2015 Behavioral Health Services Survey for Consumers
Disability Rights New Mexico (DRNM) is interested in hearing about your experiences as you have accessed behavioral/mental health services in New Mexico. This survey will help us to advocate for better services. Your participation is completely optional and your answers will remain anonymous. If you'd like this survey in an alternate format, please call DRNM at 1-800-432-4682. Thank you!
Have you tried to access mental/behavioral health services in New Mexico since January 1, 2015?
Clear selection
What kind of services did you use or try to access?
Please check all that apply.
Have you received services from any of the following agencies?
Please check all that apply.
Since January 1, 2015, how many times have you gone to the Emergency Room to get mental/behavioral health services?
Since January 1, 2015, have many times have you been hospitalized for a mental/behavioral health issue?
(This may include substance use).
Since January 1, 2015, has your need for emergency treatment for behavioral/mental health issues:
Please check one.
Clear selection
Since January 1, 2015, have you been able to make appointments for mental/behavioral health services?
In other words, was a clinician available for appointments with you within 2 weeks of your needing it?
Clear selection
In general, how would you rate your physical health?
Clear selection
Please comment on your physical health, if you would like to:
In general, how would you rate your mental or emotional health?
Clear selection
Please comment on your mental or emotional health, if you would like to:
What is your age range?
Clear selection
What is your highest level of education?
Clear selection
What is your race?
Clear selection
Is there anything else that you would like to share about your experiences as you have attempted to access behavioral/mental health services in New Mexico?
Would you be interested in a more in-depth interview with a staff member from Disability Rights New Mexico?
If you would like to be interviewed, please type your name, phone number, and/or email address below. Thank you!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy