By Randy Cohen, ATC, DPT
Mental health is a pervasive issue in the athletics community. Approximately one in every five youths in America will meet the criteria for mental health disorder, and the rate of mental illness for those ages 18 to 25 is nearly 30 percent. Due to these high rates of occurrence and the close relationship between mental and physical wellness, I consider psychological concerns to be the number one issue facing athletes today. Like other medical issues, psychological concerns in athletes carry the risk of litigation should the situation be mishandled. Fortunately, you can mitigate your risk in these situations by knowing your athletes and following your institution’s protocols.
Know and be Comfortable with Your Athletes
One of the biggest indicators of underlying mental health issues I see is a change in the athlete’s personality or behavior – something that can be easily recognized if you have a good relationship with your athlete. While you may “know” the athlete’s injury history, it is important for you to know the athlete as a person. Things such as what’s important to them in life and their inter-personal relationships (friends and family members they are close to) can be helpful if they suffer a major setback. For example, if you know your athlete is very close with their grandmother who recently passed away, you should be hyper vigilant of any signs of mental or emotional distress.
Beyond knowing an athlete well enough to recognize changes in behavior or personality, you should strive for a relationship in which your athlete is comfortable confiding in you, should they be distressed. If there is a problem, a direct admission either prompted or unprompted will be a much clearer indication of an underlying mental health issue than a simple observation. While it is an extreme example, you need to be comfortable enough to look your athlete in the eyes and ask, “Are you going to kill yourself? How are you going to do it?” This ability to triage is vital in managing a mental health crisis. Once you get this answer, you need to have a mental health management plan or emergency mental health management plan to guide you depending on the severity of the situation
Follow Your School’s Plan
The mental health management plan should include triage with directions on the next steps and which mental health professionals in your community/institution to refer them to (see the inter-association consensus statement on psychological concern at the collegiate level for details). Just as your institution has an emergency action plan for physical injuries and conditions, so too should it have an emergency mental health plan for students showcasing severe psychological concerns, such as suicidal thoughts. Both the mental health management plan and the emergency mental health plan should be devised by your institution to ensure the best possible course of treatment for the athlete, and to help defend you and your institution should you be accused of mishandling a case.
One beneficial thing that our athletic training department does after any incident requiring the use of our emergency mental health plan is have a post incident debriefing during which we reflect on and analyze the incident. During this time, it’s useful to think about questions such as “Were there any signs of psychological concern leading up to this incident?”, “Was our existing plan effective in managing the situation or does it need to be revised/expanded?” and “Is there anything that we could’ve done to prevent such an incident that we can implement going forward?” All these questions will hopefully lead to a safer, healthier place for your athletes.
Challenge to You: Fight the Stigma
One thing everyone, not just athletic trainers, must do is fight the stigma surrounding mental illness. While mental health awareness has sharply increased in the past few years, there is still the perception that mental illness is a weakness rather than an illness that can be treated and managed by the proper professionals. In a sense, it’s no different than suffering from asthma.
This stigma is especially troubling in athletics, where anything perceived as weakness is often hidden. The mentality of playing through nagging injuries without informing the coach or athletic trainer doesn’t help either. It would certainly be easier for our athletes to admit to feeling depressed or otherwise upset if they didn’t feel like they were weak by doing so.
Do your part to reverse this stigma inside and outside of the athletic training facility by normalizing mental illness. One day it could save an athlete’s life.