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Housing Support Service

Preventing anti-social behaviour in North Staffordshire by supporting people with mental health needs and avoiding evictions.

Refer someone you support

If you're a locality connector or local authority you can refer someone you support. Just fill out the referral form below and someone will be in touch!

Customer details

Please enter the full name of the person you are supporting
Please enter the date of birth of the person you are supporting
GP name and address
Referrer’s details
Your first and last names
Please list the organisation you are making a referral from
The best number to contact you on
Customer accommodation
Customer ethnicity
Customer risk assessment
This could be any current or previous mental wellbeing issues that affected their mood or behaviour. Or any capacity or memory concerns such as Dementia.
This could be outstanding debt, struggling to pay rent, or having accounts in arrears.
Any known incidents of physical or verbal abuse, threats, physical aggression or violence towards others, including loss of temper with staff
Are there any current issues with alcohol or any other substances related to the person or the property
Any current or previous incidents of domestic abuse, harassment, or threats from family partner or associates. Is there anyone else living at the property we need to be aware of?
This could be anything that would prevent or hinder our access to the property like pets.
Reason for referral
Please provide details on what we can help your customer with