Mental Health Services Needs Survey

Thank you for participating in this completely anonymous and confidential Mental Health Services Needs Survey.  Everything that you say in responding to this survey is strictly confidential and will not be associated with your name in any way.

	Have you ever experienced any of the following:   (Check  þ all that apply.)
	Anxiety
	Depression
	Excessive Rage and Anger
	Low Self Esteem
	Suicidal Thoughts
	Stress
	Violent Thoughts to Harm Self or Others
	Not applicable

	Have you ever been diagnosed and/or received treatment of any of the following:    (Check  þ all that apply.)
	Alcohol Abuse
	Anxiety
	Bipolar Disorder
	Depression
	Paranoia
	Schizophrenia
	Stress
	Substance Abuse
	Victim of Sexual Assault
	Not applicable

	If the College provided psychological and mental health services, how likely would you use these services?
	--Click Here--Definitely would use these servicesSomewhat likelyNever use these services

	You Answered 'Never use these services' to the question "If the College provided psychological and mental health services, how likely would you use these services?" Please specify here as to why you would not use these services:

	Do you believe that students at Broward College would benefit from the College offering these services?
	--Click Here--YesNo

	You Answered 'NO' to the question "Do you believe that students at Broward College would benefit from the College offering these services?:" Please specify here as to why students would not benefit from these services:

	If you had a counselor or someone to talk to about problems you have coping, would you take advantage of a 24-hour hotline to get help?
	--Click Here--YesNo

	You Answered 'NO' to the question "If you had a counselor or someone to talk to about problems you have coping, would you take advantage of a 24-hour hotline to get help?:" Please specify here as to why you would not use these services:

	If you needed help to cope with problems that you are experiencing, which of the following would stop you from getting the help you need?   (Check  þ all that apply.)
	Cannot afford it-too expensive
	Do not know where to get help
	Embarrassed
	Don’t want to admit I need help
	Trying to handle it on my own
	Don’t have time-too busy
	Not applicable

	Any comments or suggestions?

Thank you for taking the time to complete our Mental Health Services Needs Survey. We appreciate your honest feedback.

Please "Click the Submit Button Below"