SCPB: Mental Health Assessment
1. Please select age
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2. On a scale from 1-10, have you felt anxious within the last 2 months?
3. On a scale from 1-10, have you felt nervous within the last 2 months?
4. On a scale from 1-10, have you ever felt panicky within the last 2 months?
5. On a scale from 1-10, have you ever felt excessively worried within the last 2 months?
6. Did you ever plan a suicide within the last 12 months?
7. Have you thought of suicide within the last 12 months?
8. While under the influence of alcohol, have you thought or planned suicide?
9. While under the influence of marijuana, have you thought or planned suicide?
10. While sober, have you thought or planned suicide?
11. Do you struggle to make friends or connect with peers?
12. Do you have a trusted adult outside your family that you can talk to if you need to?
13. Do you believe you need to do something to improve your emotional or mental health? Please explain.
14. How much do you think learning more about mental health would improve your mental health?
15. Would you like to see more information about mental health, suicide prevention, self-care etc. Please explain.