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• W4380082954 abstract "Open AccessThe role of mental health care in reaching optimal performance in sportsAaron A. Mack, David Baron, and Jean ReinertAaron A. MackDr. Aaron Mack, M.D., MSc., Department of Psychiatry, Research, and Innovation, St Luke’s University Health Network, 800 Ostrum Street, #107, Bethlehem, PA 18015, USA[email protected]https://orcid.org/0009-0009-0136-9305 Department of Psychiatry, Research, and Innovation, St Luke’s University Health Network, Bethlehem, PA, USA Search for more papers by this author, David Baron Department of Psychiatry, Western University of Health Sciences, Pomona, CA, USA Search for more papers by this author, and Jean Reinert Department of Psychiatry, Research, and Innovation, St Luke’s University Health Network, Bethlehem, PA, USA Search for more papers by this authorPublished Online:June 09, 2023https://doi.org/10.1024/2674-0052/a000050PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreIntroductionMental health care should be seen as an essential factor in sports performance, and athletes should be supported when seeking care for mental health issues. The Covid-19 pandemic has raised awareness of the importance of mental health care in sports. Athletes are speaking up about their experiences with mental health issues, underscoring the need for better care, resources, and support. Annual physical and mental health screenings, along with ongoing monitoring, should be implemented to ensure the overall health of athletes. This paper proposes reframing mental health care in sports as a ‘legal performance enhancement’ to improve and maintain athletic performance.Mental health has historically been a marginal field within the realm of sports performance. Even though psychological and mental well-being are known to be key factors in sports performance, mental health is often overlooked and not given the same degree of attention as other aspects of an athlete’s performance, such as physical conditioning and nutrition.However, more so recently, during the Covid-19 pandemic, we have seen an undeniable shift in the public’s awareness of the importance of mental health care, particularly among athletes. Several high-profile athletes [1] have increasingly been speaking out about their own experience with mental health issues and the need for better mental health care and support. This shifts how mental health is viewed and affects an athletes’ performance. It is now becoming widely accepted that mental health is an essential factor in athletic performance and that athletes need to be proactive in seeking care for mental health issues. Thus, this paper proposes a fundamental shift in how we view the mental health care paradigm in sports by reframing it as a ‘legal performance enhancement’ that will improve and maintain an athlete’s performance.ObjectivesThe objective of this concept paper is to introduce mental health as a core component of an athlete’s development and performance. Intentionally addressing mental health in sports is a proactive approach that can shift current perceptions of remaining reactive to mental health issues.BackgroundSports psychiatry has advanced significantly over the past few decades, leading to a greater acceptance of seeking help for mental health issues among high performing athletes. Evidence suggests that athletes with better mental health are more likely to perform better than their peers, stay motivated, and show greater resilience in the face of difficult situations on and off the playing field [2, 3, 4, 5, 6]. Moreover, early sport-specific mental health interventions can improve an athlete’s performance [4, 5, 7]. However, mental health is often not given the same level of attention as other aspects of an athlete’s performance, and it is usually overlooked or downplayed as a factor in athletic performance. Despite the increasing awareness of the importance of mental health on performance, many athletes are still often reluctant to seek help for their mental health issues. This is in part due to the stigma that is still attached to seeking help for mental health issues, preventing athletes from admitting to feeling vulnerable and losing their competitive edge. Many athletes feel that disclosing mental health issues evoke feelings of shame and being seen as being not “mentally tough” [8, 9]; further leading to a culture of silence, continued stigma, and the undervaluing of mental health in the sports world. For this reason, it is imperative that athletes are supported when taking the initiative to seek care for any mental health issues they may be experiencing, and by fully integrating sports psychiatrists and sports psychologists into sports medicine, we can change this cultural viewpoint.Sports medicine physicians are essential in helping to maintain athletes’ safety and physical health, providing comprehensive medical care from injury prevention to diagnosis and treatment. Their primary focus is not on the mental health aspects of athletes. However, in the proposed framework sports medicine physicians can assist in recognizing early signs of mental illness and bridging the gap between athletes and the appropriate mental healthcare professionals, helping them to understand both the risks and benefits of seeking help.While psychiatrists play a key role in treating mental health issues, the field of sports psychiatry is still in its infancy compared to sports psychology. Sports psychologists have been invaluable in helping athletes manage the mental and emotional demands of competition and training, providing support, guidance, and strategies to help athletes stay focused and motivated while maintaining a healthy balance between sports and life. In the proposed framework, sports psychologists can further guide athletes on safely and ethically navigating to more specialized mental healthcare through collaboration with sports psychiatrists, while still helping athletes develop skills and strategies needed to cope with the unique stressors associated with the demands of their sport.Proposed approachThe proposed approach is to redefine mental health care as a ‘legal performance enhancement’ for athletes, with the aim of giving mental health the same attention and importance as any other performance-enhancing tool. To obtain a comprehensive understanding of the overall health of athletes, specific early screenings and monitoring must be implemented and conducted to gain an accurate view of their physical and mental health, including well-being, stressors, and adjustments [2, 3] so that timely sport appropriate interventions are implemented. This shift in perspective would allow mental health to be seen as a tool to improve performance rather than just managing psychopathological issues. To that end, the proposed approach includes the implementation of two assessments: the Psychiatric Basic Assessment (PBA) and Sports Psychiatric Examination (SPE) [10].The PBA should be administered annually with the preparticipation physical evaluation (PPE) to provide a baseline measure of an athlete’s mental health, allowing for potential concerns to be identified early and addressed. The SPE is a comprehensive, in-depth assessment and provides a more complete picture of an athlete’s mental health over time. This allows for any changes or issues to be identified and attended to quickly with individualized sport appropriate treatment plans. Treatment plans may include a variety of mental health interventions, such as cognitive-behavioral therapy (CBT), mindfulness, and sport appropriate psychotropics, to help improve an athletes’ performance and resilience in the face of difficulty.Implications for sports psychiatry, athletes and sporting organizationsThe implications of this shift could lead to a greater focus on mental health interventions and the development of new techniques to improve performance. This could include providing education on the signs and symptoms of mental health issues, and guidance on how to seek help for mental health issues. This shift would also help destigmatize mental health care and encourage greater dialogue and support around the issue.Additionally, sports psychiatry can also play an essential role in creating guidelines and protocols to ensure that the use of mental health treatments is done ethically and safely. This could include developing guidelines on the use of sport-appropriate psychotropics and other treatments, and developing protocols to ensure that athletes receive the best possible care and support.Furthermore, it is important to understand the implications of an athlete seeking help for mental health issues. Seeking help for mental health issues can be a difficult decision for athletes. However, it is vital to recognize the potential benefits of seeking help and the importance of mental health treatment in sports performance. Suppose mental health awareness is initiated early, such as before college or becoming a professional. It can reduce the internal taboo, shame, and stigma an athlete faces while seeking help. In addition, sports psychiatrists can support athletes and coaches to help them navigate the complex process of seeking help for mental health issues and ensure that athletes receive the best possible care.Overall, the redefinition of early mental health screening and treatment has the potential to revolutionize sports performance, and sports psychiatrists have an important role to play in ensuring that this shift in attitude is conducted ethically and safely; and this shift would also help to destigmatize mental health care treatment, encouraging greater dialogue and support around mental health issues.ConclusionIn conclusion, this paper has explored redefining mental health care in the context of sports as a “legal performance enhancement”. By reframing mental health care in this way, the role of sports psychiatrists can be expanded to include not just treating psychopathological issues but also developing strategies to help athletes achieve and maintain their optimal performance. However, this cannot be done by sports psychiatrist alone, a multidisciplinary collaborative effort which includes sports medicine, sports psychologists, and sports psychiatrists is needed. They each play a critical role in helping athletes manage the physical, mental, and emotional demands of competition and training. In the proposed framework, these professionals can help athletes better understand and manage the physical and psychological aspects of their sport. The pre-participation Psychiatric Basic Assessment (PBA) and Sports Psychiatric Examination (SPE) concepts mentioned in this paper support the potential of early mental health screenings and interventions to improve and maintain performance. They provide a foundation for further research into the effects of mental health and early mental health care on athletes’ performance.Furthermore, this shift in perspective could lead to more comprehensive mental health awareness programs for all sporting levels (primary, collegiate, and professional), greater collaboration between medical professionals, and the promotion of mental health resources and support within sports organizations. Ultimately, redefining mental health care in sports could lead to a new paradigm in which mental health is given the same attention and importance as any other aspect of an athlete’s performance.By emphasizing mental health, sports organizations could create a healthier and more supportive environment for all athletes, leading to increased camaraderie and trust between athletes, coaches, and other staff, thus allowing for a better understanding of mental health needs and more effective strategies for performance enhancement. In addition, this shift in perspective can open the door for more evidence-based research into the effects of mental health interventions on athletes’ performance, which could help optimize athletes’ performance in various sports. Ultimately, by recognizing and addressing the importance of mental health in sports, we can create a better and healthier environment for athletes and help them achieve their highest potential.References1 Meister A, Lavanchy M. Athletes are shifting the narrative around mental health at work [Internet]. Harvard Business Review. 2021 Sep 24. Available from https://hbr.org/2021/09/athletes-are-shifting-the-narrative-around-mental-health-at-work First citation in articleGoogle Scholar2 Mcmanama O’Brien KH, Rowan M, Willoughby K, Griffith K, Christino MA. Psychological resilience in young female athletes. Int J Environ Res Public Health. 2021;18(16):8668. First citation in articleGoogle Scholar3 Athletes for Hope [Internet]. Mental Health & Athletes. 2021. Available from: https://www.athletesforhope.org/2019/05/mental-health-and-athletes/ First citation in articleGoogle Scholar4 Purcell R, Gwyther K, Rice SM. Mental health in elite athletes: increased awareness requires an early intervention framework to respond to athlete needs. Sports Med Open. 2019;5(1):46:46. https://doi.org/10.1186/s40798-019-0220-1 First citation in articleGoogle Scholar5 Breslin G, et al. A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials. Syst Rev. 2017;6(1):177. https://doi.org/10.1186/s13643-017-0568-6 First citation in articleGoogle Scholar6 Ekelund R, Holmström S, Stenling A. Mental health in athletes: where are the treatment studies? Front Psychol. 2022;13:781177. First citation in articleGoogle Scholar7 Balcombe L, De Leo D. Psychological screening and tracking of athletes and digital mental health solutions in a hybrid model of care: mini review. JMIR Form Res. 2020;4(12):e22755. First citation in articleGoogle Scholar8 Cooks-Campbell A. Mental health in athletes: moving beyond the stigma [Internet]. BetterUp. 2022 Feb 4. Available from: https://www.betterup.com/blog/mental-health-in-athletes First citation in articleGoogle Scholar9 Brown GT. Mind, body and sport: understanding and supporting student-athlete mental wellness [Internet]. NCAA. 2014 Oct. Available from https://www.naspa.org/images/uploads/events/Mind_Body_and_Sport.pdf First citation in articleGoogle Scholar10 Gonzalez Hofmann C, Wyssen A, Schorb A, Allroggen M, Dallmann P, Schmidt RE, et al. Sports psychiatric examination in competitive sports. Dtsch Z Sportmed. 2021;72:307–15. https://doi.org/10.5960/dzsm.2021.502 First citation in articleGoogle ScholarFiguresReferencesRelatedDetails Volume 0Issue 0ISSN: 2674-0052eISSN: 2674-0052 ReceivedApril 21, 2023AcceptedMay 24, 2023Published onlineJune 9, 2023 InformationSports Psychiatry (2023), 0,https://doi.org/10.1024/2674-0052/a000050.© 2023The Author(s)LicensesDistributed as a Hogrefe OpenMind article under the license CC BY-NC-ND 4.0 ( https://creativecommons.org/licenses/by-nc-nd/4.0)Conflict of interest:The authors declare no conflict of interest.PDF download" @default.
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