Mental Health Recovery Research

                                 Consumer Survey

Welcome to the  www.MentalHealthRecovery.org  consumer survey.

This survey will assess how you evaluate the specific mental health

treatment you receive, the professional staff who provide your

treatment and your assessment of the results of your treatment.

At the end of this survey, you will be offered an opportunity to

provide your input or opinions regarding what you believe would

have improved the mental health care you received.

Please enter your name, or a name, or a number, which you wish to use as an identifier:

Name :

( Optional input )          TOP OF SURVEY

Please enter your preferred contact mode(s): postal address, email and/or phone:

      Contact address:      

      Contact email::   

       Contact phone::       

         ( Optional input )  

Please provide the following basic characteristics:

Gender:       

                         Male   

                        Female

Age Range:  

                       Under 18 years

                       18 years to 25 years

                       25 years to 50 years

                    Over 50 years of age

Ethnicity:

Yearly Salary Range:  

                      Under $20,000

                      $20,000 to $40,000

                      $40,000 to $60,000

                      $60,000 to $80,000

                      $80,000 to $100,000

                     Over $100,000

Please indicate which of the following types of mental health  services you are receiving, or have received in the past, which you will be using for this survey:

        Individual treatment sessions:                        

          Group treatment sessions:   

         Applied Behavior Modification Techniques:   

        Other, specify: 

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Please identify the treatment setting:

         Private Therapist's Office:          

         Psychiatric Hospital:        

         General Hospital:   

          Out Patient Mental Health Facility:   

  Other, specify:    

Please identify the primary professional who provided the treatment you are evaluating on this survey :

             Psychiatrist:                    

          Psychologist:                        

          Social Worker:   

           Nurse:          

             Behavior Specialist:        

          Other, specify: 

Please describe the type of problems you addressed in treatment during these services:

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Please indicate your agreement or disagreement with each of the following statements by selecting the choice that best represents your opinion.  If any question or statement  is about something you have not experienced, indicate that this item is "not applicable" to you.       

1. I liked the services that I received.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
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2. If I had other options, I would not choose these services from this setting again.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
   

3. I would recommend this treatment setting to a friend or family member.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
   

4. The location of this treatment setting was convenient.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
   

5. Treatment staff were willing to see me as often as I felt it was necessary.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
   

6. Treatment staff answered my questions promptly.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
   

7. Treatment services were available at times that were good for me.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
   

8. I was able to get the services I thought I needed.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
   

9. Treatment staff believed that I could grow, change and recover.

   Strongly Agree
   Agree
   I am Neutral
   Disagree
   Strongly Disagree
   Not Applicable
   
   

10. I felt free to complain.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

11. I was told what treatment and/ or medication side effects to watch for.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

12. My wishes about who is and is not to be given information about my treatment were respected.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

13. Staff were sensitive to my cultural and ethnic background.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

14. Staff helped me obtain the information needed so I could take charge of managing my illness.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

15. Due to my treatment, I deal more effectively with daily problems.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

16. Due to my treatment, I am better able to control my life.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

17. Due to my treatment, I am better able to deal with crisis.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

18. Due to my treatment, I am getting along better with my family.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

19. Due to my treatment, I do better in social situations.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

20. Due to my treatment, I do better in school and/or work.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    
    

21. Since beginning my treatment, my symptoms are not bothering me as much.

    Strongly Agree
    Agree
    I am Neutral
    Disagree
    Strongly Disagree
    Not Applicable
    

22. I wish to receive feedback regarding the results of this survey:

    By Email
    By Phone
    By Postal Mail            

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