William E. Morgan, D.C.

Chiropractors typically practice in a more warm and engaging manner than most other specialties. We touch people and establish strong trusting relationships with our patients. Interaction with patients usually includes discussions that extend past the patient's physical condition. We frequently know the details of our patients work and home life and their state of wellbeing. These trusting relationships place chiropractors in a prime vantage for being sentinels for behavioral health conditions. If we observe unhealthy behaviors in our patients, we need to articulate our concerns to them. When patients exhibit self-destructive behavior, clinical depression or other psychological conditions, it is our responsibility to refer them to a behavioral health professional.

What to look for

Suspect a serious behavioral health condition when you observe patients who lose interest in life, or if they exhibit any of these traits:

• Feelings of hopelessness
• Thoughts of suicide
• Loss of appetite
• Lethargy or extreme fatigue
• Foreboding sadness
• Inability to sleep
• Changes in eating habits
• Refractory pain (refractory pain can lead to various behavioral health disorders such as depression and alienation)
• Seasonal Depression

A question that I ask patients who seem to be troubled is "Have you lost the joy of life?" If they have lost the joy in life, I insist upon a consultation with a behavioral health specialist. Delve into your patient's mindset. If your patient has self-destructive traits or clinical depression, you need to make a referral to a behavioral health specialist. Always take comments about suicide seriously and refer immediately to a mental health professional.

To whom should you refer?

There are many behavioral health specialists from which to choose: psychiatrists, psychologists, social workers, marriage counselors, addiction counselors, pastors and other clergyman, and behavioral health trained nurses In some cases it is easier to convince a patient to see a clergyman trained in counseling than for them to see a psychiatrist. More severe cases of behavioral disorders such as suicidal, self-destructive, or dangerous behavior should be referred to a clinical psychologist or psychiatrist.

How to refer

For many people being sent to a psychiatrist is humiliating and they may resist. You will need to reassure your patient that this is normal, ordinary and standard care. You are the doctor and if they need to see a specialist, it is your responsibility to get them to that professional! Contact the specialist and explain the situation. Be caringly assertive in your interactions with your patient.

Follow-up

Stay engaged with your patient even after you have made the referral. When you refer a patient to a specialist, it does not end your relationship with that patient. You still need to involve them in the healthy chiropractic practices of wellness: spinal care, exercise, proper eating and hydration, temperance, prudence, adequate sleep, and [preferably] drug-free pain relief. (Never tell a patient to discontinue their medication.) You may even encourage your patient to purchase full-spectrum lighting to combat SAD (seasonal affective disorder).

It is wise to communicate with the behavioral health specialist to make sure that your patient is keeping scheduled appointments and to keep informed about your patient's progress.

Wellness and Mental Health