Because of the nature of chiropractic care, practice members often feel free to confide in us things they might not tell other providers. This is especially true if you practice in a lifetime family wellness model.

Sometimes practice members use their time in the office to vent or share stressful events and circumstances in their lives. They may not even be looking for advice but are just letting off steam.

You may be the only person who they think cares for them, touches them and even hugs them. Or maybe they are surrounded by people but feel more comfortable confiding in you.

So what do you do if a patient who is particularly distraught makes a comment about committing suicide? It may not even be that direct. Perhaps they share some frustration and express that life isn't worth it any more for them. There are many ways that a patient could verbalize this reaching out for help. They may even make a joke about it.

Make sure you take these utterances seriously and take some action that could save their life.

The key questions to ask someone who verbalizes suicidal ideation is to ask them if they have actually attempted it and if they have an actual plan. Both of these are big red flags.

Its one thing to get the blues and make an off hand comment about ending it all but its quite another to make a plan and even more concerning is making an actual attempt.

How you respond actually starts on their first visit with your HIPAA forms and releases. Don't gloss over what your patients put down (or don't put down) on these forms. Did they give permission to share their health information with anyone?

Did they give you permission to share it in a health emergency? Did they give permission to discuss their health with their wife, their husband? If not - ask them why and perhaps prod them to give permission to speak to loved ones about their health - especially in an emergency.

Also check to see if they gave you the name (and permission to contact) of their primary care provider or any other health care provider.

Make sure you have contact information for local mental health professionals and support groups. Perhaps have flyers, business cards or a referral sheet on hand to share with patients needing such support. Include a suicide hotline number with these as well.

If you have a minor who is verbalizing harming themselves then your need to act is clear. While you want to be sensitive to the child telling you things in confidence this is an example of when you go straight to the parents and alert them about what's happening. You will want to let the child know you are going to do this and that you have to do it so as to salvage their trust in case they think its been broken.

All of these are possible avenues for you to help your patient get the help and support they need.

So when a patient verbalizes suicidal thoughts get some more detail on how serious they are about it. Review the HIPAA release the patient signed to see what permissions they gave. If your concerns are heightened after this encourage the patient to discuss his situation with a significant other, clergy or primary care provider. Offer to help facilitate this discussion.

Give the patient recommendations for a therapist, support group etc. and make sure you provide a suicide hotline number.

Last but not least - make sure you document the incident in your notes and follow-up with the patient - especially if they do not have another appointment scheduled.

If for some reason you cannot reach the patient for a follow-up and your concerns become elevated then you could check with the local police department and see if they do “wellness checks” for this sort of thing.

Expressions of suicidal ideation are a serious thing and should be taken seriously by chiropractors. Put together your game plan ahead of time, educate and share it with your staff and make sure you have everything you need on hand to offer support to your practice members when they are struggling with these thoughts.