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Are you or have you ever been a risk to yourself or others?
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Please note:
The Creative Living Centre is not a crisis service. If you are in immediate danger or need urgent mental health support, please contact 999 or 111, or use your local emergency services. We aim to respond to new enquiries within 2 working days.
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Support for you
Accessing Our Service
RESOURCES
Timetable
Fundraise
Hire a room
Donate
Work with us
Volunteer With Us
About Us
Our Team
Our Impact
Our Funders
Our Policies
Contact Us
Blog
News
Newsletter