Crisis Cards Evaluation survey

General information and about you

Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (BNSSG CCG) and Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) are reviewing the effectiveness of the mental health crisis cards pilot.

The reason for this review is that BNSSG CCG and AWP want to understand how the crisis cards have been used and how useful they have been for the people who have had one given to them.

You have been asked to take part in this evaluation because you are a person who may have received a crisis card from AWP Bristol or supported someone who has done so. Your experiences of having had a crisis card will be highly valuable in informing what is working well currently and what may need to change in the future. Participation is entirely voluntary and will be very helpful in ensuring the review is hearing from people with lived experience.

Any data stored will be done so in accordance with the Data Protection Act and any reports produced will anonymise what is shared with us.

If you would like to take part, please either complete a paper survey and post in the stamped addressed envelope provided or complete this online survey.

BNSSG CCG and AWP are committed to ensuring that the views of people with lived experience of mental health and carers are heard as part of this work. They would like to work with and hear from people who:

·         Have received a mental health crisis card
·         Have used a mental health crisis card
·         Are close family members/friends/carers of people who have used the crisis card.

All responses will be treated with the highest confidentiality, with only summary data being used in the report that an individual would not be identifiable from. Please respond to this questionnaire by Friday 31st May 2019.

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* 1. Are you (tick all that apply):

Someone who has received a mental health crisis card

Someone who has used a mental health crisis card

A close family member/friend/carer of someone using or has used the crisis card

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* 2. Which area team are you / the person you care for currently supported by?

Bristol North Area Team – based at the Greenway Centre

Bristol Central and East Team – based at Speedwell

Bristol South Team – based at Petherton Road

Not sure

Another team or service (please specify)

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* 3. Were you provided with enough information about the crisis card when you received one?

No information provided

Not enough information provided

Enough information provided

More than enough information provided

Too much information provided

Not sure / not applicable

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* 4. Do you have any comments about the design of the card and the content of it?

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* 5. Based on your time using the crisis card please rate the following statements:

	Not at all	Not very	Somewhat	Very	Always	Not sure / not applicable
I find / found the crisis card useful	I find / found the crisis card useful Not at all	I find / found the crisis card useful Not very	I find / found the crisis card useful Somewhat	I find / found the crisis card useful Very	I find / found the crisis card useful Always	I find / found the crisis card useful Not sure / not applicable
I am / was involved in planning how I would use the crisis card	I am / was involved in planning how I would use the crisis card Not at all	I am / was involved in planning how I would use the crisis card Not very	I am / was involved in planning how I would use the crisis card Somewhat	I am / was involved in planning how I would use the crisis card Very	I am / was involved in planning how I would use the crisis card Always	I am / was involved in planning how I would use the crisis card Not sure / not applicable
I have benefited from my use of the crisis card	I have benefited from my use of the crisis card Not at all	I have benefited from my use of the crisis card Not very	I have benefited from my use of the crisis card Somewhat	I have benefited from my use of the crisis card Very	I have benefited from my use of the crisis card Always	I have benefited from my use of the crisis card Not sure / not applicable
The plan for my use of the card was followed	The plan for my use of the card was followed Not at all	The plan for my use of the card was followed Not very	The plan for my use of the card was followed Somewhat	The plan for my use of the card was followed Very	The plan for my use of the card was followed Always	The plan for my use of the card was followed Not sure / not applicable
I have made use of the crisis card in a time of need	I have made use of the crisis card in a time of need Not at all	I have made use of the crisis card in a time of need Not very	I have made use of the crisis card in a time of need Somewhat	I have made use of the crisis card in a time of need Very	I have made use of the crisis card in a time of need Always	I have made use of the crisis card in a time of need Not sure / not applicable

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* 6. Please share anything you would like to tell us about your responses to the statements:

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* 7. What works well with the crisis card?

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* 8. What does not work well, or was negative about the crisis card?

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* 9. What would you do to improve the crisis card?

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* 10. Do you / the person you care for still have the crisis card?

Yes

Not sure/not applicable

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* 11. Tell us why you still do or don’t have your crisis card?

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* 12. Tell us about your experience of using the card (include how you have used it / the impact it has had for you / how others have used it if you have provided to them e.g. police / A & E / other health professionals / crisis teams)?

Crisis Cards Evaluation survey

General information and about you

Question Title

* 1. Are you (tick all that apply):

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* 2. Which area team are you / the person you care for currently supported by?

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* 3. Were you provided with enough information about the crisis card when you received one?

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* 4. Do you have any comments about the design of the card and the content of it?

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* 5. Based on your time using the crisis card please rate the following statements:

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* 6. Please share anything you would like to tell us about your responses to the statements:

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* 7. What works well with the crisis card?

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* 8. What does not work well, or was negative about the crisis card?

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* 9. What would you do to improve the crisis card?

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* 10. Do you / the person you care for still have the crisis card?

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* 11. Tell us why you still do or don’t have your crisis card?

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* 12. Tell us about your experience of using the card (include how you have used it / the impact it has had for you / how others have used it if you have provided to them e.g. police / A & E / other health professionals / crisis teams)?

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* 13. Do you have anything else you would like to tell us about the crisis card?