Please take a few minutes to fill out this survey on  mental health. 

The questionnaire consists of some sections . Please read and  mark your answers. if your response is no, skip to the question number as per mentioned. 

We value your feedback and your responses will be kept confidential. Thank you for your input.

Please provide us with the following information.


1 What is your gender?
2 What is your age?
3 What is the highest level of education you have attained?
4 What is your marital status?
5 When was the last time you saw someone from the government mental health services?
6 Current legislation promotes the transition towards mental health services based in the community?
7 Overall how would you rate your mental health?
8 Is there a history of mental disorder in your family?
9 if "Yes", please select which of the family member(s) has/had a history of mental illness.
10 Have you ever angry or fought with some one?
11 Have you felt particularly low or down for more than 2 weeks in a row?
12 In the last 12 months have you had any counselling sessions
13 Are you habituated to drugs and alcohol?
14 How knowledgeable are you about mental health related issues?
15 In your opinion, how common are the following mental health problems in your Community??
16 Would you accept a friend or a coworker having a mental health problem?
17 What should be the community’s response to mental health problems?
18 What is the most important way in which the health facility could better respond to the mental health problems?
19 Would you be able to notice the signs and symptoms of a person suffering with a Mental Health Problem?

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