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Mental Health Hospital Emergency Room Care Survey (Family and Friends)

You are invited to participate in an online survey about patients who recently visited a hospital
emergency room in New York City for psychiatric evaluation. National Alliance on Mental
Illness, NYC (NAMI NYC) and Manhattan Together want to learn about people’s experiences
in order to improve mental health care in emergency rooms. The survey can be completed by
a patient or by a family member or friend who accompanied a patient to a hospital emergency
room for psychiatric evaluation.
The survey should take about 10-15 minutes to answer.

Your participation in this survey is voluntary. You are free not to answer the survey or any particular question you do not wish to answer for any reason.

Participation in the survey has no affect on any services the patient receives.
 
Your survey answers will be sent to a link at SurveyMonkey.com where data will be stored in a password protected electronic format. Survey Monkey does not collect identifying information such as your name, email address, or IP address. Therefore, your responses will remain anonymous. No one will be able to identify you or your answers, and no one will know whether or not you participated in the study.
 
At the end of the survey you will be asked if you are interested in participating in a in depth conversation on your experience. If you choose to provide contact information, your survey responses may no longer be anonymous. However, no names or identifying information would be included in any reports or presentations based on these data, and your responses to this survey will remain confidential.

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* 1. ELECTRONIC CONSENT: Please select your choice below. Clicking on the “Agree” button indicates that
  • You have read the above information
  • You voluntarily agree to participate
  • You are 18 years of age or older

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* 2. If you are answering the survey as a family member or friend of a patient,

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* 3. Questions for Family Members or Friends
 
Part I: Background
Please select the borough of the hospital you visited most recently:

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* 4. Please select the hospital you visited:

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* 5. About when did you visit the Emergency Room?

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* 6. To the best of your knowledge, was this the patient's first visit to an emergency room for psychiatric concerns?

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* 7. To the best of your knowledge, how did the patient arrive?

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* 8. To the best of your knowledge, did the patient come voluntarily?

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* 9. About what time of the day did the patient arrive in the Emergency Room?

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* 10. How long did the patient wait until they were evaluated for the reason for the visit?

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* 11. How much time did the patient spend in the ER?

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* 12. Was the patient admitted to the hospital?

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* 13. If not admitted, to the best of your knowledge, was the patient given information or any referral to other care?

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* 14. If yes to # 13, to the best of your knowledge, was the information or referral helpful?

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* 15. Part II: Experience at the ER

Hospital staff allowed the patient to make a choice for me to stay with them in the ER.

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* 16. To the best of my knowledge, doctors and other hospital staff asked for the patient’s
approval to allow them to disclose any confidential treatment information, and respected the
patient’s decision.

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* 17. Doctors and other hospital staff asked me about the patient and considered my answers
about the patient to determine her/his best care.

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* 18. The patient was able to wait in a private area of the ER.

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* 19. The patient was treated with respect by doctors and hospital staff.

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* 20. The doctors and hospital staff treated me with respect.

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* 21. A doctor, social worker or peer counselor gave the patient the emotional support the patient
needed.

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* 22. I would recommend this hospital psychiatric ER to others.

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* 23. How can the hospital improve the experience of families and friends in the psychiatric ER?

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* 24. Part III.  Follow Up.  We are looking to have more detailed conversations about ER experiences and hope to find more people who would like to get involved in working to improve conditions in ERs.

Would you agree to talk with us about this psychiatric ER experience?

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* 25. If yes, please provide information about how to contact you:

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* 26. How old are you?

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* 27. Which of the following best describes you? (check all that apply)

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* 28. To which gender identity do you most identify?

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* 29. Does the patient have medical insurance?

0 of 29 answered
 

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