Elite athletes like Olympic gymnast Simone Biles and tennis champion Naomi Osaka broke the norms when it came to elite athletes talking about their mental health this year.
Osaka withdrew from the French Open and Biles from several Olympic gymnastic events, both citing mental distress.
The decisions created international social media uproars, and they were flooded with both support and condemnation – a reaction that highlights key stresses for elite athletes.
Research by the Orygen centre at the National Institute for Youth Mental health found athletes experienced “ ‘high to very high’ physiological distress compared to the general community (17.15 per cent versus 9.5 per cent)”.
The study, based on 749 Australian Institute of Sports (AIS) athletes last year, said elite athletes were at high risk because of sports-related stressors and “the overlap in competitive playing years with the peak age of onset of mental ill-health”. But there was little good data on athletes who were currently competing.
A number of factors contribute towards neglecting the mental health and wellbeing of an elite athlete.
The key barriers include fear of the consequences of seeking help, intense public and media scrutiny, managing ongoing competitive pressures to perform, and lack of helpful support.
Other factors are the greater stigma around elite athletes seeking mental help than the general population and, finally, poorer mental health literacy.
Professor Simon Rice, a clinical psychologist who leads Orygen’s young men’s mental health research, said many of the studies in the area fell short.
“There’s been an explosion of research in athlete mental health over the last 10 years. Before that, it was not well considered in the research literature. The key problem with the studies is they’re often very low in scientific quality and require larger funding pools,” he said.
“When sports codes and organisations see a body like the International Olympic Committee taking leadership, they recognise that they need to be doing more well,” Prof Rice says.
A 2016 study led by Prof Rice, which took an overview of the available research in the area, recommended introducing early intervention programs, including mental health screening.
It suggested promoting mental health awareness initiatives to support groups, such as partners, friends, family, coaching staff, and administrative staff, to help overcome treatment barriers and stigma for elite athletes.
Olympic athletes carry the patriotic responsibility of winning medals for their countries, and team-sports athletes carry the responsibility of devoted fans on their shoulders. This is an added outside burden that extends beyond the pressure that competitive athletes place upon themselves.
Massage therapist Lily Starling, whose Los Angeles practice includes many athletes, says it is difficult for athletes to take care of their mental health.
“Athletes are largely seen as disposable in our culture. This is combined with a total misconception about how good their lives end up being as a result of us putting them through all of that,” she says.
Culturally, it has been particularly difficult for males to seek help, or to take care of themselves.
Ms Starling said they had to add “sports” to the names of treatments like facials and massages so they sounded more acceptable.
“It couldn’t just be like a relaxing day for the guys at the spa. So we had to create this as a way for men to give themselves permission to get self-care. And I think that is more amplified in sports.”
There has been more progress in the past 10 years in supporting the mental health of elite athletes. But come game time, they are expected to win.
It is difficult to balance a sports person’s performance and their psychological condition.
“This idea of turning off your body’s signals and your mind’s signals makes it really hard to get to a place where it’s a normal thing to ask for help and to look for help and to receive help,” Ms Starling says.
Orygen co-developed a new screening tool last year. Orygen research director Professor Rosemary Purcell says the tool helps sports medicine navigate and investigate athlete’s mental illness.
“It’s exciting to think where athlete mental health will go in the next 10 to 15 years,” she says.
Prof Rice says improvement in this area will have benefits when it comes to althletic performance.
“We’ll start to see some of the most significant gains in performance come from the mental health side, cognitive side, and the sports psychology side,” he says.
Intervention, training and awareness will have big impacts.
“Intervention that’s provided earlier in the course of a problem or an illness is more likely to be effective than someone reaching out for help when they’re at crisis point, and there are lots more complexities.
“For sports organisations to get better at early identification they need to be using the right kinds of screening tools. So that’s a technical component, but they also need to have people well trained.
“We need to put people through good mental health literacy awareness – that’s for players, coaches, high-performance staff and even their entourages.”
He says leadership of codes and sporting settings have to provide a clear model of care and care pathways so that players can get help in a really timely way.
In settings with fewer resources, “it’s going to be important … that players are aware how they can navigate care pathways in the general community through their GP and things like that.”