Accessible by Design: Three Ways to Rethink Your Mental Health Questionnaires

May is Mental Health Month, a time when many clinics and health systems refocus on identifying depression, anxiety, substance use concerns, and other needs early. Questionnaire screenings can be a powerful doorway to support. But when they are not accessible for people with disabilities, or when they happen without clear consent, accommodations, and follow-up, the doorway can turn into a barrier.

Following the principle, “nothing about us without us,” Screening for All’s resources were initially developed with its technical advisory group (TAG) made up of people with lived disability experiences. Across several Screening for All conversations with the TAG and clinical subject matter experts, three themes about questionnaires came through consistently:

• Mental health questionnaires are often issued repeatedly without meaningful follow-up;
• Tools and environments often do not match real access needs; and
• Practitioners may be unaware of what can (and cannot) be adapted when screening instruments are copyrighted and validated.

For both patients and providers, the throughline is trust: people engage when the process is understandable, respectful, and leads somewhere.

Barrier 1: Repeated screenings without follow-up

People are sometimes asked to complete the same depression, anxiety, substance use, or safety questionnaires during every visit, without a conversation about why, what the results mean, or what happens next. For patients, repeatedly sharing sensitive information about one’s mental health without transparency about what it’s being used for can feel invasive. For providers, it can feel like a quality improvement metric that crowds out care.

When a screening does not lead to follow-up, people may understandably hold back the next time or worry that answers will be used in ways they did not agree to. The result is a system that collects data but misses the point: helping someone feel safer, better understood, and connected to support.

A better approach: Use mental health screening as the start of a shared plan. That can be as simple as naming the purpose up front, acknowledging results, and explaining what follow-up will look like if something is flagged.

Barrier 2: Inaccessible screening tools and environments

The barrier is not always the questions themselves, but the delivery. What happens when your questionnaire has small print, a dense layout, or cannot be read by a screen reader? What happens when there is time pressure, lack of privacy, sensory overload, or no option for support in completing a questionnaire?

When access needs are not met, people may have to guess, rush, or disclose sensitive answers out loud to someone else. That raises privacy concerns and can distort results, especially when screenings touch topics, like suicidality, substance use, or violence. These barriers can disrupt the accuracy of screening and erode patient trust.

A better approach: Treat accessibility as part of clinical quality, not an add-on. The goal is for the patient to understand the questions, answer privately, and stay in control, regardless of disability, communication style, or support needs. Offer flexibility in how and when questionnaires are completed, such as allowing patients the chance to complete them before their appointment.

Barrier 3: Copyright and validation restrictions that limit adaptation

Clinicians may feel stuck: the most widely used instruments are copyrighted and validated, and teams are told they should not change wording, order, or scoring. When the standard experience does not work for a patient, it can seem like there are only two options: force it or skip it.

‘One standard way’ often means ’one inaccessible way.’ Patients should not have to choose between participating in care and meeting their access needs.

A better approach: Teams can improve patients’ experiences by providing alternate formats and support for privacy and communication and establishing clear workflows for follow-up. It is also important to consider validated alternative instruments when clinically appropriate for individuals with intellectual and developmental disabilities.

Alternative instruments include, but are not limited to:

• Glasgow Depression Scale for People with a Learning Disability (GDS-LD) (self-report)
• Glasgow Anxiety Scale for People with a Learning Disability (GAS-ID) (self-report)
• Anxiety, Depression, and Mood Scale (ADAMS) (caregiver report)
• Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD) (self-/caregiver report)
• Reiss Scale for Maladaptive Behavior (caregiver report)

Resources to support accessible questionnaire screenings

To support this work, we created two companion resources, one centered on patient rights and one on clinical practice, so teams can align on expectations and patients can walk in informed.

Your Rights During Questionnaire Screenings is designed for patients with disabilities, and supporters, who want to know what to expect, what questions they can ask, and how to request accommodations. Find it here: https://mcd.org/screening-for-all/resources/your-rights-during-questionnaire-screenings

Guidelines for Questionnaire Screenings is designed for healthcare professionals and clinical teams with practical guidance on preparation, consent, accessibility, communication, and follow-up, especially when questionnaires cover sensitive topics. Find it here: https://mcd.org/screening-for-all/resources/guidelines-for-questionnaire-screenings

This Mental Health Month, we are thinking about screening as a relationship practice, not just a form. When questionnaire screenings are accessible for people with disabilities, the data become more reliable, the experience becomes more respectful, and the next step becomes clearer. That is how screening can earn its place as a true entry point to care.