MHSN | Mental Health Society of Nepal

Section 1: Demographic Information

1. Name (Optional):

2. Age:

16-25 26-35 36-45 46+

3. Gender:

Male Female Non-binary Prefer not to say

4. Occupation:

College Student Employee Business Owner Other:

5. Address:

Section 2: Mental Health Awareness

6. Are you familiar with the concept of mental health?:

Yes No Somewhat

7. Have you ever attended any mental health awareness programs?:

Yes No

8. How would you rate the effectiveness of mental health awareness programs you have attended? (Rate on a scale: 1 = Not effective, 5 = Very effective):

1 2 3 4 5

9.What mental health topics do you think should be covered more in awareness programs? (Check all that apply):

Stress management Coping with anxiety and depression Work-life balance Recognizing early signs of mental health issues Overcoming stigma and seeking help Others

Section 3: Mental Health Challenges and Issues

10. Have you ever experienced any of the following mental health issues? :

Depression Anxiety Bipolar disorder PTSD (Post-Traumatic Stress Disorder) OCD (Obsessive-Compulsive Disorder) Eating disorders Substance abuse/addiction Other

11. How would you describe the impact of mental health issues on your daily life? :

Minimal Moderate Severe

12. Have you ever faced discrimination or stigma because of mental health issues?:

Yes No

13. Have you or someone you know ever faced a mental health crisis?:

Yes No If yes, what steps were taken to address it?

14.How do you usually cope with stress or mental health challenges?:

Talking to friends/family Professional therapy or counseling Substance use (alcohol, drugs, etc.) Other:

Section 4: Access to Mental Health Support

15. . Do you think mental health services are easily accessible in your community? :

Yes No

16.What types of mental health support would you like to see more of in Nepal?:

Free or affordable counseling services Workplace mental health programs Community support groups School and college mental health initiatives Online resources and teletherapy options

17.Are there any specific barriers that prevent you or others from accessing mental health care? :

Lack of awareness Financial constraints Stigma/shame Lack of qualified professionals Long waiting times Other:

18. If you have sought professional help, how would you rate your experience? (Rate on a scale: 1 = Poor, 5 = Excellent) :

1 2 3 4 5

Section 5: Awareness and Prevention

19. How do you think mental health awareness can be improved in Nepal? (Check all that apply) :

Social media campaigns Educational programs in schools and colleges Free mental health workshops in communities Public service announcements on TV and radio Collaborations with local leaders and influencers

20.Would you be interested in attending mental health workshops or seminars? :

Yes No

If yes, what topics would interest you the most?

Section 6: Suggestions and Feedback

21. What can MHSN do to better support mental health in your community? :

22.Any additional comments or suggestions? :

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Mental Health Survey Form

Section 1: Demographic Information

Section 2: Mental Health Awareness

Section 3: Mental Health Challenges and Issues

Section 4: Access to Mental Health Support

Section 5: Awareness and Prevention

Section 6: Suggestions and Feedback

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