or intervention is not available.
The crisis plans written into the CPA should help to prevent a crisis before it occurs. If the crisis cannot be averted, the CPA should ensure that the person's choices and needs are known to everyone involved in their care and are put into practice wherever possible. This should mean that the crisis is tackled in a way that is both acceptable to them and most likely to be effective.
The CPA is essential in laying out care needs and entitlements. If the person has a CPA, they should be involved in developing it and see the written plan on completion. The contents of their CPA should be respected and followed by their CMHT and by others involved in their care. If they are not satisfied on any of these points they should take their complaint, in the first instance, to their CMHT. If it is still not resolved, they should go to an advocacy service. Contact MindinfoLine or and see the Mind booklet, Mind guide to advocacy for more details.
For more information about the CPA, see the Mind factsheet, Community care 2: Systems for delivering mental health services.
Advance Directives
An advance directive is a way a person can make their views about treatment known in case they are unable to give consent to treatment, or make informed choices, at some future time. An advance directive applies only to treatment a person does not wish to have. They cannot force a doctor to give them a particular form of treatment but, it does allow them to refuse treatment.
There are certain conditions that need to be settled before an advance directive can be put into practice but doctors and other staff involved in a person's treatment must usually take their wishes into account. For more information about advance directives, see Mind's legal briefing: advance directives.
Crisis cards and joint crisis plans
The mental health service user group Survivors Speak Out were the first to introduce crisis cards. The idea is that the service user would fill in the card to say what kind of treatment they did or did not want to receive in a crisis. Blank copies of crisis cards can be obtained from Survivors Speak Out and MDF The Bipolar Organisation. See 'Useful contacts' for details.
An alternative to a crisis card is a joint crisis plan. This is discussed and written jointly by the service user and the staff involved in his or her care (you will also need to speak to someone in your CMHT). Joint crisis plans may have more influence with mental health professionals than crisis cards because they have been mutually agreed.
For a joint crisis plan template, see the Institute of Psychiatry's website or write to the them. See 'Useful contacts' for details.
Services for other mental health crises
You will not meet the criteria for an acute mental health crisis if you do not have a severe mental health problem. Consequently, you will not be referred to the public sector's mental health crisis services (such as inpatient psychiatric wards, CRTs and community-based alternatives to hospital admission).
Anyone can experience an episode of mental distress when emotions or behaviours become painful, out of control or unmanageable, even if they don't meet the criteria for an acute mental health crisis. This can happen to people with a range of mental health problems as well as to people with no history of mental distress. If this describes an experience you are having, you may identify it as a crisis. During this crisis, you may need to use services that you would not need at any other time.
GPs
The description of the GP's role already given (see 'What is a crisis?') is equally applicable to a situation where the mental health crisis is not 'acute.'
In fact, if your crisis is not 'acute' it is much more likely that you will be able to manage it at primary care level, without involving secondary services.
As well as regular appointments with your doctor, you may have access to a counsellor or therapist through your GP's practice. The GP may prescribe medication, such as antidepressants. It is up to you whether you choose to take them. Antidepressants are not the answer for everyone and may not address the underlying cause of your crisis. See the Mind booklet Making sense of antidepressants for more information.
If there are other lifestyle factors that could be having a negative affect on your mental health, such as diet and exercise, your GP can give you advice on these issues or refer you to a specialist. If you do need assessment by secondary mental health services, your GP can make the referral.
Secondary services
For some people, a crisis can be part of a longer-term mental health problem for which they have been referred to secondary mental health services.
Referrals to secondary services can take months and you may feel you need to see someone quickly. In this case, your GP can refer you as an urgent case. If the time delay is still too much and you feel you cannot cope, you can go directly to your local A&E department and ask to see the on-call psychiatrist. If you find it too difficult to leave your home, you can telephone A&E and ask for the on-call psychiatrist to make a home visit.
The fact that you have been referred to secondary services for a mental health problem does not necessarily mean that you need to use secondary services to manage your immediate crisis. Your GP and other primary care staff, and the other services listed in this section may provide sufficient help and support until your referral comes through, or until the crisis has passed.
Whether you choose to contact secondary services will be based on a number of factors, including the availability of other services in your area and your knowledge of what has worked in the past. If you are not sure whether to you need to use secondary services, your GP and some of the telephone helplines services can help you to make that decision.
Telephone helplines
Telephone helplines can be a good resource if you need immediate support. They can be especially important to you if:
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your local care and support services are not available outside 'office hours'
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you are not eligible for extended hours support from NHS or Social Services
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you live in a rural or isolated area and have to travel further to reach local services
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you have a physical or mental disability that makes it difficult for you to leave your home.
Samaritans is available to anyone in distress or despair, as well as the helplines of national charities that focus on a specific mental health problem. There may be local helplines that cover your geographical area. Check your phone book and other local directories for details. See the section on telephone helplines in 'Other community-based services' for more information.
Online support
In recent years, Internet and email have proved good sources of support for people experiencing mental health crises. These resources have the advantage of being available 24 hours a day, seven days a week to those with Internet access. In terms of access and coverage, these resources have even greater advantages than telephone helplines, as long as you have access to an Internet-connected computer.
The most useful online resources contain information that is accurate, correct and up-to-date, and support services that are likely to improve your mental health. Sometimes access to information can be essential for crisis management. Through online sources, people can access this information at the time they need it and in the privacy of their own home.
Many people in a crisis also find it helpful to make contact with others who have lived through a similar experience. Online discussion forums can be useful in enabling people to overcome isolation, gain moral support and learn practical tips for coping with, and resolving, their crisis.
However, online resources are not necessarily subject to the same quality control as telephone helplines. Anyone with the skills and equipment can create and maintain a website.
Problematic websites include those that do not promote recovery or healthy ways of managing a mental health problem but are aimed at triggering negative behaviours, thoughts and feelings. Eating disorders and self-harm are conditions that have been featured in these kinds of website.
Unsurprisingly, these websites can cause considerable mental distress and make the original problem more difficult to manage. They are likely to be counter-productive and possibly dangerous to someone in a crisis.
Other websites you may wish to avoid are those that provide interactive facilities such as discussion forums that are not adequately moderated. 'Moderation' is the assessment of content before, appears on a public forum. Individuals who contribute to discussion forums will usually have their contribution assessed by an individual or group that maintains the forum and is responsible for quality control. The aim of moderation is to prevent information that is offensive, false or likely to cause harm to others' mental health from being publicly available.
The issue of moderation is controversial. Some would argue that any moderation inhibits the free exchange of views. Ultimately, it is your choice whether or not to use an unmoderated discussion forum. What is important is that your choice is fully informed and likely to help you manage your crisis.
There are some basic points to bear in mind when you are assessing a website for its quality. They should:
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display the date when they were last updated
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provide references for any information they give
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be accessible (that is, clearly laid out, easy to navigate and provide a way of enlarging the words for people with visually impairments).
These points are only indications, not guarantees, of a website's quality.
Online facilities provided by NHS Direct and the leading national charities in mental health provide high quality information and support services. In addition, they often provide links to other relevant websites, including those created and maintained by mental health service users. These linked websites should have been assessed for their quality and relevance. It is important to bear in mind that no organisation can be responsible for the content of external websites.
Voluntary organisations
Local voluntary organisations involved in mental health, such as local Mind associations (LMAs), may be able to help you through your crisis by providing information, advice, counselling or other day services. To find out what is available in your area, ask your GP, CMHT, local NHS trust or contact MindinfoLine.
Social, personal and financial services
The causes of a crisis, and the factors that can make a crisis difficult to manage, are too numerous and too varied to cover in this factsheet. Particular areas of a person's life that can directly cause or trigger a crisis include:
If you recognise any of these factors in your own crisis, you might find it helpful to contact an organisation that gives information and support in that particular area. Mind also publishes factsheets and booklets on many of these issues. Contact Mind Publications for details.
Further reading
Mind booklets
How to parent when you're in a crisis, Mind, 2004
How to survive a mid-life crisis, Mind, 2004.
Making sense of antidepressants, Mind, 2006.
The Mind guide to advocacy, Mind, 2005.
Mind rights guide 3: Consent to treatment, Mind, 2004.
Mind factsheets
A brief guide to who's who in mental health, Mind Information Unit, 2005.
Community care 1: the spectrum of mental health services, Mind Information Unit, 2005.
Community care 2: systems for delivering mental health services, Mind Information Unit, 2002.
Community care 3: how to access community care services, Mind Information Unit, 2002.
Young person's introduction to mental health, Mind, 2004.
Legal briefing
Legal briefing: advance directives, Mind Legal Unit, 2003.
Studies into crisis services
Cobb, A. 1995, Mind's model of a 24 hour crisis service, Mind, London.
Minghella E., Ford R., Freeman T., Hoult J., McGlynn P., O'Halloran P.1998, Open all hours: 24 hour response for people with mental health emergencies, The Sainsbury Centre for Mental Health.
The Mental Health Foundation 2003, The Crisis Project Workbook, Mental Health Foundation.
The Sainsbury Centre for Mental Health and the Mental Health Foundation 2002, Being there in a crisis, Mental Health Foundation.
Tomlinson, D. and Allen, K. (ed). 1999, Crisis services and hospital crises: mental health at a turning point, Ashgate.
Department of Health and National Assembly for Wales publications
Appleby, L. 2004, The National Service Framework for Mental Health – five years on, DH.1
Department of Health, 2001, Mental health policy implementation guide, DH.
Department of Health, 1999, National service framework for mental health: modern standards and service models, DH.
Welsh Assembly Government, 2005, Raising the standard: the revised adult Mental Health National Service Framework and Action Plan for Wales, WAG.
Useful contacts
Mental health
Eating Disorders Association (EDA)
103 Prince of Wales Road, Norwich NR1 1DW
adult helpline: 0845 634 1414 (10.30am to 8.30pm Mon to Fri;1pm to 4.30pm Sat)
youth helpline: 0845 634 7650 (4.30pm to 8.30pm Mon to Fri; 1pm to 4.30pm Sat)
textphone: 01603 753 322
youthline text service: 07 977 493 345 (for response within 24 hours)
email: helpmail@edauk.com (adults) or talkback@edauk.com (under 18s)
web: www.edauk.com
The leading UK charity for eating disorders. Co-ordinates a network of self-help groups and individual postal, telephone and email contacts.
Hafal
Suite C2, William Knox House, Britannic Way, Llandarcy, Neath SA10 6EL
tel: 01792 816 600
email: hafal@hafal.org
web: www.hafal.org
The leading charity for severe mental health problems in Wales.
Institute of Psychiatry (IoP)
Kings College London, De Crespigny Park, London SE5 8AT
tel: 020 7836 5454
web: www.iop.kcl.ac.uk
For templates of joint crisis plans.
MDF The Bipolar Organisation
Castle Works, 21 St George's Road, London SE1 6ES
tel: 08456 340 540, fax: 020 7793 2639
email: mdf@mdf.org.uk
web: www.mdf.org.uk
The leading UK charity for people with bipolar affective disorder (manic depression). Runs self-help groups across the UK and gives access to safe, secure online discussions via their website.
NHS Direct
tel: 0845 4647
email: via website
web: www.nhsdirect.nhs.uk
For information and advice on any health problem, including the services you may need to contact. Available 24 hours a day.
No Panic
93 Brands Farm Way, Telford, Shropshire TF3 2JQ
tel: 0808 808 0545 (free helpline 10pm to 10am everyday; also night-time anxiety crisis line - answer phone only)
email: ceo@nopanic.org.uk
web: www.nopanic.org.uk
Charity to help those with panic attacks, phobias, obsessive compulsive disorders, anxiety disorders and tranquiliser withdrawal.
Rethink
Head Office, 5th Floor, Royal London House, 22-25 Finsbury Square, London EC2A 1DX
tel: 020 8974 6814 (national advice service,10am to 3pm Mon to Fri)
email: advice@rethink.org (national advice service)
web: www.rethink.org
The largest charity for severe mental health problems in England. Runs 13 regional helplines.
Samaritans
Chris, PO Box 9090, Stirling FK8 2SA (information, help and postal support)
tel: 08457 90 90 90 (national helpline)
email: jo@samaritans.org
web: www.samaritans.org.uk
Available 24 hours a day to give support to people experiencing distress or despair. The contacts above can put you in touch with your local Samaritans branch.
Survivors Speak Out
44 Seldon House, Stewarts Road, London SW8 4DP
tel: 020 622 5738
Campaigning organisation that provides templates for crisis cards and information on related issues, such as Advance Directives.
General
Citizens Advice
Myddleton House, 115-123 Pentonville Road, London N1 9LZ
tel: 020 7833 2181
web: www.adviceguide.org.uk (for your nearest CAB office)
The leading UK charity giving free information and advice on legal, financial and other problems.
Job Centre Plus
web: www.jobcentreplus.gov.uk
Gives advice and practical support to those seeking education, training and benefits. See their website to find your nearest Jobcentre Plus office or check your phone book or other local directory.
National Debtline
Tricorn House, 51-53 Hagely Road, Edgbaston
Birmingham B16 8TP
freephone: 0808 808 4000 (9.00am to 9.30 Mon to Fri; 9.30am to 1pm Sat), fax: 0121 410 6230
email: via online form on website
website: www.nationaldebtline.co.uk
For people with debt problems in England and Wales.
Parentline Plus
tel: 0808 800 222 (freephone 24-hour helpline)
textphone: 0800 783 6783 (freephone helplines)
email: via online form on website
web: www.parentlineplus.org.uk
Provides information, self-help groups and support on parenting for anyone involved in bringing up children.
Rape Crisis (England and Wales)
email: info@rapecrisis.org.uk
web: www.rapecrisis.org.uk
Online resource to provide information so that survivors of rape and domestic violence can get the help they need. The contacts above can put you in touch with your nearest Rape Crisis centre.
RELATE
tel: 0845 456 1310 (lo-call)
email: via online forms on website
web: www.relate.org.uk
Provides counselling and other support services on relationship problems for individuals, couples and families. The contacts above can put you in touch with your nearest Relate centre.
Shelter
88 Old Street, London EC1V 9HU
tel: 0845 458 4590 (general enquiries) or 0808 800 4444 (freephone helpline 8am to 12 midnight, seven days a week.)
email: info@shelter.org.uk
web: http://england.shelter.org.uk (England) or
http://cymru.shelter.org.uk (Wales)
For leading national charity for advice and support on homelessness and housing problems.
Women's Aid
Head Office, PO Box 391, Bristol BS99 7WS
tel: 0808 2000 247 (freephone 24-hour helpline)
email: helpline@womensaid.org.uk
web: www.womensaid.org.uk
The main national charity working to end domestic violence against women and children. Refuges across England and Wales.
This factsheet was written by Rachael Twomey, Mind Information Unit, April 2006
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