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U-COPE Referral Form

Inclusion criteria;                                                                                            

Currently registered as a student studying at the following universities;

University of Liverpool (UOL)

Liverpool John Moores (LJMU)

Hope University

Liverpool School of Tropical Medicine (LSTM)

University of Liverpool International College (UoLIC)

Liverpool Institute for Performing Arts (LIPA)

  • Recent (within the last year) self harming behaviour. May be self-reported                
  • Self-harm refers to an intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act, and is an expression of emotional distress NICE 2004

Exclusion Criteria:                                                                                          

  • Presenting with symptoms of acute mental distress such as psychosis
  • Already engaged with a secondary mental health service
  • Currently engaging with another therapy
  • on a waiting list for another therapy 
  • Drug or alcohol use is the primary problem     


Students Information

Date format: DD/MM/YYYY

Students Contact Details

We will contact the student via email so please have the email account that they check and are happy for us to use

Students GP Details

Details of the referral