Your editorial suggests that physiotherapists are an untapped resource in suicide prevention. What led you to focus on
this issue?

Our team noticed that physiotherapists regularly build deep, trusting relationships with patients who are known to be at high risk for suicidal thoughts—especially those with chronic conditions or life-changing injuries. 

Research shows that over 50 per cent of physiotherapists encounter disclosures of suicidal ideation at least once a year and nearly half have heard about plans for suicide during their career. 

Yet despite this reality, suicide prevention training hasn’t traditionally been part of a physiotherapist’s education. 

This gap prompted us to rethink the public health approach to suicide prevention, shifting from a model that depends solely on mental health specialists to one that recognises physiotherapists as vital frontline responders.

Some clinicians might feel that suicide prevention falls outside the traditional scope of physiotherapy. What would you say to them?

Physiotherapists don’t need to function as psychotherapists or psychiatrists but instead can serve as sentinels and connecters, trained to spot warning signs, ask the right questions, listen without judgement and safely guide patients to help. 

Their role aligns perfectly with the principle of ‘every door is the right door’ in healthcare. 

Physiotherapists are already crossing into these conversations informally; what’s missing is the structure, confidence and training to do it well and safely.

You mention that many physiotherapists already receive disclosures of suicidal thoughts from patients. Why do you think this happens?

There are two key reasons. The first is therapeutic rapport. 

Physiotherapists often work with patients for months at a time, allowing people to feel heard and seen. 

That trust makes it more likely for vulnerable patients to open up.

The second is our patient population. We work a lot with individuals living with chronic pain, disability or significant injury. 

Within these populations, nearly 25–50 per cent report suicidal thoughts or behaviour. 

This overlap isn’t accidental; it’s systemic. When emotional pain coincides with physical pain and the listener cares and stays present over time, people talk.

What practical steps can a physiotherapist take if a patient discloses suicidal ideation?

Here’s a quick guide that practitioners can follow:

•    stop and listen—pause what you are doing; create a safe, confidential space
•    acknowledge and empathise—‘That sounds really hard. I’m concerned about you.’
•    ask directly but sensitively—‘It’s really common for people who feel overwhelmed or in pain to think about suicide. Are you currently having, or have you ever had, thoughts of suicide? Do you have a plan?’
•    assess risk—listen for a plan, intent or means; follow clinical judgement
•    collaborate on the next steps—offer to call crisis lines (eg, local suicide hotlines), GPs or mental health services with the patient
•    create a safety plan—if trained, help develop a safety plan, ie, identify personal coping strategies, supportive people and distractions
•    escalate if needed—in emergencies, call crisis services or emergency responders, even without consent if there’s immediate danger
•    document thoroughly—date, time, what was said, who was told and what happened next
•    follow up—check in at subsequent sessions, reinforce the plan and show continued care. These steps align with international guidance for allied health professionals.

How could education and training better prepare physiotherapists to respond to psychological distress without overstepping professional boundaries?

Training should cover core competencies, eg, recognising warning signs, asking about suicidal thoughts and knowing when/how to refer. 

Educators should make use of interactive methods such as role-play, decision trees and safety-plan checklists to build confidence in real scenarios.

An important aspect is clarifying boundaries. 

Non-specialised physiotherapists are not qualified to treat mental disorders; their role is to initiate conversations and guide patients to expert care.

Training should also include ethics and principles of self-care, eg, duty to warn, avoidance of vicarious trauma and knowing when to step back and get support. 

Physiotherapists should become competent trauma-informed care providers, equipped with the awareness needed to give gentle, person-centred responses.

Embedding these elements into entry-level programs and ongoing development would help physiotherapists step into this role safely and confidently.

What is the one message you hope clinical physiotherapists take away from your editorial?

You already matter. You are a trusted point of contact for people in distress, even if you don’t realise it. 

With just a bit of training and backing, you can bridge the gap, start vital conversations and guide someone toward help that may save their life. 

You don’t have to be a mental health expert; you just have to care.

>> Professor Davy Vancampfort is the academic coordinator for the Rehabilitation in Mental Health Care specialisation within the Master of Rehabilitation Sciences and Physiotherapy program at KU Leuven, Belgium. Davy has a particular interest in investigating the intersection of mental and
physical health.

COURSE OF INTEREST: 2024 eTalk #5—Suicide prevention is everyone’s business: how physiotherapists can support clients in distress