Suicide Attempt Support Needs Survey

Questionnaire

Montgomery County Emergency Service is conducting this confidential survey to determine the need for support services for adults (18/Over) in SE Pennsylvania who have made or tried to make a suicide attempt. Thank you for helping us learn more about this need.

If this survey triggers thoughts of suicide

please call the National Suicide Prevention Lifeline at 1-800-273-8255

or text HOME to 741741.

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* 1. Do mental health services offer enough help for suicidal persons?

YES: Strongly agree

YES: Agree Somewhat

NO: Disagree Somewhat

NO: Strongly disagree

Briefly how could services for suicidal persons be better?

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* 2. Do you feel there is a need for a support group to help persons who have made suicide attempts?

YES

Don't Know

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* 3. Would you seek help from a peer specialist who had experienced a suicide attempt if one were available?

Definitely would

Probably would

Probably would not

Definitely would not

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* 4. Do you think that there should be a 24/7 peer warm line for persons with thoughts of suicide?

YES

Don't Know

Would other peer-led services, like a respite, help?

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* 5. What would you do to get help if you had thoughts of making a suicide attempt?

Reach out to Family Member, Friend, Other Trusted Person

Contact Peer Specialist or Other Peer-led Resource

Use my W.R.A.P. or Safety Plan

Call a Hot Line, Crisis Center, or Mobile Crisis Team

Go to a Hospital Emergency Department

Other Source of Help (please specify)

None of the above

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* 6. Should psychiatric hospitals have suicide prevention groups for current patients?

Strongly agree

Agree

Disagree

Strongly disagree

Briefly how do you think hospitals could better help suicidal persons?

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* 7. Have you ever made a suicide attempt, i.e., wanted to die and did something to try to end your life?

YES

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* 8. If yes, how many suicide attempts have you made?

One

Two to four

Five or more

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* 9. Did you ever require medical treatment for hurting yourself in a suicide attempt?

YES: I received care at a hospital or other healthcare provider

YES: I did not seek medical treatment

NO: I did not need medical treatment

NO: I never made a suicide attempt

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* 10. Have you ever had thoughts of making a suicide attempt or another attempt?

YES: I have had thoughts of making a suicide attempt in the past

YES: I have frequent thoughts of making a suicide attempt

NO: I have not had thoughts of making a suicide attempt