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A chiropractor talks to a patient about mental health.

Patient Mental Health

What is your responsibility as a chiropractor?

According to the CDC, 41% of the population* has some sort of anxiety or depressive disorder post-COVID. Our post-pandemic world has created high levels of stress for everyone from children to seniors. What does this mean for you as a chiropractor?

Chiropractors are not trained to be mental health specialists. While mental health isn't a specific function of chiropractic, it is your responsibility to do what's in the best interest of the patient. Because DCs see their patients regularly, you are often in a good position to recognize mental health changes or threats. As a practitioner, it's your responsibility to recognize and assess risk, then make the appropriate referral for the patient so they can receive care.

Ask the Right Questions

First, you need to ask the right questions. Taking a good history is the first step. Ask questions about the biological, physiological, and mental health components of your patient and look for trouble indicators. Then there are things you might spot during the physical exam.

Example: if a patient reports experiencing a rapid heart rate or breathing, in the room or at other times, you need to decide:

  • Is the patient in need of additional care?
  • Where should you refer them, and is the situation emergent, urgent, or routine?

Many times, we think about these things with our new patients, and we forget about our existing patients. Ask about their stress level, and what is impacting that stress level. Relationships and jobs change. People move. Children leave home. Family members become ill. All these things can impact physical and mental well-being. Even when a doctor has been seeing a patient for a long time, it’s important to have conversations.

Some red flags might be:

  • They say they’re having feelings of sadness, or emptiness.
  • They have loss of interest in things.
  • They’re experiencing sleep disturbances.
  • They feel unsafe.
  • They can’t control their worry.
  • They’re restless.
  • They feel tense much of the time.
  • They fatigue easily.
  • They have a rapid heart rate, increased sweating, or difficulty breathing.

These are all things that require assessment and triage.

Respect Your Patient

Having respect for the patient is key. We can’t be judgmental of what they tell us. It’s important to be respectful and empathetic about what they have been through and what they're experiencing. Sometimes, the best thing you can do when a patient shares challenging information is to acknowledge that, and recognize, "I'm sorry you've been through this," or, "This has been really tough, and I'm glad that you're here, and I'm glad that you're talking about these things, and we can find help." Sometimes patients need to hear you can offer a way to get them the help that they need, want, and deserve. Educate and reassure them.

When patients feel things or experience things they've never felt before, it can be very scary. If you can give them an educational component and say, "What you're feeling is very real, and here's what I'm thinking, and here's who can help you get through this," they will feel supported.

What if You Don’t Act?

If a patient shows signs of anxiety, stress or depression and you don’t act on it, are there potential consequences? That depends. It’s important to be cognizant of the scope and the regulation you’re licensed under. It may be different for each state. The other key component is the referral process. Make sure that you’re referring the patient out to the appropriate provider to address their condition.

Talking about mental health can be very difficult for people, and this includes chiropractors. If you have a patient in the office who indicates they are struggling, there are ways to help ease into that conversation and get the information you need to be able to provide appropriate care.

Recognizing Red Flags

Chiropractors see patients more frequently than many other types of health care providers. This puts you in a position to potentially recognize red flags and to ask questions that will enable you to provide assistance. Include history-taking and note making as part of your regular process and have a plan and resources ready should you need to refer a patient out.


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