Documentary- Self Harm Survey

1. Page 1

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1. Have you ever self harmed?

If No- submit your answer and do not partake in the rest of the Questionnaire.

Yes
No

2. How long have/had you self harmed for?

3. Do your parent/guardian(s) know?

Yes
No
Other (please specify):

4. What caused you to self harm?

5. Do you feel any better or worse afterwards?

Yes
No
Other (please specify):

6. Have you ever had any help?

Yes
No
Other (please specify):

Comments:

7. Would you like any help?

Yes
No
Other (please specify):

8. Do you think you will ever stop?

Yes
No
Maybe

If you have already stopped, did you think you would stop at worse times?

9. Any other comments?

10. If you would like any help then please speak to your GP or visit Student Welfare in SO1.
Or visit any of these websites:

- www.mind.org.uk
- www.selfharm.co.uk
- www.youngminds.org.uk

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