Friends and Family Survey
Home

Find Treatment

News Links

Your Views

Literature

Resources

Benefits

Contact Them

Contact Us


Purpose: This survey is meant to explore the different manifestations of stigma attached to mental illness as experienced by the family and friends of consumer of mental health resources.

Intended Scope: Mental Health Allies in the United States of America

Type of Sampling Technique: Convenience Sampling (Voluntary Survey)

Please read the following note before proceeding: It is recognized that there is a number of ways that individuals refer to themselves when discussing their status as being related or involved with an individual with a mental illness, such as mental health partner, patient ally, supporter, etc. For the purpose the purpose of this survey the word ally will be used to refer to those who are in some way involved with an individual with a mental illness.

In the event that you become uncomfortable with the statements in this survey please feel free to discontinue the survey and seek what help that you deem necessary to maintain your sense of wellbeing.

Note: This is an anonymous study. Information gathered may be published but will not include identifying information.

What is your relationship with the individual with a mental illness:  

If other explain:  

Gender:  Male Female

Age (years):  

State of residence:  

Town of residence:  

(Optional)Race/Ethnicity  

If other explain:

Level of Education (Choose only the highest level you have obtained):  

I am:  

Please choose your answer to the following statements.


I believe that in general people's opinion of me have been adversely changed when they discovered that I am an ally.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I believe that in general people's opinion of me have been improved when they discovered that I am an ally.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I believe that people in my community avoid me as a result of them knowing me to be an ally.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I believe that if I reveal my status as an ally to a new acquaintance it would hurt the chances of a friendship developing.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I believe that a romantic relationship that I was in was ended once the individual found out that I am an ally
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I believe that it being known that I am an ally has prevented the formation of future romantic relationships.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I believe that I have been turned down for a job when a potential employer learns of my status as an ally.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I believe that I have been "fired", or "let-go" as a result of an employer learning of my status as an ally.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I have noticed that there is a negative view of people with mental illness displayed in the mass media.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I feel that society has a negative view of those who are diagnosed with a mental illness
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I have found that there is not as much of a negative view of mental illness in the mass media than I have been led to believe.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I have become more supportive of the individual with the mental illness since learning that the individual I am involved with has a psychiatric/psychological diagnosis.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I find it hard to relate to the individual that has the mental illness.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I find that I actively avoid the individual in my life that has the mental illness.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I regularly visit the individual with the mental illness that I know when they are hospitalized for psychiatric/psychological reasons.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I neglect to visit the individual with the mental illness that I know when they are hospitalized for psychiatric/psychological reasons.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

Friends have become less available to me since learning that I am an ally.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

Friends have become less available to me since learning that I am an ally.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

Friends have actively avoided me since learning that I am an ally.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I believe that the legal system has an unrealistic negative view of people who have a mental illness.
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree

I have less expectations of the individual with the mental illness as a result of their diagnosed condition(s)(psychological/psychiatric):
Absolutely Disagree   Strongly Disagree   Disagree   Neither Agree or Disagree   Agree   Strongly Agree   Absolutely Agree



Please use the available space below to elaborate on your answers or to add in additional comments.



  


Home |  Find Treatment |  News Links |  Your Views |  Literature |  Resources
Benefits |  Contact Them |  Contact Us