WHAT ARE MENTAL HEALTH ISSUES/DISORDERS?

In order to be considered a mental disorder, an individual must have several symptoms at once, which are severe enough to disrupt normal daily functioning and must occur for a certain length of time. The American Psychiatric Association’s DSM- 5 defines a mental health disorder as a “syndrome characterized by clinically significant disturbance in an individual’s cognition, emotional regulator, or behavior that reflects dysfunction in psychological, biological, or developmental processes underlying mental functioning. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder…” Needless to say there are plenty of stressors that occur that can cause or put an individual at risk for developing mental health disorders or mental health concerns. Mental health issues are a serious concern and important to recognize in ourselves or others so we can provide the most timely and effective treatment.

Athletes are just as likely to suffer from mental health issues as non-athletes. The very nature of sport can bring about psychological issues in athletes, even though participation in athletics has many benefits. It is important to understand the signs of mental health disorders and how to address them to limit impact on participation in sport and daily life.

• Recognize to Recover mental health guide

COVID 19 AND MENTAL HEALTH

During this unprecedented time of the Coronavirus Pandemic, our lives have been disrupted. Training, playing and even watching sports is different in our current landscape. This crisis can cause negative impacts on our mental and emotional wellbeing. It is important to be aware of the impact this can have on our health so we can help ourselves. Self-care and knowledge of resources that are available are helpful in times of crisis.

The cancellations of competitions, training sessions and disruption to your normal schedule can be difficult to deal with. Understand that you are not alone. The World’s sporting community is with you. There are resources available for you to help cope with this sense of loss, the lack of normalcy and the uncertainty of what lies ahead.

The most important thing to focus on in this COVID-19 landscape is the health and safety of yourself and your loved ones. That means following the guidelines and orders set in place by the CDC, local and federal governments.

• Recognize to Recover COVID 19 mental health resources

MENTAL HEALTH AWARENESS

Creating a safe and inclusive environment involves being able to recognize and refer individuals who may be struggling with mental health issues. Below is a resource, which will be part of an education course, geared towards helping coaches, referees, administrators, and parents understand the importance of awareness of mental health issues amongst their athletes, the importance of creating a safe and inclusive environment, and resources to refer individuals to access the help they may need.

Mental Health Awareness Guide

COMMON MENTAL HEALTH DISORDERS IN ATHLETES

» SLEEP DISORDERS AND SLEEP CONCERNS
» MAJOR DEPRESSIVE DISORDER AND DEPRESSION SYMPTOMS
» ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
» ANXIETY AND RELATED DISORDERS
» EATING DISORDERS
» SUICIDE

UNIQUE STRESSORS OF ATHLETES

Demanding training schedule
Balancing demands of sport w/ school/social/family responsibilities
Developing social relationships
Frequent travel
Competitive stress
Injuries
Coach-Athlete relationship
Competition with teammates
Internal and socially encouraged pattern of toughing it out alone
Managing transition out of sport (e.g. out of club/ collegiate athletics, retirement)
Media pressure
Overtraining, staleness and burnout

EVENTS THAT CAN TRIGGER MENTAL HEALTH CONCERNS

Any event that requires adaptation and coping can produce stress, which can lead to emotional problems. These “triggers” are generally thought to be negative life experiences, but positive life experiences can also cause stress and an emotional reaction. Examples can be getting married, or buying a house. For an athlete positive experiences like becoming a starter or getting more playing time are positive but can cause an increase in stress. There are also many negative experiences that can trigger psychological concerns.

The following are triggering events that athletes may experience and could lead to mental health concerns:
• Poor performance or perceived “poor” performance by athlete
• Conflicts with coaches or teammates
• A debilitating injury or illness resulting in loss of playing time, future opportunities or surgery
• Concussions
• Issues with non-athletic related life » Class/school issues-schedule, grades, workload » Family/relationship issues
• Changes in importance of sport » Expectations by self/parents » Role of sport in life
• Violence » Being assaulted » Domestic violence » Automobile accident » Witnessing personal injury or assault of family member, friend or teammate
• Death of a loved one or close friend
• Social media
• Alcohol or drug use
• Significant dieting or weight loss
• History of physical or sexual abuse
• Gambling issues
• Post-Traumatic Stress Disorder (PTSD)

ANXIETY

Anxiety disorders are the most common mental health disorder in the United States. Symptoms of anxiety worsen with added stress. Performance expectation in sport can be a large factor among many for athletes dealing with anxiety.

EMOTIONAL SYMPTOMS

Excessive feelings of worry, fear or dread that are difficult to control
Preoccupation of what could go on in the future
Feelings ranging from general uneasiness to complete immobilization
Feeling jumpy or easily startled
Feeling of being out of control

Risk factors that can predispose you to developing anxiety:

• Family history
• Environmental factors (poor relationships, lack of social support)
• Injury or illness-especially if it is long term, career or season ending
• Competitive failure
• Retirement from sport
• Pain
• Concussion

Depression

Depression is a common mental health condition that affects all populations across the United States. Many times depression is related to other issues outside of sport participation, however, athletes may experience depression following an injury, or in response to the end of their athletic career.

EMOTIONAL SYMPTOMS

Sad, anxious or “empty” mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness and helplessness
Thoughts or talk about death, suicide or of “not being around anymore”
Restlessness or irritability

How to help yourself or others:

• Reach out to a close friend, teammate, family member or trusted authority figure (coach, teacher)
• Talk to your primary care physician, team physician, athletic trainer or sports medicine professional
• Find a mental health provider in your community
» MentalHealth.gov
» National Alliance on Mental Health Illness
» National Suicide Prevention Lifeline: 800-273-8255 (TALK)
• Use resources at school or university (counselors, mental health care providers, student health/wellness)
• Use online resources
• Develop a trust and open communication with your mental health provider
• Practice self-care (quality sleep, eat well, stress management techniques)

Suicide

For individuals age 10-24, suicide is the second leading cause of death. Identifying those at risk, and helping to reduce the stigma around seeking help, we can reduce the numbers of suicides.

WARNING SIGNS

Talking about suicide or talking/writing about death
Hopelessness
Self-loathing or self-hatred
Social withdrawal from friends or family
Loss of interest or pleasure in hobbies/activities that were enjoyable
Restlessness, irritability, anxiety
Aggression or agitation
Reckless or self-destructive behavior
Increased alcohol or drug use
Dramatic mood swings

How to help yourself or others:

• Get professional help immediately
• Resources are available by phone
» Call police if you or a loved one are in immediate danger
» National Suicide Prevention Lifeline 1-800-273-8255
» Many mental health clinics have “walk-in” or emergency services
» MentalHealth.gov
» National Alliance on Mental Health Illness
• Don’t leave the individual alone.
• Prevention is key:
» Education
» Seeking help early
» Support Resources Specific to your area/community/ school environment
» Suicide prevention programs

Myths about suicide:

• People who are open or talk about suicide do not commit suicide
• Mentioning the word “suicide” or having a conversation about it may give a person the idea
• All suicidal people have mental illnesses
• A suicide threat is just a call for attention and should not be taken seriously
• Suicide happens without warning
• If a person attempts suicide and survives they will never attempt suicide again
• Once someone is suicidal they are that way forever

**All of these myths are damaging assumptions to individuals who are in the greatest need for help. Taking this issues seriously, recognizing the signs and helping/encouraging people to access the appropriate resources will help decrease the incidence of suicides.

HOW TO HAVE CONVERSATIONS ABOUT MENTAL HEALTH ISSUES

Talking about mental health issues can be difficult. As athlete’s it is difficult for us to admit we are struggling. Mental toughness is a big topic that is discussed and encouraged as a part of sport culture. With mental health issues, one cannot simply, “tough it out”, we must rely on resources or others to help us.

The biggest part of helping athletes seek treatment for mental health issues is counteracting the stigma. It is important to generate a culture that encourages asking for help when needed. Where being vulnerable or sensitive is a strength. Where because you have a mental health issue, you are not rejected by teammates or coaches, but instead supported and encouraged to seek help.

Providing the individual with information and helping de-bunk several misconceptions or concerns about the process can help decrease the stigma and increase their change of following through with seeking the help they need from qualified providers. The following concerns can be helpful to address, even if the individual is not outwardly concerned about seeking counseling:

POTENTIAL PEOPLE INVOLVED IN IDENTIFYING MENTAL HEALTH ISSUES IN ATHLETES

» ATHLETIC TRAINER » TEACHER
» TEAM PHYSICIAN » PARENTS
» COACHES » FRIENDS
» THE ATHLETE THEMSELVES » TEAMMATES

THE ROLE OF INDIVIDUALS INVOLVED IN IDENTIFYING MENTAL HEALTH ISSUES IN ATHLETES

Athletic Trainers, Coaches, Teachers, Teammates, Parents and Friends are not responsible for diagnosing specific mental health conditions, but play a key role in recognizing when there are concerns and taking action to help the athlete gain access to the necessary resources for evaluation and treatment.

If you suspect someone of having any mental health related issue or if someone has brought the issue to your attention, the following guidelines can be helpful in addressing the individual and acting to get them the help they need:

• Pull the athlete aside to speak to them in a private, non-confrontational setting
• Do NOT accuse the individual of having a mental health disorder or issues you’ve noticed they are exhibiting
• The first and most important step when helping someone seek the necessary resources is to assess for risk of suicidal thoughts or behaviors, non-suicidal self-injury or other harm. These warning signs are listed in the suicide section.
• ALWAYS SEEK EMERGENCY MEDICAL HELP if the person’s life is in immediate danger. If you have reason to believe someone may be actively suicidal call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or call 911
• Express why it is important to address these for the individual’s overall health and wellbeing
• Be sensitive and empathetic
• Listen opening and non-judgmentally-allow the individual to feel respected, accepted and understood
• Give reassurance and information-mental health issues are treatable, which people can recover from with the right help.
• Encourage appropriate help. There are many professionals who are well equipped to offer help to an individual suffering from mental health signs and symptoms.

Types of Professionals:

• Doctors (Primary care physicians or psychiatrists)
• Social workers, counselors, and other mental health professionals
• Certified peer specialists

**It is not your responsibility to diagnose or treat an individual with mental health issues. It is you responsibility to support them and help guide them in accessing the care they need.

The first and most important step when helping someone seek the necessary resources is to assess for risk of suicidal thoughts or behaviors, non-suicidal self-injury or other harm. These warning signs are listed in the suicide section.
• ALWAYS SEEK EMERGENCY MEDICAL HELP if the person’s life is in immediate danger. If you have reason to believe someone may be actively suicidal call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or call 911
• Instead express your concern for the person and give examples of specific symptoms Some examples of how to begin a discussion are listed below:
• You’ve looked or seemed (sad, angry, nervous) recently. How are things going for you?
• I’m concerned about (mention specific situation or incident of concern), and I’d like to be helpful if I can.
• I get the idea you’ve been pretty stressed out lately. Can you tell me what’s going on?
• I imagine that you could have a lot of feelings about (the incident or situation presented). How is it affecting you?
• How have you been feeling lately?
• I understand that that you’ve been going through a tough time. How are you doing?
• When I hear you say things like (repeat the statement of concern), makes me think that you must be feeling pretty bad. Can you tell me more about it?
• What we are talking about is really important, but beyond the scope of my training. I’d like to help you find someone who is more qualified to help.
• I think it would be helpful to talk to someone about these problems. What would you think about that?

FINDING RESOURCES TO HELP YOURSELF OR OTHERS WITH MENTAL HEALTH RELATED ISSUES

Resources for Athletes:
• MentalHealth.gov
• NCAA Sports Science Institute
• National Alliance on Mental Health Illness
• Mental Health First Aid

Resources for Coaches, Parents, Staff Members:
• MentalHealth.gov
• NCAA Sports Science Institute
• National Alliance on Mental Health Illness
• Mental Health First Aid

SOURCES

Chang, C., Putukian, M., Aerni, G., Diamond, A., Hong, G., Ingram, Y., … Wolanin, A. (2019). Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement—Executive Summary. British Journal of Sports Medicine, 54(4), 216–220. https://doi.org/10.1136/bjsports-2019-101583

Chang, C. (2020). Mental Health Issues and Psychological Factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary. Br J Sports Med, 54, 216–220. https://doi.org/10.1136/bjsports-2019-101583

Mental Health. (n.d.). Retrieved April 7, 2020, from http://www.ncaa.org/sport-science-institute/mental-health

Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., … Engebretsen, L. (2019). Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine, 53(11), 667–699. https://doi.org/10.1136/bjsports-2019-100715

USA. (2020, March 23). Retrieved April 7, 2020, from https://www.mentalhealthfirstaid.org

Find Support | NAMI: National Alliance on Mental Illness. (n.d.). Retrieved April 10, 2020, from https://www.nami.org/Find- Support

How To Get Mental Health Help | MentalHealth.gov. (n.d.). Retrieved April 10, 2020, from https://www.mentalhealth.gov/ get-help