‘The ‘gold standard’ on athlete mental health needs an update’

13 March 2014
Category: WINNING MIND – the art of achieving
Dr Pippa Grange

There is an argument to say that what happens within sport is to a large degree a mirror of what happens in the rest of society (albeit with some idiosyncrasies and outliers). If this is the case when it comes to mental health, then elite athletes are indeed in trouble.

Current figures estimate that around 45% of Australians will experience moderate to high levels of psychological distress across their lifetime – just short of half of us. The National Survey of Mental Health and Wellbeing conducted every decade confirmed that while 26% of young people reported experiencing a significant mental health problem in the last 12 months (higher than any other age group), the vast majority (87% of young men and 69% of young women) did not receive any professional help.

These figures are stunning for a country with so much opportunity, peace and prosperity relative to others. The mental health of Australia is a national regret.

So it comes as no real surprise to me to see our athletes burdened with at least the same struggle as the general population. It is not uncommon for us to think of some athletes as symbols of strength, resilience and health, protected by personal success and (sometimes imagined) teams of experts managing their every need. Except that personal success doesn’t guarantee protection from depression or anxiety, and possibly, neither will the teams of experts even when they are in place.

Elite sport can be tough on mental health. There are plenty of risk factors, including: a narrow identity, isolation from family supports, disconnection from the ‘real world’, ideas about self-worth being based on winning and losing a game /a medal /a flag, injury, lifestyle, involuntary career termination, and for some, feeling authentic in the balance of public and private life.

There are also many protective factors, not least the friendships, bonds, a shared sense of purpose, support and encouragement from a broad range of people, including psychologists and doctors.

Psychology is sport has come a very long way in the last decade to the point now where most sports understand the necessity of mental health as an underpinning performance factor, let alone the basic need for a happy and fulfilled life. But when resources are tight, psychology services in sport often need to be delivered in compromised ways, resulting in an ‘episode of care’ when someone is unwell, rather than a longer term investment in the wellbeing of the athlete. Healthcare can become something that feels like it is being done ‘to’ an athlete when something is awry, rather than something in which the athlete can participate fully. The risk is a system that emphasizes ‘broken-fixed’ or ‘ill-well’ dichotomies, rather than more realistic continuums where the athlete can stay autonomous but supported; in charge of their own world and not just in the hands of the experts.

Even when a sport is able to resource the ‘gold standard’ of psychological care for athletes, there is still the problem of stereotypes and the pluck it takes for anyone to go and speak to someone for the first time about not feeling OK. The upshot is there are too many reasons why athletes may not seek help early enough to avoid a deeper struggle than they might have otherwise had.

At the Young and Well CRC ‘Connect’ conference in Melbourne last month, Professor Ian Hickie noted that social support, a critical factor in staying well, is not built by health professionals, but is created between peers and teammates. Perhaps we need to revisit what works for today’s athlete, and today’s dynamic and changing sports’ environment.

I suspect that we are at risk of missing the mark on athlete wellbeing in an increasingly technological world if we do not act. As indispensible as the care relationship is, it may simply not be enough on it’s own any more.

So what is the answer? Of the one million Australians who are experiencing distress today, 96% of them are online. Perhaps we need to look to technology for new resources that enable (self-directed) early acknowledgement and intervention, allow peer connection and social support, and move away from the time-limited, top-down, controlled and expert-only response to mental health.

Something has to give – let’s make sure it’s not the mental health of our athletes.

Dr Pippa Grange

References

1 ABS 4326.0 – National Survey of Mental Health and Wellbeing: Summary of Results, 2007

2 http://www.yawcrc.org.au/safe-and-supportive/national-surveys