Form – Adults
The Cycle Against Suicide Buddy.
Participating on the Cycle Against Suicide Buddy programme can be rewarding for people and can lead to changes in one’s life which reduce distress and increase one’s ability to cope with life’s difficulties. However, at times it may bring up uncomfortable aspects of one’s life. Sometimes aspects of a session can be challenging but over time will typically lead to a greater ability to cope.
An individual has access to a Cycle Against Suicide Buddy for up to a three-month period. Sessions will ordinarily be 60 minutes in duration, at a date and time agreed upon. At the initial meeting between both the Cycle Against Suicide Buddy and the individual, both parties will determine together how frequently they meet. All meetings are delivered online via zoom only.
Due to the high demand for the Cycle Against Suicide ‘Buddy’ programme, we ask that if individuals are unable to attend or wish to cancel their session on our ‘Buddy’ Programme, they do so 24 hours in advance of the session.
It is a requirement to keep minimum but appropriate records. Your records are maintained by Cycle Against Suicide, secured by use of password and a firewall with a secure access log and only are accessible to the Cycle Against Suicide ‘Buddy’ Service Management Team.
Cycle Against Suicide complies with the EU Data Protection Directive 95/46/EC as set forth by the European Union regarding the collection, use, and retention of personal data from European Union member countries. Cycle Against Suicide has certified that it adheres to the requirements of notice, choice, onward transfer, security, data integrity, access and enforcement.
We collect two types of data: personal data, and sensitive personal data. Personal data can be used to identify or contact you, and may include: your name, address, date of birth, telephone number, and email address. This will only be collected if you voluntarily submit it to us. Sensitive personal data is relating to your health and is collected for the purposes of the provision of the Cycle Against Suicide ‘Buddy’ Programme and is necessary to be obtained in order to advise the most accurate service for you.
Further information on our Privacy Policies are available at: https://www.cycleagainstsuicide.com/wp-content/uploads/2018/05/Cycle-Against-Suicide-Privacy-Policy.pdf
Details of sessions strictly confidential except in the following situations:
- A person presents an acute, physical danger to
- If there is past or present suspected child abuse/neglect or elder abuse/neglect is disclosed or
- When a serious threat to a reasonably well-identified victim is communicated to the mental health professional.
- A court order issued overruling confidentiality.
It is requirement by law to inform legal authorities or social services so that protective measures can be taken. If a significant level of risk to yourself is disclosed, contact with your general practitioner and/ or emergency contact may be necessary and appropriate. It is anticipated that should this situation arise, it would be discussed and an appropriate plan of action would be put in place by you and the Cycle Against Suicide Buddy.
USE OF DATA
As part of ensuring services are effectively delivered, Cycle Against Suicide will collect a small amount of data to help identify if services are being effective or if they are not. From time to time we will utilise data gathered from individuals across our services on an aggregated basis to assist with service improvement. Overall results from analysis of this aggregated data will sometimes be released into the public sphere to assist with research and official statistics, with your data forming a very small part of a large data set, with your data in no way being individually identifiable to anyone outside of Cycle Against Suicide.
CONSENT TO RECEIVING COMMUNICATION REGARDING CYCLE AGAINST SUICIDE ‘BUDDY’ PROGRAMME
To provide an effective and efficient service, it is necessary to retain contact information for each client. Contact from Cycle Against Suicide will most frequently be in the form of email. From time to time it may be necessary to contact you via phone.
If you consent to being contacted using the following methods, please initial where appropriate.
- I consent to contact via phone (including voicemail) using the number provided to Cycle Against Suicide
- I consent to contact via email using the email address provided to Cycle Against Suicide
CONSENT TO MENTAL HEALTH ASSESSMENT AND INTERVENTION
- I have read this informed consent policy completely and agree to its
- I understand that Cycle Against Suicide is responsible for maintaining all professional standards as set out in legislation.
- I understand that all information shared between myself and the Cycle Against Suicide Buddy is confidential and no information will be released without my consent, where possible. I understand that there are specific and limited exceptions to confidentiality which I have read
- I understand that my engagement with Cycle Against Suicide is for the purposes of availing/participating on the Cycle Against Suicide ‘Buddy Programme’ and to discuss in an informal manner challenges I am currently experiencing. I fully understand that the Cycle Against Suicide ‘Buddy’ Programme is not counselling, therapy or a medical diagnosis in any way.