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Get the free Mental Health and Alcohol and Other Drug Programs Service Provider Referral Form

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This form is designed for GPs and Service Providers to refer consumers to mental health and alcohol and other drug programs at GPH. It includes sections for referrer information, consumer details,
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Gather all necessary information about mental health and alcohol consumption.
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Start with personal details: name, age, and relevant medical history.
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Answer questions about your current mental health status honestly.
04
Indicate any past diagnoses or treatments related to mental health.
05
Provide information on your alcohol consumption: frequency, quantity, and any negative effects.
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Reflect on how alcohol affects your mental health and overall well-being.
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Be straightforward about any feelings of dependency or addiction.
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Review your responses for accuracy and completeness before submitting.

Who needs mental health and alcohol?

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Individuals experiencing mental health disorders.
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People struggling with alcohol abuse or dependency.
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Friends and family members of those affected.
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Healthcare professionals seeking to understand patient needs.
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Employers aiming to support employee mental well-being.
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Mental health refers to our emotional, psychological, and social well-being, while alcohol refers to a psychoactive substance that can affect mental and physical health. The relationship between the two is significant, as alcohol consumption can impact mental health by altering mood, exacerbating mental disorders, and affecting cognitive functions.
Individuals who are undergoing treatment for mental health issues or have substance use disorders may be required to file mental health and alcohol disclosures. This requirement can apply to healthcare providers, researchers, and specific employers that need to ensure a safe environment.
To fill out a mental health and alcohol assessment, individuals typically need to provide detailed information about their mental health history, any diagnoses, current medications, substance use patterns, and any treatment received. It's important to be thorough and honest to ensure accurate assessment.
The purpose of assessing mental health and alcohol use is to identify individuals who may be at risk for mental health issues or substance misuse. This helps in implementing appropriate interventions, providing necessary support, and promoting overall well-being.
Information that must be reported includes personal history of mental health conditions, details about alcohol consumption (frequency and quantity), any previous treatment for mental health or alcohol-related issues, and current symptoms that may be influencing their well-being.
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