Mental Health Next Steps QuizMental Health Next Steps QuizTestQuestionsDemographicInformationSubmit SurveyThis survey will help you reflect on your mental health needs and your next steps. It will also help us provide better information and support for people like you!1. Are you answering the following questions based on your own needs or for someone else? I’m here for me I’m here for someone else2. Do you believe you need to do something to improve your emotional or mental health? No Yes I don't know3. Do you think your emotional or mental health problems are at risk of getting worse if you aren’t able to take action? No, it will get better on its own No, it will stay about the same Yes, it will get somewhat worse Yes, it will get much worse4. How much do you think learning more about mental health would help improve your mental health?4. How much do you think learning more about mental health would help improve your mental health? Definitely won't help Might help Will probably help Definitely will help5. How much do you think connecting with others who have mental health conditions would help improve your mental health?5. How much do you think connecting with others who have mental health conditions would help improve your mental health? Definitely won't help Might help Will probably help Definitely will help6. How much do you think learning about treatment options would help improve your mental health?6. How much do you think learning about treatment options would help improve your mental health? Definitely won't help Might help Will probably help Definitely will help7. How much do you think receiving mental health treatment would help improve your mental health?7. How much do you think receiving mental health treatment would help improve your mental health? Definitely won't help Might help Will probably help Definitely will help8. How much do you think using online self-help tools would help improve your mental health?8. How much do you think using online self-help tools would help improve your mental health? Definitely won't help Might help Will probably help Definitely will help9. How much do you think waiting to see what happens if you do nothing would help improve your mental health?9. How much do you think waiting to see what happens if you do nothing would help improve your mental health? Definitely won't help Might help Will probably help Definitely will help10. Do you intend to learn more about mental health?10. Do you intend to learn more about mental health? I definitely will not do this I probably will not do this I will probably do this I will definitely do this11. Do you intend to connect with others who have mental health conditions?11. Do you intend to connect with others who have mental health conditions? I definitely will not do this I probably will not do this I will probably do this I will definitely do this12. Do you intend to learn about treatment options?12. Do you intend to learn about treatment options? I definitely will not do this I probably will not do this I will probably do this I will definitely do this13. Do you intend to receive treatment for your mental health?13. Do you intend to receive treatment for your mental health? I definitely will not do this I probably will not do this I will probably do this I will definitely do this14. Do you intend to use online self-help tools?14. Do you intend to use online self-help tools? I definitely will not do this I probably will not do this I will probably do this I will definitely do this15. Do you intend to wait to see what happens if you do nothing?15. Do you intend to wait to see what happens if you do nothing? I definitely will not do this I probably will not do this I will probably do this I will definitely do this16. Do you have a specific plan to take any of these actions? Check all that apply.16. Do you have a specific plan to take any of these actions? Check all that apply. Learn more about mental health Connect with others who have mental health conditions Learn about treatment options Receive treatment for your mental health Use online self-help tools17. How confident are you in your ability to learn more about mental health?17. How confident are you in your ability to learn more about mental health? Not at all confident Somewhat confident Moderately confident Very confident18. How confident are you in your ability to connect with others who have mental health conditions?18. How confident are you in your ability to connect with others who have mental health conditions? Not at all confident Somewhat confident Moderately confident Very confident19. How confident are you in your ability to learn about treatment options?19. How confident are you in your ability to learn about treatment options? Not at all confident Somewhat confident Moderately confident Very confident20. How confident are you in your ability to receive treatment for your mental health?20. How confident are you in your ability to receive treatment for your mental health? Not at all confident Somewhat confident Moderately confident Very confident21. How confident are you in your ability to use online self-help tools?21. How confident are you in your ability to use online self-help tools? Not at all confident Somewhat confident Moderately confident Very confident22. If you don’t think you’re going to do anything about your mental health, which of the following statements do you relate to (check all that apply):22. If you don’t think you’re going to do anything about your mental health, which of the following statements do you relate to (check all that apply): I'm not ready I can't afford it I want to talk to someone else first I don't know what I'm supposed to do next Taking action seems too overwhelming Other...22A. Other23. We're doing quality improvement on this survey. Do you have any comments about the questions you just answered to help us improve it?Have you already answered optional demographics questions on a mental health test today?* Yes NoPlease take a moment to answer the following optional questions. Your answers are totally anonymous—we won't be able to identify you based on this information. Your answers help us provide better information and support for people like you.You can answer as many or as few questions as you would like. When you are done, scroll to the bottom of the survey and click "submit" to receive your screening results.If you already answered these questions on a mental health test today, you do not need to answer them again here.About YouAge Range9-1011-1314-1516-1718-2425-3435-4445-5455-6465+Gender Male Female Non-BinaryEnter GenderPlease check this box if you identify as transgender. Please check this box if you identify as transgender.Race/EthnicityAmerican Indian or Alaska NativeAsianBlack or African American (non-Hispanic)Hispanic or LatinoMiddle Eastern or North AfricanNative Hawaiian or other Pacific IslanderWhite (non-Hispanic)More than one of the aboveOtherHousehold IncomeLess than $20,000$20,000 - $39,999$40,000 - $59,999$60,000 - $79,999$80,000 - $99,999$100,000 - $149,999$150,000+Which of the following populations describes you?Select all that apply. Veteran or active duty military Caregiver of someone living with emotional or physical illness LGBTQ+ Student Trauma survivor New or expecting mother Healthcare workerWho are you caring for?Select all that apply. My spouse or partner My parent My child Another relative Other...Caring For - OtherAs a caregiver, what supports do you need? The person I'm helping is getting treatment but is getting worse (meds or therapy stopped working) The person I'm helping is getting treatment but also needs something else (side effects cause other problems, not sure what else to do) The person I'm helping doesn't want treatment and I want to figure out how to help them I need help because the stress of caretaking is hard Other...Caregiver Support - OtherWhich of the following best describes your sexual orientation? Lesbian Gay Bisexual Queer Pansexual Asexual Other...Sexual Orientation - OtherAbout Your Mental HealthHave you ever been diagnosed with a mental health condition by a professional (doctor, therapist, etc.)? Yes NoHave you ever received treatment/support for a mental health problem? Yes NoAre you receiving treatment/support now? Yes NoWhat are the main things contributing to your mental health problems right now?Choose up to 3. Coronavirus Racism Relationship problems Past trauma Current events (news, politics, etc.) Loneliness or isolation Grief or loss of someone or something Financial problems Other…Mental Health Problems - OtherAbout Your HealthDo you currently have health insurance? Yes NoDo you have any of the following general health conditions?Select all that apply. Heart disease Diabetes Cancer Arthritis or other chronic pain COPD or other lung conditions Movement Disorders (involuntary tics, tardive dyskinesia) HIV/AIDS Other...If 'Other' please specify (for general health conditions)Additional InformationStateI live outside the United StatesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingI live in a U.S. TerritoryZip/Postal CodeWhat country do you live in?AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsEmailThis field is for validation purposes and should be left unchanged.
