Health care providers are often the first point of contact for individuals struggling with mental health issues. Here's how you can intervene when a patient shows signs of suicidal ideation.
Posted in Articles on Monday, September 8, 2025
Suicide is a significant public health issue worldwide, especially in the United States. According to the World Health Organization, more than 700,000 people die by suicide each year, making it one of the leading causes of death globally. In the United States alone, the Centers for Disease Control and Prevention (CDC) reports that suicide is the second leading cause of death among individuals aged 10-34 and remains a significant concern across all age groups. As health care providers, we are often the first point of contact for individuals struggling with mental health issues. When properly educated, chiropractors, naturopaths and other alternative healthcare providers can play a crucial role in recognizing signs of suicidal ideation and providing timely intervention.
Prevalence of Suicide
As practitioners, we find that many patients are opening up to doctors and providers about depression and suicidal thoughts. In April 2025, the CDC released new data indicating the prevalence of depression in adolescents and adults has increased by 60% in the past decade.1 1 in 10 adults take prescription medications for depression, with women more than twice as likely to take medication for depression than men. In 2023, it was reported that suicide rates were highest among adults aged 85 and older at 22.66 deaths per 100,000, followed by those aged 75 to 84 at 19.44 per 100,000.2
Understanding Suicide Ideation
Suicidal ideation refers to thoughts about self-harm or taking one’s own life. These thoughts can range from fleeting considerations to well-developed plans. Not all individuals who experience suicidal ideation will attempt suicide, but the presence of such thoughts is a critical warning sign that should never be ignored.
Suicidal ideation can be passive (e.g., wishing one were dead) or active (e.g., planning how to end one’s life). Regardless of type, it signals deep psychological distress and often coexists with mental health disorders such as depression, anxiety, PTSD, or substance use disorders.
Why Health Care Providers Must Be Vigilant
Patients who are contemplating suicide do not always present with obvious mental health complaints. Many may seek your care for physical ailments, such as chronic pain, which may have emotional or psychological components. Conditions such as depression, anxiety, or PTSD should always be taken into consideration as complicating or contributing factors in a case. You or your staff may encounter patients experiencing suicidal ideation without realizing it.
We are holistic practitioners. We take a whole-person approach to health and wellness and consider the mind-body connection. We know our patients on a deeper level than many other professionals. Several patients who die by suicide have visited a healthcare provider within a month—even a week—before their death. The patient may be crying out for help if we would only listen. Our treatment visits offer a window of opportunity for detection and prevention.
Recognizing the Risk Factor, Warning Signs, and Red Flags
Recognizing suicidal tendencies and ideation requires a combination of clinical observation, purposeful communication, and a thorough patient history. Risk factors, warning signs, and red flags may not appear in the intake forms. Ensure your intake forms are updated to incorporate pertinent information. Even so, patients typically do not fill out forms correctly. Astute observation and questioning are an art in consultation.
Risk Factors of Suicide
There is no single cause of suicide. The taking of one’s life is a convergence of multiple factors and not always a rational thought. Depression is the most common condition associated with suicide. Mental health disorders, social isolation, chronic illness, family loss, hopelessness, low self-esteem, and seasonal variations are common risk factors for suicide. A provider should look for these factors among their patients.
Warning Signs of Suicide
It is incumbent upon us all to look for the warning signs of suicide. If a person talks about wanting to die or kill themselves, even in jest, it should always be taken seriously. Persistent depression, anxiety, or agitation and anger are also causes for concern. A person who is feeling hopeless, feeling trapped, or feels they may be a burden to others is a warning sign.
Certain people are more social than others, but a person who withdraws from relationships and social activities, begins giving away their possessions, or makes final arrangements for their death should also be addressed. Past attempts at suicide, recent trauma, substance abuse, or social life stressors such as divorce, job loss, and financial hardships may also be triggers.
In a consultation, it is crucial to inquire about the patient’s social history. After all, we address their activities of daily living (ADLs), but do we ask about them? It is appropriate, when given the above circumstances, to ask the patient about their feelings, if they feel depressed or have thought about suicide. Screening tools are helpful, but they do not replace human interaction. I once had an elderly patient who, after her treatment, exclaimed that I was her only doctor who seemed to care. She said her medical doctor “… asks me what prescriptions I need. He is just waiting for me to die.” In my opinion, this is the root of why we became doctors.
Doctor, Heal Thyself
If you identify with any of the above warning signs and red flags, seek help. You are worth it. Reach out to others and talk to them about your feelings. A text or email never replaces a telephone call. Phone a friend. If that is not practical, try cloud-based video conferencing such as Zoom, Teams, or FaceTime. We tend to be locked in the office for endless hours, never seeing sunlight other than through a window. Have lunch or coffee with a friend, go to dinner with others, or join your state association and attend their convention live. Networking does not refer to the internet.
Lastly, consider seeking professional help. You can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988. If you are facing mental health struggles, emotional distress, alcohol or drug use concerns, or just need someone to talk to, the Lifeline has counselors available to talk with you 24/7.
Screening Tools and Clinical Dialogue
Routine screening for suicidal ideation should be in your arsenal to assess high-risk patients. Tools such as the Patient Health Questionnaire-9 (PHQ-9), particularly item 9 (“Thoughts that you would be better off dead or of hurting yourself”), are practical for an initial assessment. Other tools include:
- Columbia-Suicide Severity Rating Scale (C-SSRS)
- Ask Suicide-Screening Questions (ASQ)
- Beck Scale for Suicide Ideation (BSS)
Responding to Suicide Risk
While tools are helpful, they do not replace human interaction. When facing mental health issues, do not be the problem solver. It is important not to minimize a person’s feelings. As healthcare professionals, we must cultivate a safe, nonjudgmental environment where patients feel comfortable sharing their thoughts. It is important to normalize these feelings without minimizing them.
Start with open-ended, empathetic questions:
- “How have you been coping with everything going on?”
- “Have you ever felt so overwhelmed that you thought about hurting yourself?”
- “Sometimes people in your situation feel hopeless or helpless—have you been feeling that way?”
If a patient expresses suicidal ideation, it is critical to ask follow-up questions to assess the immediacy and severity:
- “Do you have a plan for how you would hurt yourself?”
- “Do you have access to the means you would use?”
- “Have you ever attempted suicide before?”
Refer the patient to competent mental health professionals in your organization or community. Just as we may refer the patient to a neurosurgeon, the mind sometimes needs care. Follow-up is also essential. Patients need ongoing support and monitoring even after the immediate risk has passed. Missed appointments, non-compliance with treatment, or lack of support systems can increase the risk of recurrence.
Conclusion
One of the most effective suicide prevention strategies is reducing stigma around mental illness. We must exhibit openness and empathy. When asking patients how they feel today, they include mental health conversations. Ensure your practice or clinic has visible materials about mental health support services. A poster on the wall is an unobtrusive method of reaching out to patients. Resources are available for download at SAMHSA.gov.
Encourage a team approach. Doctors, assistants, and massage therapists should be trained to recognize signs of distress and know how to respond. Let your practice be a place of healing in every sense—physical, mental, and emotional.
Sources
- New Reports Highlight Depression Prevalence and Medication Use in the U.S., CDC, National Center for Health Statistics, April 16, 2025.
- Suicide Statistics, American Foundation for Suicide Prevention
About the Author
Dr. Mario Fucinari is a Certified Professional Compliance Officer, Certified Physician Practice Manager, Certified Insurance Consultant, and member of the Medicare Carrier Advisory Committee. As an NCMIC Speakers Bureau member, Dr. Fucinari travels throughout the year, frequently speaking to audiences nationwide and sharing his chiropractic expertise and insights into using best practices for documentation, compliance, billing, and coding. To have Dr. Fucinari speak at conventions or webinars, contact him at doc@askmario.com or call NCMIC for availability.