MO.gov
DMH - Adult Consumer Survey
In order to provide the best possible mental health services, we need to know what
you think about the services you received DURING THE PAST YEAR, the people who
provided them, and the results. Your answers are confidential and will not influence the services you receive.
Which agency do you receive services from?
*
Select One
Adapt
Arthur Center
BJC (Farmington)
BJC (St. Louis)
BJC (St. Louis Co.)
Bootheel
Burrell (Columbia)
Burrell (Springfield)
Clark Center
Community Counseling Center (Bollinger)
Community Counseling Center (Cape Girardeau)
Community Counseling Center (Madison)
Community Counseling Center (Perry)
Community Counseling Center (Sainte Genevieve)
Comprehensive Health
Compass (Jefferson County)
Compass (Clinton)
Compass (Jefferson City)
Compass (Rolla)
Compass (Warrensburg)
Compass (Wentzville)
Comprehensive Mental Health Services
Family Counseling
Family Guidance Center
Hopewell Center
Independence Center
Mark Twain
Mineral Area
New Horizons (Columbia)
New Horizons (Jefferson City)
North Central
Ozark Center
Ozarks Healthcare
Places for People
Preferred Family (Hannibal)
Preferred Family (Kirksville)
Preferred Family (Trenton)
ReDiscover
Southeast Mo. Behavioral Health
Swope
Tri-County
Truman
Instructions: Fill in the circle that best represents your opinion (agreement or disagreement) of each item.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
1. I like the services that I receive here.
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2
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5
6
2. If I had other choices, I would still get services from this agency.
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2
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5
6
3. I would recommend this agency to a friend or family member.
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2
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5
6
4. The location of services was convenient (parking, public trans., distance, etc.).
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5. Staff were willing to see me as often as I felt was necessary.
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6. Staff returned my call in 24 hours.
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7. Services were available at times that were good for me.
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8. I was able to get all the services I thought I needed.
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6
9. I was able to see a psychiatrist when I wanted to.
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6
10. Staff here believe that I can grow, change and recover.
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6
11. I felt comfortable asking questions about my treatment and medication.
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6
12. I felt free to complain.
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6
13. I was given information about my rights.
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6
14. Staff encouraged me to take responsibility for how I live my life.
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15. If I was prescribed medication, staff told me what side effects to watch out for.
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16. Staff respected my wishes about who is given information about my treatment.
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6
17. I, not staff, decided my treatment goals.
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6
18. Staff were sensitive to my cultural background (race, religion, language, etc.)
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5
6
19. Staff helped me obtain information needed to take charge of managing my illness
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5
6
20. I was encouraged to use consumer-run programs (support groups, drop-in centers, warm lines, etc.)
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21. I deal more effectively with daily problems.
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22. I am better able to control my life.
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23. I am better able to deal with crisis.
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6
24. I am getting along better with my family.
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6
25. I do better in social situations.
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6
26. I do better in school and/or work.
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6
27. My housing situation has improved.
1
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6
28. My symptoms are not bothering me as much.
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29. I do things that are more meaningful to me.
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30. I am better able to take care of my needs.
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31. I am better able to handle things when they go wrong.
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32. I am better able to do things that I want to do.
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33. I am happy with the friendships I have.
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6
34. I have people with whom I can do enjoyable things.
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6
35. I feel I belong in the community.
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6
36. In a crisis, I would have the support I need from family or friends.
1
2
3
4
5
6
Please provide the following information for statistical purposes.
What programs are you involved in? (mark all that apply)
Community Psychiatric Rehabilitation
Other Mental Health Programs
Comprehensive Substance Treatment and Rehabilitation
Other Substance Use Treatment Programs
How long have you been enrolled in programs?
Less than one year
One year or more
37. What is your race? (mark all that apply)
American Indian or Alaska Native
White (Caucasian)
Native Hawaiian or other Pacific Islander
Black (African American)
Asian
Other
38. Are you of Hispanic/Latino origin?
Hispanic or Latino
Not Hispanic or Latino
39. What is your age?
18-20
21-34
35-49
50-64
65-74
75 +
40. What is your gender?
Male
Female
Male and Female
Male from Female
Female from Male
Agender
Non-binary
Gender fluid
Genderqueer/Gender Nonconforming
Intersex
Not Specified
Not Known
41. Are you deaf or hard of hearing?
Yes
No
42. Were you arrested during the last 12 months?
Yes
No
43. Over the last year, have your encounters with the police?
been reduced
stayed the same
increased
not applicable
44. In the past year have you called about a crisis after normal office hours?
Yes
No
Evaluate the following statements.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
45. When I contacted the crisis hotline, I was satisfied that staff responded promptly.
1
2
3
4
5
46. I was satisfied with the overall crisis services I received.
1
2
3
4
5
47. What type of housing do you live in? (mark only one)
Independent Living
Homeless
Supervised Individual Living
Hospital
Semi-Independent Apartment
Nursing Home
Living with friends/relatives
Jail or Prison
RCF/Group Home
Other
48. Type of Vocational Activity? (Mark only one)
Full-Time Independent Competitive Employment
Part-Time Independent Competitive Employment
Assisted Competitive Model
Sporadic or Casual Employment
Supported Employment
Sheltered Workshop
Non-paid Work Experience
No Employment of any kind
Retired
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