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Mental health referral templates

PLEASE NOTE the cut off dates for referring your patients/clients to the Psychological Support Services (PSS) and Primary Integrated Care Supports Program (PICS) during the holiday period:

  • PICS:  Last date that referrals can be sent to the CESPHN will be COB Wednesday 23 December 2020.
  • PSS: Last date that referrals can be sent to the CESPHN will be COB Friday 11 December 2020.
  • Suicide Prevention referrals through PSS will be accepted up until COB Friday 11 December 2020.

PICS referrals will reopen on Monday 4 January 2021 and PSS referrals will reopen on Monday 11 January 2021

Mental Health Date as at PDF Word Best Practice Medical Director Online

PSS – GP Initial Referral for adults and young people and children Mental Health Treatment Plan

25 June 2020

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PSS – GP Review Referral for adults and young people and children Mental Health Treatment Plan

25 June 2020

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Resources – Depression, Anxiety, and Stress Scales (DASS 21)

24 September 2019

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Resources – Health of the Nation Outcome Scale (HoNOS)

Refer online

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Resources – Edinburgh Postnatal Depression Scale (EPDS)

24 September 2019

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Resources – Kessler Psychological Distress Scale (K10)

24 September 2019

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Resources – Kessler Psychological Distress Scale (K10+)

24 September 2019

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Services Referral – Black Dog Insitute Referral Forms for Clinics

Download forms from hospital’s website

Services Referral – headspace Ashfield

24 September 2019

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Services Referral – headspace Bondi Junction

24 September 2019

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Services Referral – headspace Camperdown

24 September 2019

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Services Referral – headspace Hurstville

24 September 2019

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Services Referral – headspace Miranda

24 September 2019

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