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Mental Health Services Questionnaire

  1. Mental Health Services Questionnaire

    The purpose of this questionnaire is to help the Department of Community Services identify barriers that prevent Service Members, Veterans, Family (SMVF) from seeking or receiving mental health services.  Information gathered by this questionnaire will not be shared with organizations outside of this project.

  2. 1. Have you ever served in the military, including National Guard, Reserves, or Active Duty?*
  3. 2. What is your military affiliation?
  4. 3. What mental health services are you aware of in Harford County? (check all that apply)
  5. 4. Are you aware of the mental health services available through the Department of Veterans Affairs Healthcare system?
  6. 5. If you knew of a Service Member, Veteran, Family Member (SMVF) in crisis, where would you refer them to?
  7. 6. Have you or a SMVF you know gone without mental health services because of a lack of availability?
  8. 7. Generally speaking, how comfortable would you feel about requesting mental health services?
  9. 8. What are some of your concerns when it comes to seeking mental health treatment? (check all that apply)
  10. 9. Have any of the concerns above ever stopped you or a SMVF you know from seeking mental health services?
  11. 10. Are you enrolled in the V.A. healthcare system
  12. 11. If you are not enrolled in the V.A. healthcare system, why not? (check all that apply)
  13. 12. Which of the following activities would you use to relieve stress? (check all that apply)
  14. 13. Would you be interested in attending suicide awareness training?
  15. 14. Are you a member of a veteran or fraternal organization such as the American Legion, VFW, Lions Club, Elks Club, etc.?
  16. To make additional comments or for questions, contact:

    Simon Ballard, Veterans Resource Coordinator | Harford County Department of Community Services Office of Drug Control Policy | 410-638-3333 | sjballard@harfordcountymd.gov

  17. Leave This Blank:

  18. This field is not part of the form submission.