Mental Illness Questionnaire
A mental illness questionnaire is used to obtain information and understand mental illness issues and attitudes. The need for developing a mental illness questionnaire may differ based on the need and can be used to evaluate an individual’s mental condition, get opinions on mental illness knowledge and programs etc.
The response received from this type questionnaire also gives room to understand the opinions individuals have on mental illness. If successfully used, a mental illness questionnaire should be able to provide an opportunity for physical and mental wellness of an individual. The questions must be easy to understand and direct. Below is a sample.
Sample Mental Illness Questionnaire
Please fill in the information below
The first letter of your first and last name:
Date of birth: _________________________
What year are you presently in? ___________________________
Please specify your gender:
Male: __________________
Female: __________________
Have any other members of your family ever suffered from any type of mental illness? (Please tick where applicable)
Yes __________________
No __________________
Do you know of any mental illness conditions? Please list below
__________________
__________________
__________________
What do you understand by the term mental illness?
________________________________________________________________________
Do you know of any signs that may indicate that a person is suffering from mental illness?
________________________________________________________________________
________________________________________________________________________
Which signs do you think mental illness patients show?
________________________________________________________________________
________________________________________________________________________
What do you understand by the term phobia?
________________________________________________________________________
________________________________________________________________________
What do you understand by the term clinical depression?
________________________________________________________________________
________________________________________________________________________
Would you recommend treatment for an individual suffering from mental illness?
________________________________________________________________________
________________________________________________________________________
Do you agree/disagree that people with mental illness tend to be violent or dangerous?
_____
What does becoming a patient in a mental hospital mean to you?
________________________________________________________________________
________________________________________________________________________
Thank you for completing this questionnaire.
For official use only
________________________________________________________________________
________________________________________________________________________
Category: Medical Questionnaire