We are conducting this survey to map mental health and well being services and supports across the Kildare/ West Wicklow region (this includes workshops, education, therapy or any other programmes) provided by statutory services and the community and voluntary sector. This mapping will inform service development across the area. By filling out this survey you will also have the opportunity to promote your service/support and the option for your service to be included on the National One Stop Shop for Mental Health and Well Being, yourmentalhealth.ie 

We appreciate you taking the time to assist us in this mapping.
If you have any queries please call Niamh Crudden (Resource Officer for Suicide Prevention, HSE Mental Health) on 086 253 5529.

If you would like to order Little Things Resources (Postcard or Poster Packs) please visit healthpromotion.ie

#littlethings can make a big difference to how you feel

Find the #littlethings that work for you - Check out: www.yourmentalhealth.ie

Call the Samaritans on 116 123 for a listening ear

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* 1. Name of Service/Organisation

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* 2. Type of service provision: Please select all relevant options

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* 3. Catchment area: Please select all relevant options

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* 4. Service telephone number:

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* 5. Website(s):

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* 6. Service email address:

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* 7. Helpline number:

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* 8. Address:

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* 9. Name of contact person in your organisation

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* 10. Contact telephone Number for this person

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* 11. Contact email for this person

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* 12. Number of staff whose work directly relates to mental health and wellbeing

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* 13. Description of service provided (Please give a short but clear outline of the service(s) that you provide):

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* 14. Areas your organisation works on

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* 15. Who does your service provide for

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* 16. Does your service/organisation offer any training or workshops in relation to mental health and wellbeing? If yes please list below.

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* 17. How often does your service/organisation provide training?

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* 18. Does your service/organisation offer any evidence based programmes such as CBT, DBT etc. If yes please list and describe below.

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* 19. Cost of service:

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* 20. Target population group: Please tick age group(s) as appropriate

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* 21. How can services be accessed?

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* 22. Opening Hours: Please provide details of your opening hours as clearly as possible

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* 23. Do your staff require training in Suicide Prevention (SafeTALK, ASIST or Understanding Self Harm) Please state the number of people in your organisation who may require these trainings.

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* 24. Have any of your staff completed safeTALK or ASIST training or understanding self harm - If so please indicate how many have received the training.

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* 25. Staff accreditation: Please tick any professional accreditation currently held by staff in your organisation.

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* 26. Other: If you there is any other information you would like to provide please do so here

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* 27. Would you like your service included on the national one stop shop mental health and wellbeing website yourmentalhealth.ie (please see website for further details)

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* 28. Organisations need to meet all of the following criteria to ensure inclusion on the site. Please tick if you feel your organisation meets this criteria.

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* 29. GPS Latitude (to allow us to include you on yourmentalhealth.ie map) :To find your precise latitude and longitude coordinates using Google Maps simply follow the instructions here:http://www.gps.ie/gps-lat-long-finder.htm

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* 30. GPS Longitude (to allow us to include you on yourmentalhealth.ie map):To find your precise latitude and longitude coordinates using Google Maps simply follow the instructions here:http://www.gps.ie/gps-lat-long-finder.htm

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