Service Evaluation

How often have you self-harmed in the last fortnight? 1 Not at all to 10 Very often

1 2 3 4 5 6 7 8 9 10

How severe has your level of self-harm been in the last fortnight? 1 Not at all to 10 Very severe

1 2 3 4 5 6 7 8 9 10

To what extent have been troubled by suicidal thoughts in the last fortnight? 1 Not at all to 10 A lot

1 2 3 4 5 6 7 8 9 10

To what extent have you engaged in suicidal planning in the last fortnight? 1 Not at all to 10 A lot

1 2 3 4 5 6 7 8 9 10

To what extent have you felt able to tolerate your distress in the last fortnight? 1 Not at all to 10 A lot

1 2 3 4 5 6 7 8 9 10

To what extent have you felt able to tolerate your thoughts in the last fortnight? 1 Not at all to 10 A lot

1 2 3 4 5 6 7 8 9 10

How positive have you felt about your relationships with your friends and family in the last fortnight? 1 Not at all positive to 10 Very positive

1 2 3 4 5 6 7 8 9 10

How positive have you felt about your daily activities (e.g. school or work) in the last fortnight? 1 Not at all positive to 10 Very positive

1 2 3 4 5 6 7 8 9 10

How positive have you felt about the future in the past fortnight? 1 Not at all positive to 10 Very positive

1 2 3 4 5 6 7 8 9 10

When answering the following questions please think about your experience at the 1: 1 support session today.

To what extent do you feel as though you have been listened to in your support session today? 1 Not at all to 10 A great deal

1 2 3 4 5 6 7 8 9 10

To what extent do you feel that you have been helped to think about moving forwards in your support session today?

1 2 3 4 5 6 7 8 9 10

What was the best thing about your experience in your support session today?

What could we improve about your experience in your support session today?

Number of hospital or medical attendances for self-harm?

Do you receive support from any other services?

Yes No

Psychiatrist

Yes No

Community Mental Health Team

Yes No

Let’s Talk Wellbeing

Yes No

NHS other

Yes No

Therapist/Counsellor (healthcare)

Yes No

Therapist/Counsellor (voluntary sector)

Yes No

CAMHS

Yes No

Other (please state)