Mental health of athletes

ELITE athletes are not immune to developing mental health problems, with research indicating that they experience comparable rates of mental health disorders as the general population. Like the general community, athletes experience non-sport-related risks for the development of mental health disorders, such as adverse life events, age, gender and inadequate social support. However, participation in elite sport confers a unique combination of both sport and non-sport-related risk factors associated with mental health disorders, such as injuries including concussion, performance failure, overtraining, social pressures to perform, stigmatisation and denial of mental health disorders. Moreover, years of active participation in elite competition commonly overlap with peak age of onset for most mental health disorders. These factors suggest that tailored and context-specific approaches are required to effectively respond to and manage the mental health of elite athletes.

Team medics are front-line providers of all aspects of player healthcare, including mental health. Although they are not expert mental health clinicians, they have a duty of care for players’ mental health and well-being.

Outcomes

This is particularly important given the significant interplay between mental and physical health outcomes. They are well positioned to play a leadership role in the recognition, initial management and co-ordination of players’ mental healthcare.

There is an absence of consensus guidelines on how best to achieve this. This has resulted in inconsistent industry responses to important domains relevant to mental health identification and management, including use of screening and assessment tools, risk identification and management, treatment provision, case coordination, sleep management and addressing substance use. Moreover, management of player mental health within the broader context of a professional team elicits a host of additional considerations.

These include managing confidentiality, navigating public and media scrutiny, involving multiple stakeholders in management planning including families, coaching and performance staff, and remaining aware of the implications for team performance and well-being.

Prevention and mental health promotion activities as well as regular mental health screening were identified as within the scope of the team medic role. They should be aware of and engage in whole-of-club mental health promotion activities, which should be evidence-based, multidisciplinary and delivered by those with relevant expertise. Preventative components, such as mental health literacy training and screening tools are essential components within any elite or professional sporting context. Screening tools should be used at specific time frames in the athlete’s career, namely, recruitment, preseason, end of season and end of contract or retirement, as well as critical life events or stressors.

Regarding treatment, if team medics had relevant clinical expertise, they could conduct mental health assessments, manage pharmacotherapy and deliver initial evidence-based treatment. Team medics who did not have relevant experience were still acknowledged to hold a duty of care and responsibility for oversight of treatment progress.

Responsibility

As such, team medics would hold responsibility for treatment coordination, which could be delegated to a nominated club professional, while the club doctor maintained oversight. When engaging external specialists, the participants agreed that club doctors should be responsible for referrals to external mental health professionals, while again maintaining oversight.

Team medics should be involved in decisions to notify the media about a player’s mental health disorder and be aware of the club’s social media policy, so that actions can be taken in the best interests of the player’s well-being. The participants endorsed standard protocols around patient confidentiality, following existing local legal and ethical protocols. There is a need for building mental health literacy for all club staff, particularly those in coaching roles or other direct player contact, to understand mental health disorders and encourage help seeking, as supported by other experts.

Special thanks to three upcoming medics Musawenkhosi Fakudze, Nkhosinathi Ntshalintshali and their leader Thando Fakudze. Keep working hard.

Until next week I love you all. God bless you.

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The two giants will clash tonight