Story Collection Form

Story collection form
Please confirm that you are over 18*

Yes, I am over 18
Please confirm that you live in Wales*

Yes, I live in Wales
Please select the category you will be participating/sharing as (please choose the most relevant / important to you)*

You have accessed or received 'crisis' services in the last 5 years, (including telephone based support, e.g. 111 press 2)You have been an in-patient in mental health care in Wales in the last 5 yearsYou are a family member or carer of someone who has been an in-patient in mental health care in Wales in the last 5 yearsYou are representing a Third sector organisation that has supported in-patients within mental health services in Wales and/or people experiencing crisis in WalesNone of these apply to me

Have you signed up to attend a Story Sharing Discussion Group?

Yes, I hope to attend a Story Sharing Discussion GroupNo, I am just sharing a story to help inform the work of this project and the group

How do I add my story?
Please use this form to share your positive/happy or more difficult moments about your experience with mental health crisis care in the last 5 years. These first-hand accounts should be in your own words.

We understand that sharing personal information about difficult experiences could be emotionally distressing, so you may want to let a trusted friend know or talk to someone who supports you, before sharing your full story with us.

Don’t worry about how your story is written. There is no judgment or right way of writing - just your way.

What will you do with my story? - Please Read
Whether you attend the in-person Discussion Groups or not, selected stories from all submissions are likely to be discussed in any of the four groups. The story owner will of course remain anonymous if they wish.

This will help the the group think about and discuss what system changes are needed in order to improve these experiences.

We’ll look at common themes and discuss how moments could have been happier or more difficult if something had been different in that moment. We believe that openness reduces shame and fosters understanding of things that need to change.

All stories will be read. We may edit stories slightly for readability, and in-line with guidelines from the Samaritans. We will always try and edit as little as possible; it’s important to us that your own words come across.

Identifiable information, potentially libellous content, or hate speech will be removed.

All stories will help in a re-design aiming to improve patient experience and outcomes. For example:
- Your story will contribute to a thematic report to inform the Strategic programme for Mental Health in Wales.
- Your story is likely to be included and discussed at some or all of the four story sharing discussion groups.
- Once you’ve sent your story, it will also be shared with NHS Wales for this project; they will hold on to your story to help them make the case for any changes that are needed, and they may share your anonymous story with others too as part of that improvement work.
I confirm I have read and understood what will happen with my story*

I understand

Your Details
Please provide us with your name. This is for internal Platfform purposes only, so we can match you to the information you have sent to us on your event sign up form.

First NameLast Name

Your Details
Are you happy for your name to be included with your story?

Yes, I am happy for my name to be included with my storyI would like an alternative (pretend) name to be included with my storyI do not want any name to be included with my story
Please provide your name

First NameLast Name
Your alternative name (please chose something that cannot be identified as the real you)

First NameLast Name

Your Story
Do you have a happy or more difficult moments you would like to share? Tick both if you want to share two*

I have a positive/happy moment to shareI have a more difficult moment to share
Thinking about your experience with Crisis and Inpatient Care Mental Health Services in the last 5 years, have you had any very positive happy moments that you are happy to share? If so, what are they?
Thinking about your experience with Crisis and Inpatient Care Mental Health Services, have you had any very difficult moments that you are happy to share? If so, what are they?
If you had the power to change anything in order to have made your experience of Crisis and Inpatient Care Mental Health Services better, what would it be? (400 words max)

0/400

How would you like us to contact you if we need to ask for further consent around public sharing of the stories?

EmailPhone-callOther
Please provide your email
example@example.com
Please provide your mobile contact number

Area CodePhone Number
Happy with your answers? If not, you can back space to check over all of the pages.

Thanks for your interest in this work. Because you are not involved in those four areas we can't offer you an opportunity to engage with this work.

However, we are really interested in understanding as many different experiences as possible. If you are happy for us to contact you about this, please leave your contact email below and press submit.

Otherwise, just please press submit and you will be directed to our campaign's website.
Email
example@example.com
Should be Empty:

Story collection form

Your Details

Your Details

Your Story

Story Sharing Consents

Happy with your answers? If not, you can back space to check over all of the pages.