The authors highlight that many patients who seek chiropractic care live with chronic pain, physical disability, social isolation, financial stress and psychological vulnerabilities — all known risk factors for suicide.
In 2025, NHS England released a new guideline, Staying Safe from Suicide, which strongly criticises traditional suicide-risk tools and checklists. Instead, the guideline recommends a relational, person‑centred approach that focuses on understanding the patient’s situation, fostering hope, and collaborating on safety.
Although the document is aimed at mental health services, the article argues that its principles are highly relevant for chiropractors everywhere.
Key Messages from the Article
Risk assessment doesn’t work
Traditional tools that categorise patients as “low,” “medium,” or “high” risk are unreliable. Many people who die by suicide had previously been assessed as low risk. Rather than relying on checklists, chiropractors should focus on the patient’s words, behaviour, and circumstances.
Relational safety is essential
A warm, empathetic and non‑judgmental therapeutic relationship increases the likelihood that a patient will open up about how they are truly feeling — even when it’s difficult. The relationship chiropractors naturally build through pain management and regular visits can be a protective factor.
A genuine biopsychosocial perspective is necessary
Suicide risk arises at the intersection of biological, psychological, and social factors. Chronic pain, work pressure, loneliness and financial difficulties affect both musculoskeletal symptoms and mental wellbeing. Chiropractors should care about more than symptoms — including context, life circumstances, and coping.
Risk is dynamic, not static
A patient’s state can change quickly — even within minutes. Chiropractors should be attentive to changes in mood, behaviour or language from one appointment to the next.
Safety work should be collaborative — not checklist‑based
The guideline recommends personalised safety plans developed with a mental health professional, not by the chiropractor. The chiropractor’s role is not to create safety plans — but to support the patient in accessing the right professionals.
Practical Recommendations for Chiropractors
The paper lists seven concrete strategies (from the NHS guideline) that chiropractors can implement:
- Recognise signs of distress
E.g., social withdrawal, silence, statements of hopelessness (“nothing helps anymore”). - Use empathetic engagement
Warm, curious questions can open dialogue.
Example: “How have you really been coping lately?” - Use open‑ended questions
Avoid yes/no checklists. - Normalise help‑seeking
Encourage the patient to speak with their GP, psychologist or other professionals. - Know your local referral options
E.g., GP, emergency department, acute psychiatry, crisis helplines. - Document neutrally and objectively
Note verbatim quotes or observed behaviour — not interpretations (“patient says: ‘I can’t cope anymore’”). - Take care of yourself as a practitioner
The work can be emotionally demanding — supervision and peer support are recommended.
Challenges for Chiropractors — According to the Paper
The paper also identifies several barriers:
- Fear of saying the wrong thing
Practitioners worry about making things worse — but research shows asking does not increase risk. - Discomfort with the topic
Some avoid the subject and thereby miss opportunities to help. - Uncertainty about professional role
Chiropractors are not expected to diagnose, treat, or carry responsibility alone. - Time pressure in consultations
Even brief moments of empathy can make a difference. - Lack of training
In the U.S., suicide prevention is largely absent from chiropractic education.
Conclusion Relevant for Chiropractors
The paper concludes that chiropractors, who often see patients regularly and over extended periods, have a unique opportunity within their existing professional framework to:
- identify early signs of psychological distress
- build relational safety
- normalise help‑seeking
- support patients in connecting with relevant services
- document concerns neutrally and professionally
This primarily requires communication skills, empathy, relational quality, and knowledge of local support systems, not that the chiropractor becomes a mental health expert.
Stanley Innes, Jean Théroux, Judith Hope. Staying Safe: lessons from suicide prevention for chiropractors and osteopaths. Chiropractic & Manual Therapies 2025.
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