Caregiver Survey

Thank you for taking our Caregiver Survey! This survey will help us understand your needs as you take care of someone living with a mental illness.

Are you providing care for a family member or friend with a mental illness?
What is your gender?
What is your gender?
What is your age?
What is your age?
What is your annual household income?
What is your annual household income?
Which mental health problem does your loved one have? (Check all that apply)
Which mental health problem does your loved one have? (Check all that apply)
Who are you caring for?
Who are you caring for?
How old is the person you're caring for?
How old is the person you're caring for?
Which of the following statements are true about your caregiving situation? (Check all that apply)
Do you feel involved in your family member’s mental health care?
Who do you talk to? (Check all that apply)
Who do you talk to? (Check all that apply)
How often do you talk to the provider?
How are you involved? (Check all that apply)
How are you involved? (Check all that apply)
Who would you want to talk to if you were involved in your loved one’s mental health care (check all that apply):
Who would you want to talk to if you were involved in your loved one’s mental health care (check all that apply):
How often would you like to talk to the provider if you were involved in your loved one’s mental health care?
How would you like to be involved in your loved one’s mental health care? (Check all that apply)
How would you like to be involved in your loved one’s mental health care? (Check all that apply)
How often do you have conversations with your loved one about their care plan or goals?
Questions Never Rarely Sometimes Often Always
If so, which of the following has been a source of conflict for you? (Check all that apply)
If so, which of the following has been a source of conflict for you? (Check all that apply)
I feel hopeful that my family member will get better.
I feel hopeful that my family member can live independently.