Mental Health Awareness Survey
*Important notice: due to content, survey is intended for indiduals in sixth grade and older.*

Thank you for agreeing to take part in this important mental health survey for StarVista’s Crisis Intervention and Suicide Prevention Center. The goal of this survey is to assess your knowledge and experience with mental health in an effort to support the youth we serve. This survey will take about 10-15 minutes of your time.

The survey includes questions on the topics of suicide and self-injury. Some of these topics may bring up discomfort; you are able to discontinue the survey at any time. We value your safety, and want you to prioritize your mental health. Your responses are voluntary and will be confidential. Responses will not be identified by individual.

What grade are you in?
What county do you live in?
If you selected "other" above, what county do you live in?
Your answer
What is your gender?
What is your sexuality?
What is your ethnicity? (check all that apply)
If you do not identify with any options above, do you identify with an ethnicity not listed? Please describe.
Your answer
Are you familiar with the term "self-injury"?
Self-injury is the intentional harming of oneself. It is a very common, yet risky, way of coping with psychological stress. Do you know anyone who has ever intentionally harmed themself?
Have you intentionally harmed yourself within the last year?
What forms of self-injury have you heard of (e.g. cutting, burning, etc.)?
Your answer
Are you familiar with the term "self-care"?
Watch this short video on self-care before answering the questions below. People share their self-care routines (YouTube)
Self-care is any activity that we do intentionally to take care of our mental, emotional, and physical health. Do you practice self-care?
Which of these self-care activities do you practice?
If you selected "none of the above," do you practice another self-care activity? Please describe.
Your answer
Next we will be asking some questions related to suicide.
Suicide is the conscious choice of ending one's life. Please answer the following questions related to suicide:
TRUE or FALSE: Most suicidal people don't really want to die; they want to end their pain/problems/stress.
TRUE or FALSE: It is never okay to ask someone if they are thinking about ending their own life.
Have you ever considered suicide?
Have you ever attempted suicide?
Do you feel you have at least one adult who you can turn to for support?
Do you have any other people you can turn to for support? If yes, describe.
Your answer
If you're struggling with self-injury, thoughts of suicide, or other mental health concerns, check out these resources for extra support:
National Suicide Hotline
Peer to Peer Teen Support
LGBTQ+ Youth Support
San Mateo County Resources
Alameda County Resources
San Francisco County Resources
Thank you so much for taking our survey!
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