Joe’s one of your favorite clients because he always shows up on time, works hard, and tells all his friends that his trainer is “the best.”

But lately, Joe hasn’t seemed himself.

He’s been showing up late to workouts, and when he does arrive, something feels off.

He’s distracted, lethargic, and your sessions together aren’t as fun as they used to be.

What’s going on with Joe?

The Canadian Mental Health Association says one in five people experience a mental health challenge in their lifetime, but most experts believe that number to be very low.

The fact is, most people don’t report mental health problems—not necessarily because they’re in denial, but because they’re not aware of them in the first place.

We’re not raised to take care of our mental health like we are our physical health, so how can anyone be expected to know when something’s wrong?

Mental illness cost me my job.

In 2015, I was diagnosed with generalized anxiety disorder—a condition that causes constant worry and can make it difficult to concentrate on tasks. I worked in the events and sports field, putting in 80 hours a week, and I struggled to cope with the stress until I burned out.

I was let go in 2016.

I’m also a personal trainer, and after losing my job, I started researching the effects of physical activity on mental well-being.

Later that year, I founded Fitness for Mental Health (FMH), a nonprofit organization that trains trainers to help clients with mental health issues, bridging the gap between the fitness and healthcare system. In 2017, FMH partnered with the Canadian Mental Health Association.

The symptoms of mental illness can come on suddenly and turn your personal training sessions upside down. But if you’re patient and keep your ears open, you may be able to help your client get back on track, and win their loyalty for life.

How to work with clients who have mental health challenges: A three-part plan

1. Remember you’re a trainer, not a doctor.

I trained clients in commercial gyms for years, and none of them ever volunteered any information about their mental well-being.

So if something isn’t right with Tuesday, 2 p.m. Joe, don’t expect him to come to you and admit he suffers from depression. You’re probably going to have to figure it out yourself.

The key, however, is discussion, not diagnosis.

Statistically, you’re likely to train someone who’s dealing with depression or anxiety, as they’re the most common mental disorders, but as a personal trainer, you don’t have the background in mental health to make the call that Joe has X, Y, or Z condition.

Anybody can pull out a diagnostics manual and say such-and-such symptom points to a particular disorder, but symptoms can be highly varied.

Ultimately, you’d just be guessing, and it’s not your place to decide what the client’s problem is and then try to treat it.

Instead, all you really have to do is start a dialogue.

Start by bringing up the changes you’ve observed. You can say something like, “I’ve noticed that you’ve been late the past three workouts, but you were never late before. Is there something you want to talk to me about?”

If the person is dealing with alcoholism or addiction, the conversations can be hard to start.

You’ll have to find words that get the ball rolling without sounding insulting or accusatory. Be gentle: “I’ve noticed that your hygiene isn’t the same. Can you tell me what’s happening?”

A nice, general approach would be to say, “You seem a little distracted. What’s going on?”

2. Let them set the pace.

There’s no question that physical activity is extremely beneficial for people with mental health problems.

Research has found that exercise can even be equally as effective as medication in treating depression—and it doesn’t take much.

Thirty minutes of medium- to high-intensity activity three times a week is what FMH prescribes, based on the science, but we’ve discovered that clients with depression don’t necessarily need that much intensity, or even a structured workout at all.

For some, just taking a walk outside or being in a group of people in a social setting can have the same effect.

Trying to make someone “push through,” train hard, or resume their normal level of intensity when they’re not up to it can actually aggravate some mental health conditions.

People who experience panic attacks, for instance, can’t always tell the difference between the increased heart rate and sweating that comes with exercise and the symptoms they get when they’re stressed.

It can take a long time to get a client like that comfortable getting their heart rate up and feeling that it’s safe to do so.

Talk to your client as far in advance as you can and meet them where they’re at. If it’s a new client, ask them how they’d like to handle days when they’re feeling down before you have your first workout together.

Say, “How would you like me to support you when you’re having a down day? Do you want me to push you? Or would you rather I laid off and we focused on doing other things?”

Days when the client isn’t feeling it may be better spent stretching, breathing, or just having a conversation.

3. Don’t be afraid to refer out.

When clients ask me about nutrition, I refer them to a dietician.

If they have an injury, I’ll suggest they see a physical therapist.

And if they reveal to me that they’re suffering from a mental health issue, I don’t mind telling them that treating specific mental health conditions isn’t what I do.

Of course, you don’t want to be so blunt or rude as to say, “I think you need to see a therapist,” but if your personal training sessions feel like they’re turning into psychotherapy, or you’re being asked questions you don’t have the answers to, you need to refer out.

I simply phrase it as, “This is outside my scope of practice; maybe you should talk to a professional about it.”

Understand that you can’t be everything to everyone, and that some people need to find their own path. You may not be able to help them, and that’s okay.

Remember, you’re not here to fix someone. You’re here to support them. And fitness is only part of a person’s recovery.

I’m a triathlete, and competitive sport helps me stay focused and driven. It’s how I manage my mental well-being. Personally, I’m able to keep myself off medication the majority of the time just by staying physically active.

However, if some stressful life event occurs, I often have to bring medication back into the mix to feel well.

Never suggest that a client can curb their use of medication or get off it entirely because they’re working out with you now, and be careful you don’t say anything to stigmatize the use of meds. Some people really need them, and may always need them.

As trainers, we need to build trust with our clients—that’s more important than losing weight and gaining muscle.

If you have trust, the client will stay with you, both while they’re dealing with a mental health episode and after they get through it.