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. It's beneficial to provide the applicant's phone number. Then our specialist debt advisers can start helping with the debts as soon as possible.
  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






 
If you need advice or support with completing this form, please contact us on 0808 801 0745 or breathingspace@mentalhealthandmoneyadvice.org
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