Mental health issues among adults and children are reported to be on the rise. In addition to everyday stress, losses associated with COVID-19 have taken their toll on many individuals and families, along with post-pandemic changes to how and where we work, job and financial security, health care, relationships, travel and more. The Centers for Disease Control and Prevention reports that from August 2020 to February 2021, the percentage of adults with recent symptoms of anxiety or depression increased from 36.4% to 41.5%.(1) A CNN/Kaiser Family Foundation survey conducted in July and August 2022 found one in five adults received mental health services in the past year.(2)
While the treatment of mental health conditions is outside chiropractic scope of practice, doctors of chiropractic can play a key role in screening for patients who may be struggling with mental health challenges and connecting them with qualified mental health providers and resources.
“Depression increases with age and with chronic pain,” adds Will Evans, DC, PhD, MCHES, who is an ACA member as well as a professor of public health and associate dean of academic affairs for the college of Nursing and Health Professions at the University of Southern Mississippi. “The odds [a chiropractor] will have a patient with a mental health issue are fairly good.”
Ready to Refer
Before becoming an educator, Dr. Evans practiced for 17 years in Eufaula, Ala., where he first became interested and involved in public and community health issues. During those years, he recalls making referrals for patients experiencing mental health challenges. Over time he assembled a trusted network of mental health providers and resources to refer patients to, when needed.
“Unlike primary care, we’re not seeing a patient two times a year. We’re [often] seeing them several times over an extended period. There’s an enhanced opportunity to talk about these issues,” he says.
Awareness of the interconnectedness of mental health, physical health, and social factors — the biopsychosocial model of healthcare – adds to the ability of chiropractors to recognize health conditions that could be related to stress or anxiety. “Some things we treat can be triggered by mental stress and mental health irregularities – these things can increase headaches, shoulder and neck pain, for example,” explains Dr. Evans.
Mental health may also impact how a patient responds to chiropractic services. Dr. Evans observes that, in his experience, when a treatment plan is not working the reason is sometimes not physical but instead rooted in a mental health issue that is diminishing a patient’s ability to comply fully with treatment. Issues such as anxiety or depression may also lead struggling patients to drop out of chiropractic treatment altogether before achieving desired outcomes.
For this reason, Dr. Evans believes “screening for mental health issues should probably be a part of the initial evaluation. Then if the patient is not responding to treatment [and you suspect it is mental health-related] you can follow up again later,” he says. The U.S. Preventive Services Task Force would agree. It has recommended in draft guidelines this year that all adults under 65 be screened for anxiety in primary care. (3-4)
(Note: Dr. Evans, who is a Master Certified Health Education Specialist, along with colleague Robert Leach, DC, touches on mental health and other health promotion activities in the Learn ACA on-demand course, “Implementing Health Promotion and Motivational Interviewing in your Chiropractic Practice.”)
There are helpful clinical tools that doctors can use to smoothly integrate the screening process into history taking, and additional steps they can take to position themselves to provide information and referrals when needed. “It’s the worst thing if a patient needs help and you don’t have the information handy,” says Dr. Evans.
He suggests every chiropractor identify qualified providers such as a licensed counselor and a licensed psychologist for potential referrals. It’s also a good idea to encourage patients who need help to find out what mental health options may be available to them through their employer. “Today, some employers offer mental health services on site. Others have telehealth options available. Patients should check with their employer; they may have access to visits free of charge.”
Dr. Evans believes that another way that chiropractors can assist is by sharing information with patients about the benefits of physical activity on stress and anxiety. He says that promoting things such as outdoor physical activities and dietary changes can further support patients who are experiencing mental health challenges or accessing mental health services. “These are all in the scope of the chiropractor to recommend,” he says.
Next week: Mental Health Referrals From the Chiropractic Clinic (Part 2): How one ACA member works to improve mental health in his community and through his practice.
Annette Bernat is ACA vice president of branding and communications.
Reviewed by the ACA Editorial Advisory Board. The information in this post is for educational purposes. It is not a replacement for treatment or consultation with a healthcare professional.
1. Vahratian A, Blumberg SJ, Terlizzi EP, Schiller JS. Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020–February 2021. MMWR Morb Mortal Wkly Rep 2021;70:490–494. DOI: http://dx.doi.org/10.15585/mmwr.mm7013e2external icon.
2. “90% of US adults say the United States is experiencing a mental health crisis, CNN/KFF poll finds,” CNN.com, Oct. 5, 2022.
3. “Screening for Anxiety in Adults,” U.S. Preventative Services Task Force.
4. “U.S. Adults Should Get Routine Anxiety Screening,” Associated Press, Sept. 20, 2022.
Mental Health Resources
The ACA Public Health Advisory Board suggests exploring the following mental health screening tools and other resources, which may be helpful to doctors of chiropractic and their patients:
• The 36-item Short Form Health Survey (SF-36)
• Hospital and Anxiety Depression Scale (HADS)
• Beck Anxiety Inventory and Beck Depression Inventory
- Centers for Disease Control and Prevention (CDC)
- Substance Abuse and Mental Health Services Administration (SAMHSA) Help Line
- Most state health departments have mental health resources on their websites (examples: Arkansas, Virginia, Florida, etc.)
- National Alliance on Mental Illness
- National Suicide Prevention Lifeline
ACA Engage 2023 Presentation: “Healthcare as a Team Sport: The Role of the Modern Chiropractor in Collaboration with Mental Health Professionals” (1CE). Presenters: James Leonard, DC and Carter Comrie, PhD, LP. Thursday, Jan. 26 | 4:00 p.m. – 5:00 p.m. To register, visit www.acatoday.org/engage.
Cupler, Z.A., Daniels, C.J., Anderson, D.R. et al. Suicide prevention, public health, and the chiropractic profession: a call to action. Chiropr Man Therap 29, 14 (2021). https://doi.org/10.1186/s12998-021-00372-7.