Mental Health Survey
Hey there! We're curious to learn about how you feel about mental health and whether you're interested in getting help or support. Your responses will help shape mental health services for youth like you! This survey should only take a few minutes—thank you for your participation!
Name
First Name
Last Name
Email
example@example.com
Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American (Non-Hispanic)
Hispanic or Latino
Middle Eastern or North African
White (Non-Hispanic)
Native Hawaiian or Another Pacific Islander
Other
Age Range
10-15
16-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
What's your zip code?
(Ex: 93301, 93307, etc.)
Gender Identity
Male
Female
Other (Feel free to elaborate if you're open to it): ______________________________________________________________________________________________________________________________
Prefer Not to Answer
1. How important is mental health to you?
NOT MUCH
1
2
3
4
VERY
5
1 is NOT MUCH, 5 is VERY
2. How aware are you of mental health services available in your area?
NOT MUCH
1
2
3
4
VERY
5
1 is NOT MUCH, 5 is VERY
3. How useful do you think peer support groups (groups with other youth) would be for mental health?
NOT MUCH
1
2
3
4
VERY
5
1 is NOT MUCH, 5 is VERY
4. Have you ever received treatment/support for a mental health problem?
Yes
No
Prefer Not to Answer
5. What are the main things contributing to your mental health problems right now? Choose up to three (3)
Coronavirus
Racism
Relationship problems
Past trauma
Current events (news, politics, etc.)
Loneliness or isolation
Grief or loss of someone or something
Financial problems
Prefer Not to Answer
6. Which of the following populations describe you? Select all that apply.
Caregiver of someone living with emotional or physical illness
LGBTQ+
Student
Trauma survivor
New or expecting mother
None Of The Above
Submit
Should be Empty: