Mental Health Referrals From the Chiropractic Clinic (Part 2)

Almost one in five adult Americans has a mental illness, yet more than half aren’t receiving treatment—and the number of people with unmet treatment needs continues to rise every year. (1)

While the treatment of mental health conditions is outside the 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.

Here’s how one ACA member, Daniel Strauss, DC, helps his patients as well as people in his community with their mental health needs.

Why DCs are Important Players in Mental Health

“Doctors of chiropractic, generally speaking, have traditionally been known to spend more time with their patients than many other healthcare professionals,” says Dr. Strauss, who is also dean of the National University of Health Sciences College of Professional Studies — Florida. “Some might say that we have a more ‘personable’ approach to patient care. This affords us the opportunity to really get to

Dr. Daniel Strauss

know our patients and, as such, we can often pick up more subtle underlying issues that the patient has.”

Dr. Strauss, who is also the vice president of a local mental health organization called Vincent House, can recall many times in his own practice when patients revealed information they had never shared before. For example, one patient pursued treatment to deal with bloating and constipation, and over time she revealed that she was in an abusive relationship and had felt “extremely depressed for months.” Yet, she never told her friends or family members about this.

“Although chiropractic physicians treat a wide variety of musculoskeletal and visceral conditions, we often have patients present with chronic complaints, eating disorders, addictive behaviors, depression, or anxiety disorders,” says Dr. Strauss. “These all can be signs of a potential underlying mental health condition.”

When It Comes to Mental Health, Time is of the Essence

Getting treatment for mental health conditions as early as possible is critical. “Research shows that if certain mental health disorders are not recognized and the necessary resources to proper treatment options provided in a timely fashion, it could lead to situations that could be life-threatening,” warns Dr. Strauss.

In a 2020 article published in the International Journal of Mental Health Systems, authors share that early identification and intervention can help keep mental health conditions from worsening and, in some cases, may even prevent onset. They further suggest that getting “other health care bodies” involved in the process may help change the trajectory of patients experiencing mental health issues.

“In our practices, it may be fairly common to see individuals who may have an underlying mental health issue,” says Dr. Strauss, “and we can’t just assume they have the outside help that they truly need.” They may be struggling with depression, for example, which is often associated with chronic pain. Or they might have an eating disorder, such as anorexia or bulimia, or have difficulty explaining frequent injuries. “Identifying a problem and connecting these patients with the appropriate resources can not only improve the quality of their lives, but also give them a sense of self-worth, purpose, and new outlook on life,” Dr. Strauss says.

Step One: Recognizing the Signs

The first step to helping patients with mental health needs is to recognize that the need exists. “There are many common signs or symptoms we need to look out for with patients that present in our offices, that could potentially require a referral to mental health services,” says Dr. Strauss. Among them are:

  • Inability to deal with stress under normal situations
  • Using drugs or alcohol to cope
  • Difficulty sleeping
  • A lack of interest in activities
  • Engaging in risky behaviors
  • A sense of guilt or helplessness
  • Mood changes
  • Agitation or violent outbursts
  • Withdrawal
  • Struggling with excessive fear
  • Difficulty maintaining a healthy appetite (or a change in appetite or weight loss)

These signs can also be associated with conditions commonly treated in chiropractic practice. “For instance, generalized muscle tension, headaches, or gastrointestinal complaints could be the result of stress,” shares Dr. Strauss. That’s why patients should be evaluated as a whole, and also where comprehensive health histories come into play.

Dr. Strauss recommends that DCs include a PHQ-9 and Generalized Anxiety Disorder Assessment (GAD-7) in their initial assessments. Both questionnaires can help determine if the patient should be referred to a mental health professional.

Making the Referral 

If you feel that a patient would benefit from mental health services, “timing is everything” says Dr. Strauss. For instance, it is imperative that if the patient is having thoughts of suicide, immediate intervention is a must.

“If it is a situation where the patient isn’t trying to harm themself, but I felt they could use mental health support, I would have a one-on-one conversation with the patient,” says Dr. Strauss. He also shares stories the patient can relate to so they feel more comfortable opening up.

At the same time, it’s important to stay within the scope of practice. “Similar to referring to an oncologist when you have a patient with cancer, we need to refer to mental health professionals for patients with mental health concerns,” Dr. Strauss says.

Mental health resources available to both doctors and patients include:

Also consider local resources, such as how Vincent House supports individuals with mental illness in Pinellas, Pasco, and Hernando Counties in Florida. “Many of these organizations will provide brochures, flyers, and literature for doctors’ offices to provide to patients that may need a referral,” says Dr. Strauss.

Going One Step Further: Education

DCs don’t have to stop there, either. “Chiropractic physicians can also take advantage of the opportunity to bring mental health education into their practices,” Dr. Strauss says.

You can do this by offering patient education classes or holding in-office seminars for the entire community. Expand on your normal wellness programs by bringing in a mental health professional to discuss common mental health conditions and treatment options.

“Inviting mental health professionals into chiropractic practices to provide this education to patients and the community not only illustrates that chiropractic physicians truly care about their patients as a whole, including their mental health, but it also shows that chiropractic physicians partner with other healthcare professionals and specialists for the common goal of helping their patients for a patient-centered care approach,” says Dr. Strauss. “Many mental health organizations and professionals offer these education classes free of charge and would be a great resource to offer patients, prospective patients, and their families—not to mention it is a potential new referral source as well.”

Christina DeBusk is a freelance contributor to the ACA blog.

Click here to read Mental Health Referrals from the Chiropractic Clinic, Part 1.

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. Mental Health America. (n.a.). The State of Mental Health in America. Retrieved August 9, 2022, from
  2. Colizzi M, Lasalvia A, Ruggeri M. (2020). Prevention and Ealy Intervention in Youth Mental Health: Is It Time for a Multidisciplinary and trans-diagnostic model for Care? Int J Mental Health Systems. doi:10.1186/s13033-020-00356-9