IA Referral Form
About this Application
This form must be completed by a Health Professional
An Initial Assessment (IA) to access services at Spirasi includes a ‘medical and psychosocial assessment, followed by
a psychotherapeutic assessment if required
Please ensure the form is completed clearly, giving as much information as possible.
Spirasi's remit for IA is based on the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT) definition of torture.
We, therefore, provide services to those whose experiences are encompassed by the following elements of the UNCAT definition:
- Experience of severe pain or suffering, whether physical or mental where it was:
- Intentionally inflicted by another person or persons:
- For specific purposes, namely obtaining information or a confession, or to punish, coerce or intimidate, and this was:
- Carried out by a state actor or person acting in an official capacity.
In addition, we may accept referrals where there has been serious threat to a civilian’s life or person by reason of indiscriminate violence in situations of international or internal armed conflict.
Spirasi will not be able to see a client unless they are registered with a GP
- Complete all sections of this application
- Reply to confirmation email with requested documents
Any queries regarding the online referral process can be submitted to firstname.lastname@example.org