Services For Yourself

Services For Yourself

If you are seeking services for yourself at CMHA Thames Valley Addiction & Mental Health Services, complete the form below to get connected with us.

Welcome*

In which Canada’s official languages are you most comfortable receiving your healthcare services?

Dans quelle langue officielle du Canada vous sentez-vous le plus à l’aise pour recevoir vos soins de santé ?

English

Français

Veuillez utiliser ce lien pour accéder à la version française de ce formulaire

https://app.smartsheet.com/b/form/a08519fa38934eff9e9425f80fb7a5f6

Where are you looking for services?*

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What can we help you with in London?*

Check the area of primary focus/need:

Select

What can we help you with in Elgin County?*

Check the area of primary focus/need:

Select

What can we help you with in Middlesex County?*

Check the area of primary focus/need:

Select

What can we help you with in Oxford County?*

Check the area of primary focus/need:

Select

What can we help you with in South Huron (Exeter)?

Check the area of primary focus/need:

Select

Help registering for a program or group

Community Wellness / Social Rehabilitation programming provides individuals meaningful activities, groups, and special events to enhance their mental and emotional health, social and physical abilities, independence and overall well-being/recovery. Social Rehabilitation / Community Wellness offers programming that focuses on all domains of wellness. These programs aim to enhance skill development, build upon individual strengths, increase coping skills and foster resiliency within participants while increasing their quality of life.

Click here to register for CMHA TVAMHS Programs

You can access information about programs and groups in our Guide on our website.

Please fill out the information below to receive support in registering for a program or group.

Housing supports in the City of London

There are multiple options available in the community for Supportive Housing See below for options available:

Experiencing, or at risk of homelessness? Please contact:

The City of London, Coordinated Access

Phone: 519-661-4663

Email: homelessprevention@london.ca

355 Wellington Street (Citi Plaza)- Second Floor Suite 248 London, ON

Looking for long-term social housing resources? Please contact:

The City of London Housing Access Centre

Phone: 519-661-0861

Email: hac@london.ca

355 Wellington Street (Citi Plaza)- Second Floor Suite 248 London, ON

Are you a tenant in need of legal advice? Please contact:

Neighbourhood Legal Services

Phone: 519-438-2890

Email: info@nlslm.cm

200-717 Richmond Street London, ON

Family Support Services for Mental Health

A variety of programs are offered to help informal caregivers learn how to navigate providing support for someone who struggles with: mental health, emotional instability, or personality disorder.

All of the services are delivered online and are intended to educate and empower participants in their caregiving journey. “Caregivers” are defined as any individual in an informal support role (eg. family members, friends, partners, co-workers, neighbours) to someone over the age of 16 years who is believed to have mental health issues. Information is also provided that promotes the mental health and wellness of the caregiver.

As this program is offered virtually, access to a device with a camera, microphone and internet is required.

Upon completion of this form, a family support staff member will be in contact with you via email to provide more information and get you registered for programming. If you have any questions regarding the services for caregivers, you can send them directly to familysupport.info@cmhatv.ca

My relationship to the person who struggles*

Select

If other, please list:*

Age of the person I support*

Relevant Information:*

A brief description of how your loved one struggles and what you are hoping to learn

Bereavement Services

Bereavement Services promotes improved quality of life for anyone grieving a suicide or substance use loss. Staff work collaboratively with family members, care-givers, clients, peers and the community to assist in moving forward after a loss. Supports include both one-to-one support and group opportunities with a focus on enhancing coping strategies, decreasing isolation and sleep disturbances, assessing overall health, identifying activators, and building resilience.

Upon completion of this form, our bereavement counsellor will be in contact to offer support. If you have any questions for our bereavement counsellor, you can send them directly to grief@cmhatv.ca

Relevant Information*

Brief description of symptoms related to grief

Loss occurred due to:*

a suicide loss

a substance use loss

Date of Loss:*

Explain any checked above:*

Explain any checked above:*

Community Services and Supports*

Please list any other professional and/or interpersonal supports that you are connected with:

Support Goals

What primary goal would you like to work on?*

Please be specific with your goal you would like to work on

What second goal would you like to work on?*

Please be specific with your goal you would like to work on

Are you a member or family member of LiUNA 1059 or 625?*

Yes

No

Current Alcohol Use*

Select

Check all substance used in the last 12 months:*

Select

Are opioids (Hydro's, Fentanyl, Oxy's, Morphine) your primary substance of concern?*

Yes

No

Current Drug Use

Select

Do any of the following mental health diagnosis apply to you?*

Select

If other mental health diagnosis, please describe:*

Does your mental health impact your ability to function?*

Yes

No

Does your substance use concern impact your ability to function?*

Yes

No

In the last 30 days, which concerns have you had the most problem with:*

Mental Health

Substance Use

Are you currently pregnant, caring for or preparing to care for any children under the age of 7?*

Yes

No

Our Heartspace program is currently focused on supporting clients who identify as female. Do you meet this criteria?*

Yes

No

Check all gambling activities you have engaged in during the last 12 months*

Select

If other gambling activity*

Are you gambling in-person, online, or both?*

Select

Gambling Activity Use*

Select

Check all gaming activities you have engaged in during the last 12 months*

Select

Other Gaming Activity*

Gaming Activity Use*

Select

Check all internet/technology activities you have engaged in during the last 12 months*

Select

Other internet activities*

Current Internet/Technology Activity Use*

Select

Check all sex/pornography activities you have engaged in during the last 12 months*

Select

If other sex/pornography activities*

Current Use Sex/Pornography*

Select

How ready are you to make changes?*

Not Ready

Unsure

Ready

Are You Currently Taking Anti-Craving Medication for Alcohol (Naltrexone)?*

Yes

No

Are You Currently Taking Methadone/Suboxone?*

Select

Do You Require Support with Your Withdrawal Symptoms Today?*

Community Withdrawal Support Program

This program is being offered in person in London and virtually to Elgin, Middlesex, Oxford and South Huron.

Is This Program For Me?

Must be willing and interested in withdrawal supports
Must be 12 years of age or above
Willing to reduce the use of one or more substances
Deemed safe to withdraw in the community
Meet provincial standards for withdrawal management

What We Offer

Substance use and withdrawal needs assessment
Referral to appropriate services and level of care
Withdrawal information for individuals and support persons
Acute withdrawal symptom monitoring and daily support during acute withdrawal
Supportive counseling as appropriate
Facilitate involvement of Primary Healthcare Providers
Community care planning
Minimize risk of withdrawal complications
Post-withdrawal support, education, and relapse prevention

Yes

No

Medical Information*

Medical/Psychiatric Conditions/History:

Primary Care Provider:*

If none, indicate N/A

Current Psychiatrist:*

If none, indicate N/A

Mental Health Supports in Elgin County

Brief Counselling

Information and Brief Support

Perinatal Mental Health

Prevention and Early Intervention Program for Psychoses (PEPP)

Community Wellness Programs / Groups

Transitional Case Management

Mental Health Supports in London

Click an option below to see the description of this service.

Community Wellness Groups / Programs

Information and Brief Support

Talk In Counselling

Transitional Case Management

Mental Health Supports in Middlesex County

Community Wellness Groups / Programs

Information and Brief Support

Transitional Case Management

Mental Health Supports in Oxford County

Mental Health Supports in South Huron (Exeter)

Community Wellness Groups / Programs

Information and Brief Support

Transitional Case Management

Brief Case Management

Brief Case Management is a goal-oriented, client directed service, designed to assist individuals experiencing persistent mental health difficulties to reach a state of wellness and stability. In collaboration with a case manager, individuals develop their personal recovery plan and work on identified goals. Interventions are focused on stabilizing symptoms of mental illness and promoting growth and resilience on a client’s recovery journey.

Brief Counselling

Brief Counselling is a structured, time-limited, and goal-oriented model. The program offers client-centered, strength-based, solution-focused approaches on a short-term basis to individuals 16+ experiencing mental health related concerns. A variety of treatment modalities are used to support positive change and coping skills.

Areas of exploration include (but are not limited to) anxiety and stress-related problems, interpersonal relationships, emotional regulation, and situational stressors. The program is a brief model that provides short-wait times and rapid access, it is not suitable to individuals in crisis and those with complex or significant mental health concerns.

Individuals with primary concerns related to addiction, grief/loss, and trauma may be more appropriate with other long-term and specialized services.

Talk In Counselling

Talk In Counselling provides single-session therapy to address an immediate life problem at their time of need and assist in developing potential solutions before it becomes a larger crisis using the Brief Single Session Therapy model.

Talk In Counselling is a preventative service that provides immediate access to counselling services and is a viable option for those waiting for ongoing support or treatment.

This service is not intended for those who are seeking support for trauma as we would recommend a longer term support in this case.

This is not intended as couples counselling, as we would only provide separate, individual counselling to each partner so we can focus on issues in their relationship and their individual strengths. This can be an excellent starting point for making changes in their relationship.

Service is provided through pre-booked appointment times.

Information and Brief Support

Information and Brief Supports are designed to provide system navigation, connection to community supports and working on short term and time sensitive goals.

This program can support individuals who have a 1-2 goals to work on and can complete next steps on goal setting independently.

Perinatal Mental Health

The Perinatal Mental Health (PMH) Case Manager works within a multidisciplinary team through Elgin and Oxford County, providing rapid response and support to mothers presenting with Post Partum Mood and Anxiety Disorders, with children up to the age of 24 months. This program works towards ensuring the wellbeing of mother and child are paramount and working alongside to improve symptoms of mental health, quality of life, education, skill development, recovery plans and connection to ongoing supports through individual sessions as well as group supports where appropriate

Prevention and Early Intervention Program for Psychoses (PEPP)

Through our Prevention and Early Intervention Program for Psychoses (PEPP), we provide early intervention services for individuals aged 16-35 living in St. Thomas or Elgin County who display signs of psychosis. Psychosis is defined as having symptoms of hallucinations (responding to auditory or visual stimulus others cannot experience) and/or delusions (a belief in a thought or idea despite clear evidence in the contrary and is not grounded in reality). A primary psychosis disorder is often associated with the individual also having additional symptoms including disorganized thoughts, speech or behaviours, as well as, confusion and/or paranoia.

To be eligible, individuals referring to the PEPP program will have to have had no prior treatment for psychosis, or, have been treated for less than 6 months prior to the date of the referral. The program is committed to working in partnership with the individual’s family who often play a vital role in outcomes. We offer Assessment, Treatment, Psychosocial support, Family Support, Peer Support, Community Wellness and Integration.

***If you are unsure if PEPP is right for you, please refer to this link https://cmhatv.ca/programs-services/pepp/ for more information***

Seniors Outreach and Recovery

Seniors Outreach and Recovery (SOAR) is a specialized service that assists community members aged 65+ and/or have a age-related illness, with mental health concerns. The Clinician assesses the person’s needs, strengths, and supports to co-develop goals and a customized recovery and support plan

Community Wellness Program / Groups

Community Wellness programming provides individuals meaningful activities, groups, and special events to enhance their mental and emotional health, social and physical abilities, independence and overall well-being/recovery. Community Wellness offers programming that focuses on all domains of wellness. These programs aim to enhance skill development, build upon individual strengths, increase coping skills and foster resiliency within participants while increasing their quality of life.

Programming includes:

Psychoeducational groups
Skill-based Programming
Therapeutic Programming in the 5 Domains of Social, Physical, Intellectual, Emotional & Spiritual
Leisure-related Programming

Transitional Case Management

Transitional Case Management is a short-term program designed to help you navigate community supports, connect to resources and services and meet your short-term goals.

A TCM might help you address housing issues, budgeting, finding social and recreational supports and supporting you in making sure your physical and mental health needs are being addressed. The TCM program is geared towards individuals who have multiple goals (3+) in these areas. If you have 1-2 goals, please select Information and Brief Support.

TCM does not provide support attending medical appointments and does not have the ability to provide transportation to appointments.

The program that best fits my needs in London is:*

Select

The program that best fits my needs in Oxford County is:*

Select

The program that best fits my needs in South Huron (Exeter) is:*

Select

The program that best fits my needs in Elgin County is:*

Select

The program that best fits my needs in Middlesex County is:*

Select

Transitional Case Management

Do your presenting concerns/immediate needs require a lengthier service engagement period or can your concerns be addressed through a brief services engagement?*

Yes - I require a 4-6-month support period to address/deal with my concerns

No - My concerns can be addressed in 1-4 appointments

Don’t Know/Uncertain

You have indicated your concerns can be addressed in 1-4 appointments:

Please go back and select Information and Brief Support from the list.

Are you currently involved in the criminal justice system (Are you on probation or parole, have pending charges in front of court, etc.)?*

Yes

No

Do you need support in finding a family doctor?*

Yes

No

Resource for finding a doctor:

If you are seeking support for finding a family doctor, please visit this website: https://www.ldam.ca/find-a-doctor

If this is your only area of concern, please go back and select Information and Brief Support.

Are you currently seeking help related to housing?*

Yes - My housing may be at risk

Yes - I am currently unhoused

No - I have a stable housing placement

Can you commit to scheduled appointments?*

Yes - I understand this is a voluntary program and plan to engage regularly with my assigned worker

No - I don’t think I am ready for regular contacts with a program/worker and would benefit from walk-in style services instead

I understand that the Transitional Case Management Program does not provide counselling services but offers navigation to no/low cost counselling services in the area.*

I acknowledge that staff in this program are not counsellors but offer support connecting to counselling services.

Yes

No

Transitional Case Management Next Steps:

Thank you for your interest in our Transitional Case Management Program. One of our staff will be reaching out to you in the next two-weeks through the contact method(s) listed on your contact form submission to discuss your interest and schedule an intake appointment.

Please monitor your email and voicemail to ensure you are aware of our follow-up.

Brief Counselling*

Please Note: Primary concerns related to trauma, substance use addictions, eating disorders, grief/bereavement may be more appropriate with other specialized programs and services and therefore Brief Counselling would not be a suitable program.

By checking yes, you understand and agree to this.

Yes

No

Prevention and Early Intervention Program for Psychoses (PEPP)

To be eligible for the PEPP program please confirm the following:*

The individual being referred is between the ages of 16-35 years old, lives in Elgin County, has been experiencing signs of psychosis for which there has been no treatment or the treatment was less than 6 months?

Yes

No

The requirements to engage with the PEPP program have not been met.

Please select another program from the drop down options.

Family Doctor

Date symptoms started*

Please describe symptoms:*

Please provide additional details for the following:*

Current Living Situation

Income Source

Current Community Supports

Employment/Education

Justice involvement

Have you received treatment in the past?*

Select

If yes, when?*

Treatment provided by:*

Are you 65 years of age or older?*

Yes

No

Please describe any other age related illness or condition we should be aware of.

Perinatal Mental Health

Are you currently*

Pregnant

Parenting

How many weeks postpartum are you?*

Is the age of the child 24 months and under?*

Yes

No

What are the ages of your child(ren)?*

Important

At this time the Perinatal Mental Health program does not offer support to those with children over 24 months.

Please review additional supports from the options above.

Are you experiencing any of the following:*

Select

Please describe any checked above

Include information around whether your experiences were during pregnancy or post-partum

Court/Justice related information

Current Charges:*

Where are the charges:*

City/County of charges

Next Court Date:

Probation/Parole Officer:

Lawyer:

Permission to Contact Lawyer*

Select

Permission to email Lawyer*

Select

Peer Support Options in London:*

Youth Peer Support (16-30)

Transitional Discharge Model (TDM) Peer Support

Peer Support Groups

Peer Support Options in Oxford:*

1:1 Peer Support

Peer Support Groups

Transitional Discharge Model (TDM) Peer Support

Peer Support Info

The Peer/Self-Help program takes place in the community and/or virtually (e.g., phone calls, video calls), based on the Peer’s preference. If meeting in-person, participants are responsible for their own transportation.

Peer Support Groups

CMHA TVAMHS Peer Support Workers offer various peer groups, that change from season to season (see the Program Guide for current offerings). The groups are open to anyone and do not require a referral.

Topics may include:

Wellness education, skill building and recovery planning
Social and community connections
Substance use, harm reduction, and addictions
Self-harm
Thrive Institute courses – an educational approach to wellness and recovery, co-created by peers and community partners

See our website to download our seasonal program guide: Community Wellness, Social Rehabilitation & Peer Support - CMHA Thames Valley (cmhatv.ca)

Youth Peer Support (16-30)

The Peer Support - Youth program offers intentional, one-to-one services to youth who have an expressed need for support for mental health and/or addictions-related challenges.

The Youth Peer Support Worker can assist the youth (Peer) to identify their own wellness needs and support them to move towards an individual sense of wellbeing.

Referrals are open to anyone between the ages of 16-30 years old.

Peer Support/Oxford Self Help

The Peer Support/Oxford Self Help Program offers one-to-one and group services to individuals who have an expressed need for support for mental health and/or addictions-related challenges. The Peer Support Worker can assist the individual (peer) to identify their own wellness needs and support them to move towards an individual sense of wellbeing.

Oxford Self Help Drop In offers a peer-led drop-in space that provides various programming such as peer-led support groups, educational groups, wellness groups, and socialization opportunities.

No referral required. Most groups can be accessed on a drop-in basis, however some special events require registration.

Transitional Discharge Model (TDM) Peer Support

The Peer Support Transitional Discharge Model (TDM) program offers one-to-one services to individuals (Peers) who are looking for additional support following discharge from an inpatient mental health stay.

One-to-one support is offered on a time limited basis. Referrals are limited to individuals who have been discharged from hospital for mental health and/or addictions related reasons within the past 3 months.

The TDM program takes place in the community and/or virtually (e.g., phone calls, video calls), based on the Peer’s preference. If meeting in-person, participants are responsible for their own transportation.

What do you hope to gain from connecting with a Peer Support Worker? Check all that apply:*

Select

Can you meet with a Peer Supporter out in the community or at a CMHA location?*

Select

Do you have a device that you can use to connect virtually with a Peer Support Worker?*

Select

Do you have any accessibility needs?*

Do you have any special concerns related to your health and safety that we should be aware of?*

When you are experiencing mental health distress, what resources do you access?*

Professional Supports (Name, Role, Telephone):

Other Supports (Name, Relationship, Telephone):

Primary Emergency Contacts (Name, Relationship, Telephone):

I give permission to the TDM Program to inform my hospital care team of my engagement in this peer support program*

Select

Your Information

Please complete the address fields if you have a current residency address (personal home, family/friend home, shelter etc.). If you do not have a current residence please leave blank.

First name:*

Last name:*

Pronouns:

Date of Birth:*

(MM/DD/YYYY)

Street Address:

City:*

Province:

Postal Code:

How do you prefer to be contacted?*

Phone

Email

Text

No phone/email

Phone Number:*

Can a confidential message be left on this phone?*

Select

Email:*

If you don't receive an email response from us, ensure you check your junk folder in case our email was delivered there.

Can a confidential message be sent to this email?*

Select

You have indicated you have no phone/email

In order to follow up on this referral, you will need to reach out directly to us for follow up information by calling 1-855-855-CMHA .

Please list an alternate phone number or email address for a family member/friend/community support worker that we can contact and relay a message to.

You may also walk in to any of our locations, which can be found here.

Your file will be closed within 30 days of the referral if no contact is made.

Alternate Contact Name and Relationship*

Alternate Contact Email Address / Phone Number*

Emergency Contact Name

Relationship

Emergency Contact Phone Number

Send me a copy of my responses

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