Applying to Join

We welcome applications from any part of Britain or abroad. Residents are funded through a number of different sources, for example Social Work, Local Authorities, NHS, benefits, or they can be self-funded.

If you are or have ever been detained in a psychiatric hospital, you are eligible to apply for funding through Section 117 Aftercare of the Mental Health Act. You can find out more about Section 117 on the Mind website.

The cost of a placement is individually assessed and we can advise further once we have received a completed application form.

Please complete the online application form below, or alternativly download a printable application form at the following link:

For further information, please contact us on 01644 440602, email lucy@lothlorien.tc or visit our Facebook page.

Please enable JavaScript in your browser to complete this form.

​APPLICANT’S DETAILS – Name *

First

Last

Date of Birth *

Address

Email *

Telephone *

Where did you hear about Lothlorien?

When would you like to come to Lothlorien and for how long?

NAME AND NUMBER OF PERSON TO BE CONTACTED IN AN EMERGENCY *

REFERRER’S DETAILS – Name *

First

Last

Job Title

Name of Organisation

Telephone *

Address

Post code

Email

GP’S DETAILS – Name *

First

Last

Address

Post code

Telephone *

Email

PSYCHIATRIST’S DETAILS – Name *

First

Last

Address

Post code

Telephone *

Email

Please tell us about your current diagnosis and mental health problems

Name and contact details of the psychiatrist who diagnosed you if different from the current psychiatrist

First

Last

Address

Post code

Telephone

Email

Please tell us about your current medication

What medication have you tried in the past?

Please tell us about your current support (i.e. friends, family, groups, organisations)

Please tell us about your current therapies and treatments

Please tell us about past therapies and treatments and whether you found them helpful

Are you currently on a Compulsory Treatment (CTO)?

We ask this because when you are discharged from hospital onto a CTO you are entitled to free aftercare services under section 117 of the Mental Health Act 1983. This means support in the community to help you with your mental health problems and to help you stay well and not have to return to hospital.

Please give details of any hospital detentions under the Mental Health Act, including date of detention and name and address of the hospital

Please give details of any hospital detentions under We ask this because when you have been detained in hospital for treatment you are entitled to free aftercare services under section 117 of the Mental Health Act 1983. This means support in the community to help you with your mental health problems and to help you stay well and not have to return to hospital.

Paragraph Please list any hospital admissions you have had for your mental health, including date and length of stay

Please give details of any serious physical illness or disabilities

Previous employment, training, volunteering, etc. (include any experience you think may tell us something about you and your life)

Previous employment, training, volunteering, etc. (include any experience you think may tell us something about you and your life)

writing physical –

GARDEN WORK – Our daily schedule includes three hours of garden work. We hope that this will bring you better mental and physical wellbeing. Do you like gardening and will you enjoy working in the garden every day?

Please list any specialist skills, experience or qualifications you may wish us to know about.

Please give details of any hobbies and interests.

Please tell us why you are interested in a stay at Lothlorien, including what you hope to gain and what you hope to bring to the community.

REFERENCE ONE – Name

First

Last

Please provide contact details of two people who may be contacted for references. One of these should be a social worker, community psychiatric nurse, doctor or care coordinator. We will also request a reference from your psychiatrist if you have one.

Telephone

Job Title

Email

Address

REFERENCE TWO – Name

First

Last

Telephone

Job Title

Email

Address

PLEASE TELL US ABOUT YOUR CURRENT WEEKLY INCOME – Employment Support Allowance

Jobseekers Allowance

Housing Benefit

Disability Living Allowance/PIP

Other income

Total income per week

Please let us about any loans or debts you have

Please let us about any savings above £8.000

I give permission for the release of clinical and medical records to the staff of Lothlorien Therapeutic Community who are authorized to discuss all matters pertinent to the progress of this application. I understand that I may revoke this authorization in writing at any time. Please circle as appropriate.

• Psychiatric information
• Social Work Assessments
• Benefit related information
• Medical information

Date *

Please check that you have completed all sections as we will be unable to process incomplete applications. I declare that all the information given in this application form is true and correct to the best of my knowledge.

Submit