Mental Health Considerations in the Runner

1. Mental Health Considerations in the Runner

2. Objectives • Identify signs and symptoms of common mental health issues • Identify core components of a mental health plan of action • Identify mental health needs as manifested in the athlete • No Disclosures

3. Stigma • Have to acknowledge the stigma is there • Why is a physical health issue so easy to seek treatment for yet a mental health issue so difficult?

4. Statistics • Nearly 1 in 5 adults experiences a mental illness within a year (National Institute of Mental Health 2017) • Approximately 1 in 25 adults in the US experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities (National Alliance on Mental Health) • Major Depressive Disorder is the leading cause of disability for ages 15-44 (Anxiety and Depression Association of America) • An estimated 49.5% of adolescents aged 13-18 had some sort of mental disorder; 22.2% had severe impairment(National Comorbidity Survey Adolescent Supplement) • 50% of all lifetime cases of mental illness begin by age 14 and 75% by age 24 (NAMI)

5. Signs and Symptoms of Depression EMOTIONAL: • Low or sad mood • Irritability • Apathy • Lack of enjoyment in daily activities • Hopelessness • COGNITIVE: • Poor concentration • Confusion • Negative thoughts • Slowness in thoughts • Suicidal thoughts

6. Signs and Symptoms of Depression (con’t) PHYSICAL: • Sleep disturbance • Fatigue (sometimes extreme) • Changes in weight • Restlessness • Decreased health • Gastrointestinal issues • BEHAVIORAL: • Disruption in daily life • Social withdrawal • Substance use / abuse • Decreased performance

7. Signs and Symptoms of Anxiety EMOTIONAL: • Fear • Excessive worry • Apprehension • Hopelessness • Feeling stuck or overwhelmed • COGNITIVE: • Indecisive • Impaired concentration • Obsessive and/or unwanted thoughts • Rumination • Negative thoughts

8. Signs and Symptoms of Anxiety (con’t) PHYSICAL: • Sleep disturbance – too much or too little • Change in appetite • Fatigue / weakness • Muscular tension • Dizziness / lightheadedness • Gastrointestinal issues • BEHAVIORAL: • Avoidance • Distractibility • Restlessness • Compulsions • Substance misuse

9. Signs of Distress in Athletes • Changes in performance • Withdrawal from teammates • Increased reckless or impulsive behavior • Not as “coachable” – irritable, sensitive to criticism, interpersonal conflicts • Unexplained physical concerns • Resistance to practice/ showing up late to practice • Neglect of appearance, grooming, hygiene

10. HAVE A PLAN! Just like there is a plan for physical health conditions, there needs to be a plan for mental health conditions… • Plan for varying levels of urgency • Know your resources • Know yourself • Have referral sources organized and at hand

11. Resources - NATA

12. Resources - NCAA

13. PPE’s • Screen for common mental health conditions such as depression and anxiety • Include questions related to nutrition, weight performance, learning disabilities, eating disorders and other mental health disorders • Is information already collected and able to be shared?

14. Team Approach • Physicians: team / primary care • School nurses / employment-based practitioners • School / campus / employee assistance program counselors • Community-based mental health care professionals • Sport psychologists

15. What do you have available? • What does your school / campus do to screen students / student-athletes? • What does your school / campus offer to support / refer students in varying level of crisis? • What community resources exist? • What exists for employee assistance programs? • What state resources exist?

16. Mental Health and the Athlete • Being an athlete doesn’t protect you from mental health issues: • might be the escape • might be exacerbating the problem • everything is individual

17. Mental Health and Athletic Performance Mental health concerns and / or events outside of athletics can affect athletic performance: • Low energy, disrupted concentration, decreased engagement • Sleep disruption • Slowed reflexes and decision making • Increased risk of injury • Excessive worry and dread before competition • Difficulty responding effectively to mistakes and / or unforeseen circumstances • Rumination and overly negative assessment of performance following competition

18. Triggering Athletic Events • Perceived poor performance • Conflicts with coaches or teammates • Injury or illness resulting in loss of playing time • Concussion • Changes in importance of sport or expectations • Burnout • Anticipated end of playing career • Sudden end of career due to injury or medical condition

19. The Athletic Trainer’s Opportunity • “Boots on the ground” • Developing rapport • Once one athlete has a positive experience, they may refer others • See all the athletes – stars & benchwarmers • May see subtle changes • See the physical complaints • See the injured & frustrated

20. Talk about it • If you are not comfortable talking about mental health, you need to get comfortable with it or ahead of time identify a source to refer them to • Talk about mental health at the beginning of the season in team meetings • Talk with coaches about mental health • Talk with parents about mental health • Emphasize that many people – with and without diagnosed mental illnesses – need help

21. Level of Concern • Having general concerns via observation / interaction • Approaching at the right time • Having escalating concerns via observation / interaction • More urgent need to approach • May involve others if no existing rapport • Involve / notify other professionals • Athlete initiated interaction • Most important scenario in which to have resources at hand • “Can I talk to you in your office?”

22. Getting someone to seek help… [Danny] Ainge has spent years learning to detect red flags of mental health concerns, which include players being habitually late or missing practice. Instead of suspending players or fining them large sums of money, Ainge requires they attend mandatory sessions with a mental health professional of their choice. "But to be honest," the Celtics president of basketball operations says, "I haven't had much success sending someone to counseling who doesn't want to do it willingly.“ ~ from Trae Young, Kevin Love and the future of mental health in the NBA by Jackie MacMullen, ESPN Senior Writer, Aug 24, 2018

23. Getting someone seek help… • Normalizing mental health care • Patience • Involve others • Setting the scene to talk to them without distractions

24. Normalizing mental health care • Parallel it to physical care • often refer to team MD / specialists • advantageous to catch physical conditions / injuries early; advantageous to catch mental health issues early • Talk about it as comfortably and directly as you would physical care • Choose words wisely, but overall message and tone are most important

25. Normalizing mental health care • Utilize examples • other athletes on team / in school (No Names) • sports figures • society • Let them know you’ll still be there • May want to bring up support of coach / parent / close friend in conversation • Encourage them to ‘give it a try’ • note that more than one visit is necessary to do that and often uncomfortable

26. Confidentiality Let them decide how you are involved in terms of updates / communication Learn rules in your specific setting / age group Consider EOB’s, billing, etc as a means of others “finding out”

27. Referral after a traumatic event Response to trauma – and the need for counseling – is individual • Right away • Farther out from event • Much later in life • Never Counselors are available, not mandated, after traumatic events

28. Suicide Prevention