Hey Everyone,
for one of my classes we are doing "the future of ASE" as our Independant Study Unit. I decided to do mental health. But I want to make sure it's okay. I've gotten a couple back from people, but they were all from people who don't have a mental health problem. So, could you guys look it over to make sure it's not insulting or anything and just to give me your opinion.
You don't have to do it!! I'm handing it out at my school, so I'm not looking for answers to the survey. The Crew's room is the student lounge, that's what they call it. And ASE1 is just the name of the school. Thanks for your time guys!
Mental Health At ASE 1
At ASE 1, there are many different languages spoken and countries represented. What many of us don’t realize though is that many students here are facing mental health issues. By participating in this survey, you’ll be helping to better understand how students at ASE cope with mental health issues. Participation in this survey is voluntary and anonymous. You may skip any questions on the survey that you do not feel comfortable with answering. If you have a different answer to any question, or want to add to your answer, feel free to write in the margins. Once you have completed the survey, please place it in my mail box or return it to me as soon as possible, but before May 23rd 2008. Thank you very much for taking the time to complete this survey.
Emily
Please circle your answer
1) Age?
15 16 17 18 19 20 21 22 23
2) What gender do you identify as?
Male Female Trans-gender
3) What sex are you?
Male Female
4) Are you:
Heterosexual Homosexual Bi-sexual?
Other: _____________________
5) Do you live with your parents?
Yes No
6) Do you have any siblings?
Yes No
7) Do you consider yourself to have a Mental Illness?
Yes No
8) Have you been diagnosed with a Mental Illness?
Yes No
If you have not been diagnosed and do not consider yourself to have a mental disorder, skip to question 18
9) Which of the following Mental Illnesses have you been diagnosed with, or consider yourself to have? (Circle all that apply)
Addiction/Substance abuse-Attention Deficit Disorder (ADD)-Attention Deficit Hyperactivity Disorder (ADHD)-Anxiety Disorder-Borderline Personality Disorder-
Eating Disorder-Gender Identity Disorder-Obsessive Compulsive Disorder
Schizophrenia-Self Harm/Self injury(if possible, please specify)
Other: _______________________________
10) Are you currently seeking medical help for your Mental Illness?
Yes No
11a) Have you ever sought help for your Mental Illness?
Yes No
11b) If yes, who were/are you seeing? (Circle all that apply)
Therapist-Councillor-Social worker-Psychologist-Psychiatrist-School Guidance councillor
Other: ______________________________
12a) Are you required to take medication for your Mental Illness?
Yes No
12b) If yes, would you be comfortable taking your medication in the Crew’s room?
Yes Maybe No
13) Does anyone in your immediate family have a mental Illness?
If so, who? ____________________________
14) Are your friends aware of your Mental health situation?
Yes all of them Only certain people No
15) Do any of your friends have a Mental health problem?
Yes 1-2 3-4 5-6 more than 7
No
16)Does your Mental Illness affect how you perform in school?
Yes No
17) Do you feel accepted at ASE even though you have a Mental Health problem?
Yes Usually No
18) Are you afraid of people with a Mental Illness?
Yes No
19) Are you aware that any of your friends have a Mental Illness?
Yes 1-2 3-4 5-6 7 and up
20)Do you feel that people with a Mental health Issue deserve special treatment?
Yes No Explain:__________________________________________ ____
21)Do you believe ASE to be an accepting place for people facing Mental health problems?
Yes, completely Usually, but there have been some problems Not at all
22)Honestly, would ASE be a safer place if everyone with a Mental Health issue were sent to an another school?
Yes Maybe No
23) Would knowing a friend was diagnosed with a Mental Illness change how you think of them?
Yes No
24)Have you ever purposely avoided someone with a Mental Illness?
Yes Maybe No
25)Do you judge people negatively because you suspect a Mental Illness? (example: scars on wrist, talking to themselves, doing “strange” things)
Yes Sometimes No
26)Do you automatically assume someone is “crazy” if they are going to see a mental health professional?
Yes No
27)Do you believe that the staff at ASE could do more to help support students with mental health difficulties?
Yes No
If so What?
__________________________________________________ __________________________________________________ __________________________________________________ _____
Thank you for completing this survey!!!
