By completing this form, you consent to your data being used anonymously by your local Healthwatch office. For more information please visit https://www.yvhsc.org.uk/privacy-policy or your local Healthwatch website https://healthwatchealing.org.uk, https://healthwatchhf.co.uk, and https://www.healthwatchhounslow.co.uk.
 
Your local Healthwatch gives you the chance to say what you think about how local health and social care services are run. Your experiences are important and can help to inform the commissioners and service providers, who have the power to make changes. 
 
This survey has been designed to understand the experiences of patients and service users when accessing mental health services in West London.
 
If you would like to give feedback on more than one service, please fill in the form separately for each service. You can complete the form as many times as you would like.
 
If you have any questions about this survey, please contact us by either calling Healthwatch Hammersmith & Fulham's office on 0203 886 0386 between the hours of 09:00 – 17:00 Monday to Friday or email info@healthwatchhf.co.uk.

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* 1. Could you tell us the name of the West London NHS Trust mental health service you have used?

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* 2. How do you rate your overall experience of the mental health service you have used?

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* 3. Can you tell us more about your experience of this service?

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* 4. How do you rate staff attitude?

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* 5. How do you rate treatment explanation?

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* 6. How do you rate quality of care?

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* 7. How do you rate waiting times? By this we mean the time you waited to be referred to the service.

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* 8. Is there any support the mental health services could have offered you to improve the experience of your past/future treatment plan?

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* 9. Can you list any charities or other organisations that have helped you with your mental health over the past year?

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* 10. If you have not received help for your mental health can you please explain any reasons or factors that may have prevented you from receiving help?

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* 11. In order for us to have an in-depth understanding of mental health care in West London, we would like to contact a few people to have a chat with us on the phone. If you would be happy for one of the Healthwatch team members to contact you over the phone, please could you leave your contact details below.

This is completely voluntary and you do not need to take part if you do not want to.

Next we will ask some questions about you. These are completely voluntary, but will help us to understand a bit more about experiences of mental health services by people from different backgrounds and communities.

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* 12. Which borough do you live in?

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* 13. Which area of the borough do you live in?

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* 14. What gender do you identify yourself as?

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* 15. What is your sexual orientation?

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* 16. Which age group are you in?

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* 17. What is your ethnicity?

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* 18. Are you religious? If so, what is your religious practice?

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* 19. Do you consider yourself to have a long term condition or health and social care need?

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* 20. Do you consider yourself to have a disability?

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* 21. Do you take care of someone else?

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* 22. Which of these best describes your employment status?

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