The West Yorkshire and Harrogate Staff Mental Health and Wellbeing Hub is for everyone who works in health and social care, not only people who work in the NHS, and not only people who deliver face-to-face care. We are here to help people who are working or volunteering in a wide variety of different roles.

The following two questionnaires are being used to give us an initial indication about your current mood and the difficulties you are experiencing, as well as how you are feeling about work and how this is affecting you. We will use this information to help us to think about the most appropriate help and support for you. It will also help us to talk with you about how any support that is being provided to you is helping. Although filling in these questionnaires will be helpful to us and to you, it may be the case that you do not want to complete them. If this is the case, you will still be able to refer yourself to the service and you will still be able to access the same range of services on offer. Choosing not to complete the questionnaires will not have any negative impact on the help you receive.

Press Skip if you want to go straight to the self-referral form. Please complete all or part of the questionnaires only if helpful to you.

All personal information that you provide to us will remain confidential. Your personal information will be held on password protected NHS approved secure data servers in accordance with strict NHS policies for managing people’s personal information. If you would like any information about how your personal information will be stored, please contact us via email bdcccg.wyh.mentalwellbeinghub@nhs.net

The content of these webpages may not be accessible to all users, if you need the content in a different format that is more accessible to you or have any questions please contact us via email bdcccg.wyh.mentalwellbeinghub@nhs.net


Questionnaire 1

IMPORTANT PLEASE READ THIS FIRST – The form has 10 statements about how you have been OVER THE LAST WEEK. Please read each statement and think how often you felt that way last week. Then choose the most appropriate response.

Over the last week Not at all Only occasionally Sometimes Often Most or all the time
I have felt tense, anxious or nervous
I have felt I have someone to turn to for support when needed
I have felt able to cope when things go wrong
Talking to people has felt too much for me
I have felt panic or terror
I made plans to end my life
I have had difficulty getting to sleep or staying asleep
I have felt despairing or hopeless
I have felt unhappy
Unwanted images or memories have been distressing me