Ashley Road

Islington Mind Ashley Road
35 Ashley Road
London
N19 3AG
Telephone: 020 7272 6936

Mental Health Recovery Pathway – Integrated Community Support

Providing open-access day services opportunities for Islington residents who experience mental distress

Referral Form

You can write "Prefer not to say" for any information you would rather not give.

Date of referral *

Name of client *

Date of birth *

Gender *

Sexuality *

Marital Status *

Address *

What borough do you live in?

Telephone No. *

Email

Mobile No.

Ethnic background *

Are you a carer? *

• Yes
• No

Do you give regular care to a friend or relative with an illness or disability without being paid?

Religion/Faith *

What is Your Mental Health Condition? *

Any other disabilities/health problems

Medication

Psychiatrist's Name

Psychiatrist's Phone

Psychiatrist's Address

GP Surgery

GP Phone

Please include details of other professionals e.g. Social Workers; CPNs; OTs; Housing Workers etc.

Name

Job Title

Address

Phone No.

Emergency contact person

Relationship to you

Phone No.

Do you have any criminal convictions? *

• Yes
• No

If Yes, please provide more details

Do you have any history of drug/alcohol abuse?

• Yes
• No

If Yes, please provide more details

What other daytime activities are you involved in?

Employment Status/Skills *

What services are you interested in? *

Are you self-referring? *

• Yes
• No

Name of referrer *

Referrer's Address *

Name of referring agency

Referrer's Email *

Referrer's Phone/Mobile

Does the service user give consent for this referral to be made? *

• Yes
• No

Any other relevant information

How did you hear about our service? *

Submit

Our waiting list for counselling is open. 

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Activities

Monday

Mother to Mother
Drop-in 11:00am – 2:00pm for mothers of children with mental health problems.
Call 020 7272 6936 (Mondays only)

Tuesday

Outcome: LGBTQ+ only drop-in
and lunch (£2.50)
Call 020 7272 5038 (Tuesdays only)

Wednesday

Freedom from Fear to Love: Support for LGBTQ+ asylum seekers and refugees. Call 020 7272 5038 (Wednesdays only) 

Thursday

Women’s only drop-in and lunch (£3.00) 11:30am – 3:30pm
Call 020 7272 6936 (Thursdays only)

Friday

Learning disability groups: Drop-in and groups 11:00am – 3:00pm
Call 020 7272 6936 (Fridays only)

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Download the timetable 

We are always looking for volunteers and service users to run groups and activities, and particularly at Outcome and Women’s Day – so do get in touch with us if you are interested.