COPING BEHAVIOURS AND HOMELESSNESS

SELF-HARM

Have you ever harmed yourself in any way, such as cutting yourself with a razor blade, knife, broken bottle, biting chunks out of yourself, throwing yourself against a wall, down stairs, banging your head against the wall, etc?

1. Never
2. Rarely
3. Sometimes
4. Often

If yes, what do you do?

EATING PROBLEMS

How often do you overeat

1. Never
2. Rarely
3. Sometimes
4. Often

How often do you undereat?

1. Never
2. Rarely
3. Sometimes
4. Often

How often do you overeat and vomit?

1. Never
2. Rarely
3. Sometimes
4. Often

Have you ever been diagnosed as anorexic or bulimic? Yes/no.

ALCOHOL & DRUGS

How much alcohol do you drink a week:

None
Pints of beer or lager? ____pints
Bottles of strong lager? ___ bottles
Pub measures of spirits (whisky, vodka, etc?) ___measures
Glasses of wine? ___glasses
Anything else/ Specify what and how much_____________________

Do you use tobacco?

1. Never
2. Rarely
3. Sometimes
4. Often

Do you use marijuana?

1. Never
2. Rarely
3. Sometimes
4. Often

Do you use cocaine?

1. Never
2. Rarely
3. Sometimes
4. Often

Do you use tranquilisers?

1. Never
2. Rarely
3. Sometimes
4. Often

Do you use uppers (speed)?

1. Never
2. Rarely
3. Sometimes
4. Often

Do you use heroin?

1. Never
2. Rarely
3. Sometimes
4. Often

Do you use any other kind of drugs? Yes/no

If yes, what? and how often?

HOMELESSNESS

Are you living with your parents? Yes/no

Have you even been in a position where you have had to stay with friends because you could find nothing else? Yes/no.

Have you ever been homeless? Yes/no

SUICIDAL THOUGHTS

Have you ever seriously thought about taking your own life?

1. Never
2. Rarely
3. Sometimes
4. Often

Within the last year, how often have you ever seriously thought about taking your own life?

1. Never
2. Rarely
3. Sometimes
4. Often

How were these thoughts related to being lesbian?

1. Very much related
2. Very related
3. Somewhat related
4. Not very related
5. Not at all related.

Have you ever tried to kill yourself? Yes/no.

If yes, how many times? _____________

Describe the most recent attempts:




















Have you thought about hurting yourself or killing yourself in the last week?

No, not at all
Thought about it once
Thought about it two or three times
Thought about it every day
Thought about it so much that I could not think of anything else

In the last week, have you made any plans to hurt or kill yourself?

No, not at all
Made plans, but did not actually try to hurt or kill myself
Actually tried to hurt or kill myself.

Thank you for completing this questionnaire, the contents of which will be totally confidential.

If you are feeling upset and want to talk to someone the LIS telephone number is: 01706.817235; if we are not here, Childline's number is 0800 1111 (freephone). Please do contact us if the questionnaire upsets you.