Mental Health Referrals in Health Coaching: Guidelines for Safe, Ethical Practice

Purpose: This paper presents evidence-informed guidelines for National Board Certified Health and Wellness Coaches (NBC-HWCs) to recognize mental health symptoms, initiate referrals, and manage safety considerations. Coaches are essential members of healthcare teams that help to improve patient outcomes and trust in healthcare providers. Currently, NBC-HWCs lack standardized referral standards, creating practice variation and vulnerabilities for coaches, clients, and primary care providers. Setting: NBC-HWCs practicing across healthcare systems, private practice, and community settings, with particular relevance for interprofessional teams in primary care and lifestyle medicine practices. Intervention: Guidelines include (1) mental health screening and referral processes, (2) referral language, and (3) crisis safety procedures, grounded in evidence, ethical codes, and scope-of-practice standards. Outcomes: Clear guidelines equip health coaches to make timely, effective referrals to licensed mental health providers, empowering interprofessional collaboration with confidence. Anticipated outcomes include improved client safety and wellbeing, stronger coach-client trust, and reduced risk of coaches practicing beyond their scope. Lessons Learned: These guidelines may support coaches in acting confidently as lifestyle medicine team members. Symptom recognition, paired with appropriate referral, normalizes mental health care within whole-person wellbeing. Establishing referral networks and understanding legal responsibilities are critical for safe practice.