Step Up For Mental Health®: Family & Caregivers

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Thank you for your interest in taking part in an interview about mental health and families! Step Up For Mental Health®'s mission is to support, educate and provide services to empower families living with the challenges of mental health disorders. We are looking to interview family members or caregivers of individuals living with mental health issues in order to develop resources and tools to provide support to these vulnerable populations.

Please take the next 5 minutes to let us know a little more about your personal experience with mental health as a caregiver or family member of someone with mental health-related issues in order to see if you would be eligible for an interview.

For more information about our cause, please visit: https://www.stepupformentalhealth.org/about/mission/

First Name *

Last Name *

Email *

Phone Number

Can we send text messages (SMS) to this number?

Yes

Clear selection

The following questions will help us understand your experience with mental health (either personally, as a family member, or caregiver).

What is your relation to another individual living with a mental health-related issue(s)? (check all that apply) *

Myself

Family Member

Caregiver

Other:

Required

What is the gender of the individual experiencing mental health issues (if it's either you, a family member, or both) *

Female

Male

Gender non-binary

I prefer not to disclose

Other:

Required

Which mental health issues(s) do you or this individual experience? (check all that apply) *

Substance Use (i.e., alcohol, cannabis, other substances)

Autism

Schizophrenia or other psychotic disorders

Neurodegenerative disorders (e.g., Alzheimer's, Dementia, Parkinson's)

Eating Disorder

Learning disability

Anxiety

Depression

Trauma (e.g., Post-Traumatic Stress Disorder (PTSD))

Physical disabilities (e.g., chronic pain, somatic symptoms)

Attention-deficit/hyperactivity

Anger Management

Bipolar Disorder

Obsessive Compulsive Disorder (OCD)

Other:

Required

What are some difficulties you've faced from your mental health issues or being a family member or caregiver of someone with mental health issues? *

Are you or a family member a part of any of the following communities? (Check all that apply) *

Bi+ (Bisexual)

Person of Color

Senior community

Other:

Required

Would you be willing to be interviewed and featured in a family and caregivers mental health booklet? *

Yes

If you're willing to do an interview, which interview method would work best for you?

In-person

Video Chat (Google meet, Zoom)

Phone call

Other:

Clear selection

Thank you for completing our survey, and we look forward to interviewing you!

Please follow Step Up for Mental Health® on social media!

https://www.facebook.com/stepupformentalhealth
https://www.instagram.com/stepupformentalhealth/
https://twitter.com/stepupformh

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