'Secrets No More" Survey

www.ZeroAttempts.org

Have you every seriously considered suicide? Have you ever actually attempted suicide? Have you lost someone important to you to suicide? Do you know someone who has attempted suicide? Can you think of anyone you know who might be considering suicide? Note all of this on this Survey Form, especially the feelings as they come up.

  • Each video is approximately five minutes long.
  • Start the stop watch when you start the first video.
  • Automatically click on the next video and continue the process.
  • Look at each person's face and read as much of the information about the person as you can.
  • Note on the survey form the time on the stop watch:
    • When you first teared
    • When you first whimpered
    • When you first cried out loud
    • When you first wailed
    • When you were moved to find out what you can do to help achieve Zero Attempts
    • Record the time when you stopped watching. Close your eyes and take some time to feel what's going on for you. Journal any particular feeling, memories, thoughts, as they come up.
  • If you didn't complete the series of videos and choose to continue after a break, start the stop watch and continue recording your process. (Use additional sheets of paper, if needed.)

The stigma around taking about suicide is one of the things take keeps suicide hidden and keeps people who are in crisis afraid to reveal their status. In an effort to reduce that stigma at some level, we would like to post your story. If you are open to that, you could remain anonymous, in which case, If you include your name and contact information, know that I am the only person who will ever see it. If it's okay to publish your name, however, let us know.

Please send a copy of your completed survey, with your age, gender, age that you may have seriously considered suicide, age if you actually attempted and by what means. Send the survey to Gordon Clay via email at gordonclay@aol.com or snail mail at PO Box 12, Brookings, OR 97415

 

 

Trigger Warning

The content displayed on this web page may be sensitive to some viewers. Viewing is not advised if you may become easily triggered.

Secrets No More Survey
Sex (Required)
Age (Required)
eMail (not required)
Name (Not required)

Date

First Considered
Means Considered

Comment (If any)

Actually Attempted
Means Considered

Comment (If any)

Most Recent Consideration
Means Considered

Comment (If any)

Time Stamp Journaling
Time
Circumstance
Feelings
0:00

Start

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