Instructions to make a referral for a mental health crisis breathing space

  1. In the form below select whether you are referring someone else or are self-referring for a mental health crisis breathing space.
  2. Enter all other details.
  3. Upload a signed Debt Respite Form from an approved mental health professional: Please note this can be a photo or scan of the original document.
  4. Submit your referral for a mental health crisis breathing space.

Breathing Space Referral Form



Yes
No

Breathing Space Applicant



Referral Details



Upload Signed Debt Respite Scheme Form






 
>