Mental Health Survey
1.
Your consent. Survey responses are anonymous, and may be shared with partners. Do you give your consent?
Yes (continue with survey)
No (go to end of survey)
2.
How would you rate your current mental health?
Excellent
Good
Fair
Poor
Very bad
Prefer not to say
3.
Have you suffered from any of the following mental health conditions in the past 12 months? (Tick as many as apply to you)?
Depression
Anxiety
Insomnia
Post-Traumatic Stress Disorder (PTSD)
Phobias
Obsessive Compulsive Disorder
Bipolar
Schizophrenia
Other
Prefer not to say
4.
If you have suffered from any of the above, do you know what triggered you to have this condition? (e.g. Covid, loneliness, financial issues, poor health, social isolation)
Yes
No
Prefer not to say
5.
If YES, please give details:
6.
Do you feel comfortable discussing your mental health with others?
Yes
No
Prefer not to say
7.
If NO, why not?
8.
If YES who do you discuss it with?
9.
Have you ever discussed your mental health with your GP?
Yes
No
Prefer not to say
10.
If YES – What support did your GP offer you? How helpful did you find the discussion?
11.
If NO – Why not?
12.
Have you ever had counselling via Talking Therapies, the NHS Counselling Service?
Yes
No
Prefer not to say
13.
If YES – How was your experience of this service?
14.
Have you ever been referred to Mental Health Services? (to see a psychiatrist etc.)
Yes
No
Prefer not to say
15.
If YES – How was your experience of using these services?
16.
Are you aware of any local charities who support people with mental health issues?
Yes
No
Prefer not to say
17.
If YES – please specify below which ones
18.
Have you ever received support for your mental health from a charity?
Yes
No
Prefer not to say
19.
If YES – how did you find the experience of using their services?
20.
Do you do anything to look after your mental health?
Yes
No
Prefer not to say
21.
If YES – Please give details below.
22.
Do you care for anyone who suffers with their mental health?
Yes
No
Prefer not to say
23.
If YES Please give details of the support you provide.
24.
If YES – do you receive any support to carry out your caring role?
Yes
No
Prefer not to say
25.
If YES – Please give details below
26.
Do you have any other comments on mental health and mental health services?
27.
If you have any suggestions for future topics for our questionnaires, please list below:
28.
Your Gender?
Male
Female
Other
Prefer not to say
29.
Your Age?
Under 50
50 - 64
65 - 74
75 - 89
90 or over
Prefer not to say
30.
Household
Just you
2 people
3 or 3 plus
Prefer not to say
31.
Physical health
Good
Fair
Poor
Prefer not to say
32.
Mental Health
Good
Fair
Poor
Prefer not to say
33.
Your Ethnicity
White British
White Irish
White Other
Asian Indian
Asian Pakistani
Asian British
Asian Other
Black Caribbean
Black African
Black British
Black Other
Mixed
Other
Prefer not to say