Mental health in prisons questionnaire

Participant number: ________________

Question 1

Has the inmate experienced any of the following?

1. Hearing voices YES NO

2. Strong mood swings YES NO

3. Any disturbing thoughts YES NO

Question 2

Has the inmate been diagnosed with depression and/or anxiety? YES NO

Question 3

Has the inmate ever self-harmed? YES NO

Question 4

Has the inmate ever become aggressive? YES NO

Question 5

Does the inmate have a dependency on either of the following?

1. Drugs YES NO

2. Alcohol YES NO

Question 6

Has the inmate ever experienced sexual dysfunction? YES NO

Total: _________________