NAMI SFV Housing and Mental Illness Survey

1. Which of the following categories best describes your relationship to persons living with mental illness?

Which of the following categories best describes your relationship to persons living with mental illness? Mental Health Consumer

Sibling of an adult living with mental illness

Parent of an adult living with mental illness

Parent of a minor living with mental illness

other family member of a minor living with mental illness

Spouse of an adult living with mental illness

other family member of an adult living with mental illness

caregiver of an adult living with mental illness

Mental Health services provider

Other

2. In the past five years where have you or your loved one with mental illness lived?
select all that apply

In the past five years where have you or your loved one with mental illness lived? select all that apply Home with family

Group Home (Unlicensed)

Group Home (Licensed facility)

Sober Living Home

Correctional Facility

Mental Health Facility

IMD

Inpatient hospital

Nursing Home

Treatment facility / eating disorders?

Treatment facility / drug rehab

Treatment facility / alcohol rehab

Treatment facility / other

Board and Care

Shared Living Arrangement (such as "Room for Rent")

Independent Living in Home or Apartment

Shared living with roommate(s) in Home or Apartment

Homeless

3. Where do you / your loved one with mental illness live now?
Select all that apply this year

Where do you / your loved one with mental illness live now? Select all that apply this year Home with family

Group Home (Unlicensed)

Group Home (Licensed facility)

Sober Living Home

Correctional Facility

Mental Health Facility

IMD

Inpatient hospital

Nursing home

Treatment facility / eating disorders

Treatment facility / drug rehab

Treatment facility / alcohol rehab

Treatment facility / other

Board and Care

Shared Living Arrangement (such as "Room for Rent")

Independent Living in Home or Apartment

Shared living with roommate(s) in Home or Apartment

Homeless

4. How would you describe your own or your loved one's mental illness diagnosis or other health or mental health issues?
select all that apply

How would you describe your own or your loved one's mental illness diagnosis or other health or mental health issues? select all that apply Alcoholism

Bi-Polar Disorder

Depression / Major Depression

Drug Addiction

Eating Disorder

Obsessive Compulsive Disorder

Panic / Anxiety Disorder

Post Traumatic Stress Disorder

Schizophrenia

Schizo-affectve Disorder

Substance Abuse / Dependancy

*
5. What is your zip code?

What is your zip code?

NAMI SFV Housing and Mental Illness SurveyExit this survey

1. Which of the following categories best describes your relationship to persons living with mental illness?

2. In the past five years where have you or your loved one with mental illness lived? select all that apply

3. Where do you / your loved one with mental illness live now?Select all that apply this year

4. How would you describe your own or your loved one's mental illness diagnosis or other health or mental health issues?select all that apply

*5. What is your zip code?

NAMI SFV Housing and Mental Illness Survey
Exit this survey

2. In the past five years where have you or your loved one with mental illness lived?
select all that apply

3. Where do you / your loved one with mental illness live now?
Select all that apply this year

4. How would you describe your own or your loved one's mental illness diagnosis or other health or mental health issues?
select all that apply

*
5. What is your zip code?