Self-Referral Form Black Kings (Mens Wellbeing Programme))

1. Black Kings: mental health and wellbeing circle

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This form helps us capture information required to administrate the programme and to support reporting back to our funders. Please complete ALL sections. (N.B. There is a separate form for healthcare or other professionals wanting to make a referral, available on our website here: https://artlift.org/refer-to-us/).   

If you need help with this form and/or need to apply in another format, please contact us: 01452 222 726 or office@artlift.org.  

INFORMATION AND CRITERIA:

Location: The Blue Coat Room, Gloucester Guildhall, 23 Eastgate St, Gloucester GL1 1NS

Access: click here for transport and venue access details

Timing: 8 x 2-hour sessions on Thursdays 6 - 8pm from 9 October – 27 November

Cost: £120 (£15 per session), payable via bank transfer or in cash at start of sessions (N.B. please talk to us if the cost or travel to the venue would prevent you from participating)

Black Kings includes:

  • Eight relaxed 2-hour sessions in a friendly, confidential space
  • A chance to explore vital topics such as Black masculinity, decolonisation, and misinformation
  • Opportunity to share and explore diverse creative activities (no former experience required!)
  • One-to-one conversations with facilitators to help explore coping strategies and positive activities

 The course is for Black men, aged 18+, who are:

  • Currently finding life challenging
  • Black or of mixed heritage with Black descent
  • Registered with a GP and/or living in Gloucestershire
  • Comfortable in a group setting
  • Able to follow simple instructions or demonstrations
  • Committed to attending as many of the sessions as possible

If you can answer ‘yes’ to, or are unsure about the following questions, this non-clinical group is unlikely to be suitable for you, and we would urge you to seek alternative support without delay (if you’re unsure, please don’t hesitate to call us):

  • Are you currently experiencing any symptoms of psychosis, such as delusional thoughts?
  • Are you currently feeling suicidal?
  • Are you currently struggling with addiction?

 

 

 

 

1. How did you hear about this group? *

 

2. Have you been referred to Artlift in the past? *