Mental Health Needs Assessment

1
How would you rate your overall mental health over the past month?
Excellent
Good
Fair
Poor
2
How often do you experience stress or anxiety?
Never
Rarely
Sometimes
Often
Always
3
In the past month, have you felt down, depressed, or hopeless?
Not at all
Several days
More than half the days
Nearly every day
4
How would you rate your ability to manage stress in your daily life?
Very well
Moderately well
Not very well
Poorly
5
Over the last two weeks, how often have you felt that you were unable to control important things in your life?
Never
Rarely
Sometimes
Often
6
Do you experience any hindrance with accessing medical care?
YESNO
7
Have you ever sought professional help for your mental health?
Yes
No
I've thought about it but haven't yet
8
If you haven’t sought help, what are the main reasons? (Select all that apply)If you haven’t sought help, what are the main reasons? (Select all that apply)
Cost of services
Lack of insurance coverage
Difficulty finding a provider
Long wait times for appointments
Lack of transportation
Stigma associated with seeking mental health carer
Lack of awareness about available services
Limited availability of services in your area
Cultural or language barriers
Concerns about confidentiality
Previous negative experiences with mental health care
Other
9
How familiar are you with the mental health services available in your community?
Very familiar
Somewhat familiar
Not familiar at all
Type option 4
10
Do you know where to go for mental health support in a crisis?
Yes
No
11
Do you feel comfortable talking to a family member, friend, or co-worker about your mental health?
Yes
No
Unsure
12
How supported do you feel by your friends and family when it comes to your mental health?
Very supported
Somewhat supported
Not supported
13
Are there any mental health resources or support groups that you’ve found helpful?
Yes
No
14
If you selected "yes", please specify. Otherwise, move on to the next question.
Huge
Large
Normal
Small
Ok
Ok
15
What kinds of mental health support would you like to see more of in your community? (Select all that apply)
More affordable services
More mental health awareness and education programs
More online or virtual mental health services
Peer support groups
Crisis hotlines or text lines
Culturally sensitive services
Other
16
If you selected "Other" please specify. Otherwise, move on to the next question.
Huge
Large
Normal
Small
Ok
Ok
17
Do you feel your workplace/school provides adequate support for mental health?
Yes
No
Not sure
18
Does your workplace/school offer any mental health resources (e.g., counseling, mental health days, support groups)?
Yes
No
Not sure
19
How comfortable would you feel discussing mental health concerns with your supervisor/teacher?
Very comfortable
Somewhat comfortable
Not comfortable
20
In the past month, how much have your mental health challenges interfered with your daily activities (e.g., work, school, social life)?
Not at all
A little
Somewhat
A great deal
21
How often do you feel overwhelmed by your mental health challenges?
Never
Rarely
Sometimes
Often
Always
22
How often do you engage in activities that help improve your mental health (e.g., exercise, meditation, hobbies)?
Daily
A few times a week
Occasionally
Rarely
Never
23
What coping strategies do you use when dealing with stress or anxiety? (Select all that apply)
Exercise
Meditation or mindfulness
Talking to a friend or family member
Writing/journaling
Engaging in hobbies
Seeking professional help
Other
24
If you If you selected "Other" please specify. Otherwise, move on to the next question.
Huge
Large
Normal
Small
Ok
Ok
25
Have you attended one of our recent events?
YESNO
26
You Can Sit With Us-Wine & Design
You Can Sit With Us-Epic Comedy Hour
You Can Sit With Us-Van Gogh Experience
YOU CAN SIT WITH US-Shakespeare in the Garden
YOU CAN SIT WITH US-$5 After 5 Huntsville Art Museum
YOU CAN SIT WITH US-Candle Making at Embrace Candles
THE MAYA PROJECT-Forms for Therapy
YOU CAN SIT WITH US-Inward with Maria Brito
YOU CAN SIT WITH US-Swing Dance Lessons at the Electric Belle
27
What type of events would you like to see from us in the future?
28
Select the box below best describing your gender (sexual orientation) and pronouns.
Female (she/her)
Male (he/him)
Nonbinary (they/them)
Other
Prefer not to say
29
Select the box below describing your ethnicity/racial background.
African American
Asian
Caucasian
Hispanic
Native American
Pacific Islander/Hawaiian
Biracial
Other
Prefer not to say
Other
30
Please select your age group:
Under 18
18-24
25-34
35-44
45-54
55-64
65-74
75 or older
31
City and State of Residence
Should be Empty: