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

Referral Form

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

Date of referral *

Name of person being referred *

Pronouns

Date of birth *

Address *

What borough do you live in?

Telephone Number *

Email

Gender *

Marital Status *

Ethnic group *

Sexual orientation *

Religion/Faith *

Employment Status/Skills *

Are you a carer? *

• Yes
• No

Do you provide regular unpaid care to an adult friend or family member?

What is Your Mental Health Condition? *

Any other disabilities/health problems

Medication

GP Surgery

GP Phone

Psychiatrist's Name

Psychiatrist's Address

Psychiatrist's Phone

Emergency contact person

Relationship to you

Emergency contact's phone

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?

Which Islington Mind 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

How did you hear about our service? *

Submit

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Activities

Monday

Mother to Mother
Drop-in 11:00am – 3:30pm for mothers of children with mental health problems.
Call 020 7272 6936 (Mondays only)

Tuesday

Outcome: 11:00am – 4:00pm
LGBTQ+ only drop-in
and lunch (£2.50)
Call 020 7272 5038 (Tuesdays only)

Wednesday

Freedom from Fear to Love: 11:00am – 3:00pm
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)
Please contact before coming for the first time

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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.

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