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Black Women's Mental Wellbeing Workshops
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1. What is your name?
Your answer
2. How old are you?
Under 16
16-34
35-49
50-64
65 and over
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3. What is your gender?
Male
Female
Other
Prefer not to say
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4. What is your race or ethnicity?
Choose
English, Welsh, Scottish, Northern Irish or British
Irish
Gypsy or Irish Traveller
Any other White background
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed or Multiple ethnic background
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
African
Caribbean
Any other Black, African or Caribbean background
Arab
Any other ethnic group
5. What is your religion or belief?
Choose
No religion or belief
Buddhist
Christian (all denominations)
Hindu
Jewish
Muslim
Sikh
Any other religion
Prefer not to say
6. What is your sexual orientation?
Choose
Bisexual
Gay man
Gay woman / lesbian
Heterosexual / straight
Other
Prefer not to say
7. Do you consider yourself to have any disabilities?
Yes
No
Prefer not to say
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8. Are you the primary carer for a child or an adult?
Yes
No
Prefer not to say
Clear selection
9. What language do you mostly speak at home?
Your answer
10. Are you suffering from any mental health issues at the moment?
Yes
No
Prefer not to say
Clear selection
11. Have you been bothered by worrying about any of the following?
Coronavirus
Your health
Your weight or how you look
Little or no desire in doing anything
Difficulties with your partner
The stress of taking care of family members
Stress at work, school or outside home
By financial problems or worries
Having no one to turn to
Something bad that happened recently
None of the above
12. Has your friends or family been suffering from any mental health issues?
Yes
No
Prefer not to say
Clear selection
13. Do you know of effective tools and techniques that help manage negative emotions?
Yes
No
Prefer not to say
Clear selection
14. Is there specialised mental health support for marginalised and ethnic groups in your community?
Yes
No
Don't know
Clear selection
15. Is mental health considered a taboo in your culture or community?
Yes
No
Don't know
Clear selection
16. Do you know where to go to access mental health support?
Yes
No
Don't know
Clear selection
17. Are you receiving any professional support for any mental health from your GP or mental health professional?
Yes
No
Prefer not to say
Clear selection
18. Do you understand that this is an introductory course to mental health giving basic techniques and where to go for support?
Yes
No
Clear selection
19. Do you understand that if you have mental health issues you should contact your GP or mental health support services?
Yes
No
Clear selection
20. What is the main reason why you would like to attend this course?
Your answer
21. What specific support do you need for this course if any?
Your answer
22. What dates and times are most suitable for you to conduct this training?
Your answer
Please provide your email address and contact number below.
Your answer
Please contact your GP if you have mental health issues or concerns for yourself or your family.
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