Mental Health and Well-Being Among Student Athletes

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1. How do you communicate with the treatment team and parents (if younger) without making the athlete feel that they’re being teamed up on or talked about behind their back?
   1. A team approach is so important, working with nutrition especially for our disordered eating/eating disorders, but in many other instances where severe depressive symptoms or bipolar disorder may definitely disrupt their eating behavior; We partner with every part of the medical team often.
   2. The biggest thing would be transparency. Always talk to a student athlete and say “here’s what I think would be helpful for your certified athletic trainer to know or this is what I think the medical doctors would need from you. DO you think that would be information you are ready to share with them or would you want me to share that information with them?”
   3. It really helps to build and maintain trust when you can say “here is what I think they need to know and here’s why.” To make sure that they don't feel talked about but feel like they're controlling the dialogue wherever they can.
   4. It also helps encourage them to have assertive communication and come back wanting to have that dialogue with their team or coaches, etc. It’s great to empower them to share that information, certainly it depends on the severity of the situation and some of the information should be communicated by the professionals.
   5. ALways discuss confidentiality and how it works/doest work. Each state has their own regulations on whether they can share information with parents or not.
   6. Best to communicate with the treatment team to get on the same page and determine who will share information with parents if in those cases it is warranted.
   7. What psychology professionals can offer is general consultation and if anyone has a concern about an individual in regards to their safety and mental health, they can talk with the professional to make them aware and take in information and give some general feedback, meanwhile the professional does not share any information about the individual they are reporting about. Unless the individual indicates release of information to that person.
   8. Within treatment teams (Especially in eating disorder cases) the client will often have to sign a medical release of information for safety if they want to continue participating in their sport. So if someone is on a medical hold for safety concerns, it has to be handled differently to make sure that communication can happen, if there is any concern with safety.
2. In your experience, what % of student athletes respond well and continue to follow up with seeking mental health help?
   1. The more options we have for them, the more success.
   2. If on a campus with many opportunities, the more success we have to get people connected and maintain connection. One the individual goes once, they often continue to follow-up.
   3. In average circumstances it often depends on finances that if there is a high cost, people drop off quickly, but in a college situation where there is no additional cost, most keep coming back.
   4. There’s no one model on how to follow up or when but I do see great success with once someones initially referred if they follow through with the first apt. They often come back.
3. How do you deal with bullying first? For instance, a student athlete is bullied for weight, now reaching out for nutrition counseling?
   1. Whenever possible, if aware of things like bullying you will need to have that conversation as a confidential resource since you want to give beneficiary feedback if they aren't in a safe safe, but you have to balance not identifying one individual and have to handle that balance.
   2. In some instances if it’s coming up enough, you may have the ability to say hey we've got to address this and that won't identify one individual more if there is more than one person getting “bullied”
   3. Empower them with the resources they can use to report any concerns with that at all times and talk to them about “hey can i help talk to address this or what steps do you want to take to speak up”. Encourage them to speak up but protect their need to not be more identifiable if they are getting bullied.
   4. A lot of this will depend on proactively having a lot of education for coaches, staff, on how to spot bullying. How to create and foster positive team culture and how to react if they are mandated reporters of hazing or bullying and if it comes up to staff they will immediately report it. But if it comes up to a confidential source, it is slightly different because the student athlete has a little more power in how they want to handle it, but making sure that your mandated reports are aware of what to look for and how to react to it to assure that safety and change that climate is always important.
   5. Because it's such an important thing to athlete safety to adresss the env. And how it can be improved.
4. How long do you think the Mental Health Issues associated with the Pandemic will linger around in the Athletic Community?
   1. We do not have the answer to this yet. The prediction is at least the next 5 years we are going to see longer term effects of this, because some people have immediate short-term strategies they are using to get through this that may impact them in the long-term. As well as so much grief, loss, and change has happened that it is estimated that it will be a decade of us seeing a rise in mental health concerns. It is likely we will see a long-term impact.
5. For younger athletes, how often do you involve parents vs solely speaking with a child?
   1. Depends on how that provider is contracted to give their services. In most cases, in most states if they are under 16 you are going to have a different confidentiality approach. You cannot guarantee confidentiality to the child.
   2. So partnering with the parent from the start will be helpful. This is a thoughtful question as sometimes that is a safe and sometimes it is not a safe environment. So partnering with parents of an athlete is really important, but tricky as we want to focus on client safety.
   3. A lot of child specialists will go through this piece immediately with the child and adults involved to establish what will be kept confidential, what will not, and what safety concerns will not be kept private.
   4. Partnering with the family members is key, because often in younger populations change in family dynamics can really aid mental health concerns.
6. What terminology do you recommend using when approaching the subject of working with a mental health professional? Ex: therapist, counselor, etc.
   1. Everyone has a different reaction to the language. There is not one word that may work for everyone and that does not mean you are doing it wrong. There are certain words that hold stigma more than others.
   2. Her title is “Associate Sport Psychologist” instead of therapist. If we put the sport in there, it can open the door to coming in to talk about sport performance and mental health as well. So that can provide holistic care and breakdown barriers.
   3. Counselor is probably the most general term and least stigmatized. Using the phrase “have you ever thought of speaking to a professional” can be helpful and a great starting place.
7. How do you handle pulling an athlete from practice?
   1. If mental health concerns are great enough an athlete will be placed on a medical hold. It is something that obviously is an important decision that we do not want to take lightly.
   2. We want to partner with a student athlete to determine what might be best for them, unless there is an imminent safety concern. If there is one, then we treat this as a crisis situation and handle that first. However, if it is something that is an ongoing concern and you think pausing participation may be helpful to take stress off and allow them recalibrate then this should be communicated.
   3. She often says “we are suggesting this time off, not because something is wrong with you, but because this might help you get through this sooner and then be able to get back out there and perform better.”
   4. Emphasizing this will help you get back out there safe and sooner shows athletes the benefit of a short-term pause on participation. Not everyone will want to pursue this option, but if there is an eating disorder or substance abuse issue then time off is not an option.
   5. In many instances outside of this, you can partner with the athlete and discuss options. Sometimes the athlete has been wanting this, but did not know how to ask for this. Sometimes it is the last thing they want to do. It is important to consider with this that your treatment team will talk to athletes and coaches, so while doing so she emphasizes the importance of everyone referring to this as a “medical hold” and not a “mental health hold” or some other variation that could bring stigma.
8. I am also wondering about youth athletes and ways to approach these same issues when they really dont make many of their own decisions, how do we ensure they have some power in this?
   1. A lot of times asking younger athletes who they feel comfortable talking to is helpful. A lot of times the guidance counselor who they have talked to or seen before can be the best for navigating how we talk to them.
   2. You can also consult with providers before developing a plan. Call that guidance counselor and ask them what they suggest, what resources to use, what pitfalls might happen if I talk to the parents first. They can help you set up a plan and have some recommendations to start with.
   3. A lot of times it is important to create that empowering space of asking the athlete who they feel comfortable talking to such as a teacher or a physician they feel comfortable opening up to.
      Partnering with parents is always helpful, unless their are safety concerns there between parent and child.
9. Knowing that eating disorder prevalence is increasing in younger populations and that many younger kids and teenagers are student athletes, how can we approach these topics when considering sports that focus on weight and weight loss?
   1. Best approach is to provide a lot of education around this and be mindful of the language you are using when addressing this.
   2. If an athlete or parent comes to you and wants weight loss, slow down the conversation and find out the why behind it, and figure out a healthful plan to do that OR determine this is not the best plan and transition your service to help the athlete in a different way.
   3. A lot of times what we see with youth athletes being in harm's way is when other people indicate they need to lose weight. Often it is when they hear others comparing such as “well that athlete is 5# lighter and doing better” or other ways of comparing.
   4. Youth female athletes are at risk of being body shamed by their teammates. Particularly if the training environment has males and females present. So be mindful of that and do what can be done to change that, as this step can help reduce the prevalence of issues at a younger age.
   5. Ultimately be mindful of language. Reduce fat talk and comparisons. Arm them with other ways of improving performance other than losing weight. Recognize what they could change in their tactics, mental preparation, sleep, hydration, self-care, etc. So it does not become that thinner is the only way to get better.
10. Many athletes we have come from many different cultures across the globe...any recommendations on how to familiarize myself or others out there on how to be more sensitive about how to approach issues?
    1. Every culture has a different language around mental health. How we approach it in the US compared to other cultures may be too direct or intimidating. Eye contact or more stigma might be felt if someone saw they are struggling.
    2. She recommends educating yourself to learn more about different cultures and their approaches. Look into books and articles on different cultures and how they handle mental health. A lot of times the more work you are doing, the better you can be as a resource to them so that they do not have to teach you.
    3. Educate, learn, and try changing your language in some ways. Instead of using the phrase “mental health” you can always try “well-being” and that may go over better.
11. Fabulous presentation! Thank you for shedding light on this! Question- Have you ever experienced a coach displaying negative bias (ex: keeping them from playing time) after learning of an athlete struggling with their mental health and have you tried to intervene or have tips on doing so?
    1. This is every athlete’s worst fear of if I am vulnerable, I will get punished for it. This is something you always want to partner with your coaches and administrators on to promote a culture where this would not be the case.
    2. There is a lot of research and date out there that shows to argue for why prioritizing mental health and well-being promotes better athletes. Data from the NCAA and other research articles can be concrete resources for other staff to view in order to support why putting mental health first is key.
    3. Have those conversations with coaches and administrators that “we have the same goal, we want the team to perform at their best, and here is how allowing athletes to seek mental health care and push pause when they need to reset can be useful.”
       Reducing the stigma at the staff level is essential, because this allows for athlete trust to be built and they will be more open in seeking help.
12. Are there any books you would recommend that can help a practitioner gain understanding of these concerns that an athlete may face?
    1. Her favorite for a brief summary of this presentation is- “Mind, Body, and Sport: Understanding and Supporting Student Athlete Wellness” by NCAA.
    2. She recommends reading a book that comes from the athlete’s perspective, such as 1st person stories of what athletes have experienced on the individual level.
    3. Athlete connected videos are helpful, personal, open, vulnerable and well-done.
13. For athletes under the age of 18 in need of a mental health referral, what do you do when parents refuse to seek help?
    1. In some states, younger kids can consent to care anyway. Some states 15, 16, 17 year olds can go get their care any way without parental approval.
    2. Partnering with the school is your best bet for those younger athletes, as there may be resources available to the student in that school even if they are not going to be something parents support outside of this.
    3. Guidance counselors again are a great resource.
       
14. Aside from google, are there websites to find local mental health providers where we can learn more about the provider than just a name?
    1. Yes. Go to psychology today and look by zip code. Providers will usually have a bio with a photo, their background, training, specialty area, etc. This is a great place to start.
    2. The providers fill this information in themselves, so it is okay to do a follow-up call to that individual and ask them to tell you about themselves and their specialization, do they work with athletes, how many athletes they work with in a year, etc.
15. How do we find resources for low-income athletes?
    1. Many mental health providers will provide a sliding scale for services. Healthcare providers want to be available if they can.
    2. Sometimes it is through an insurance provider, other insurance does not cover much, there is a wide range there.
    3. Ask health practitioners in the community who allows sliding scale feels where they reduce it with proof of low-income. This can provide extended access and partnering with those knowing that there are pro bono services is helpful.
    4. Community resources are often available for if you qualify for low-income status. This may give you access to free or reduced services that are available already through the community.