First and Last Name
Email
Phone Number
Address
What State Is Your Church Located In?
City
Country United States
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---------------
Afghanistan
Ă…land Islands
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Virgin Islands, U.S.
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What is your role at your church? Lead Pastor
Executive Pastor
What is the name of your church?
Please List Your Church Website
How many attendees currently attend your church weekly? <50
100-500
500-1000
3k +
How long have you been in your role at your church? < 1 year
1-3 years
4-10 years
10+ years
What is your level of experience with offering Mental Health Support? None
Beginner
I know where to send those who need extra support
My church has a counseling department
What statement best describes your experience with speaking about mental health concerns? I don’t have any experience …
I have very little experience…
I have moderate experience...
I have a lot of experience…
What areas of mental health would you like to gain confidence in addressing?
Have you received consulting/coaching regarding mental health before? If yes, please describe.
Are you or any members of your staff currently licensed or certified in mental health? If so, please provide their name, title, and credentials
Do you have a process should a mental health crisis arise? Yes, I contact a crisis center
Yes, our staff handles it
No
I haven't had a need for crisis support at our church
How often do you find a need for mental health support for a church member? Never
Maybe a couple times a year
Every month
Weekly
What type of therapist are you comfortable referring to? Christian Therapist
A therapist who identifies as Christian but maintains a neutral stance on religion during therapy sessions
No preference as long as they are well trained
Which demographics do you find your church needing more support for mental health with: Children
Adolescents
Adult
Marriage
Family
Senior Ministry
How many hours a week over the next 12 weeks are you willing to invest in to become a mental health informed church? 1-2
2-3
3-5
Do you have any special needs or considerations that you would like me to be aware of?
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