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Questionnaire template

Mental Wellbeing Check-in

A short check-in on attitudes to mental health, recent feelings, stress, coping and support needs for service users.

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Healthcare · Mental health assessment. All Healthcare templates

Questions in this template

Your Views on Mental Health

  1. Thank you for sharing how you are doing. Your answers are anonymous and will help us improve the mental health support we offer.

  2. How important is looking after your mental health to you?

    Choose one:

    • Very important
    • Somewhat important
    • Neither important nor unimportant
    • Somewhat unimportant
    • Not at all important
  3. How much do you agree or disagree with each statement?

    • I am at ease discussing my own mental health.
    • Asking for help with mental health shows strength.

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree

How You Have Been Feeling

  1. During the past week, which of these feelings did you have often?

    Choose any that apply:

    • Happiness
    • Sadness
    • Anxiety
    • Anger
    • Excitement
    • Indifference
    • None of these
  2. Over the past month, how stressed have you felt on the whole?

    A number from 1 to 10

Coping and Support

  1. How often do you use each of these to cope?

    • Physical exercise
    • Meditation or mindfulness
    • Talking with a friend or relative
    • Counselling or therapy

    For each row: choose one:

    • Always
    • Often
    • Sometimes
    • Rarely
    • Never
  2. When you feel stressed or upset, who do you usually turn to?

    Choose any that apply:

    • Family
    • Friends
    • A counsellor or therapist
    • I usually keep it to myself
  3. What makes this support helpful, or less helpful, for you?

    Asked only when q_support_sources.outcome is not None and q_support_sources.outcome & 7 != 0

    Open answer

  4. If you are comfortable, tell us about a time you dealt well with something stressful or upsetting.

    Open answer

How We Can Help

  1. Which resources or kinds of support would do most to improve your mental wellbeing?

    Open answer