Drug misuse Eating disorder Intellectual disability/ Learning disability Legal highs Not sure Obsessive compulsive disorder Personality disorder Psychotic illness Post-Traumatic Stress Disorder Requiring crisis / emergency support Schizophrenia Self-harm Undiagnosed (please specify) Finally, we would like to ask you some questions relating to the person who has shared this experience. All responses will be treated within the principles of confidentiality and anonymity. Use of monitoring information will involve statistical summaries only. No information which could be used to identify you will be made available in any way. All responses are processed in line with our strict and robust data protection obligations Under 11-18 19 29 30 - 39 40 49 50 59 60 69 70- 79 80 Prefer not – – – – 10 years years years years years years years + to Your Age: years comment (✓) Northern England Scotland Republic of Elsewhere, write in the Ireland Ireland current name of What is your country country of birth? White Chinese Irish Indian Pakistani Black Black Black Mixed Any What Traveller Caribbean African other ethnic other is your ethnic ethnic group group Gender: Male Female Other (please specify)_________ Disability: In accordance with the Disability Discrimination Act 1995, a disability is defined as a physical or mental impairment which has a substantial and effect on a person's ability to carry out normal day-to-day activities. Under this definition, do you consider yourself as having a disability?
Drug misuse Eating disorder Intellectual disability/ Learning disability Legal highs Not sure Obsessive compulsive disorder Personality disorder Psychotic illness Post-Traumatic Stress Disorder Requiring crisis / emergency support Schizophrenia Self-harm Undiagnosed (please specify) Finally, we would like to ask you some questions relating to the person who has shared this experience. All responses will be treated within the principles of confidentiality and anonymity. Use of monitoring information will involve statistical summaries only. No information which could be used to identify you will be made available in any way. All responses are processed in line with our strict and robust data protection obligations Your Age: (✓) Under 10 years 11-18 years 19 – 29 years 30 - 39 years 40 – 49 50 – 59 years 60 – 69 years 70- 79 years 80 years + Prefer not to comment What is your country of birth? Northern Ireland England Scotland Republic of Ireland Elsewhere, write in the current name of country What is your ethnic White Chinese Irish Traveller Indian Pakistani Black Caribbean Black African Black other Mixed ethnic group Any other ethnic group Gender: Male Female Other (please specify)_________ Disability: In accordance with the Disability Discrimination Act 1995, a disability is defined as a physical or mental impairment which has a substantial and effect on a person's ability to carry out normal day-to-day activities. Under this definition, do you consider yourself as having a disability?
CAMHS__AND_AUTISM_FINAL_DRAFT.DOCX