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Mind, Body and Sport: Mental health checklists

By Scott Goldman

Clinical and sub-clinical changes in mood and mental states can affect the ability of student-athletes to function effectively – on the field of play, in the classroom and during their lifecourse. Many mental health disorders are at least partially rooted in biology. However, environmental stressors – including stressors associated with being a student-athlete – can play a critical role in whether these vulnerabilities turn into burdensome health conditions. One of the best ways to limit the negative consequences of most mental health conditions is early detection and treatment. This is where athletics departments and sports medicine departments can play a critical role: establishing prevention programming and reducing stigma around care-seeking, setting a plan to encourage effective early detection, and communicating to all stakeholders about how to manage emergency and nonemergency mental health issues.  

The following four checklists can help athletics departments and sports medicine departments assess and plan for managing mental health issues among student-athletes.

Checklist No. 1 Prevention And Preparation

1.  Conduct a needs assessment                                       

  • Get input from all relevant stakeholder groups. Learn about perceptions of student-athlete mental health/performance needs, ideas for enhancing mental health performance services for student-athletes and barriers to change. These stakeholders groups will vary by campus but should include:
    • Athletes (talking to your Student-Athlete Advisory Committee is a good place to start).
    • Sports medicine and athletic training staff members.
    • Athletics administrators.
    • Coaches and other staff who have direct contact with student-athletes.
    • Faculty athletics representatives.
  • If you are concerned about getting honest feedback from these stakeholder groups, consider using an anonymous needs assessment form (an example is available at www.NCAA.org/health-and-safety/sport-science-institute).
  • Be sure to talk with your compliance director about concerns she/he may have about pursuing enhanced mental health/performance services for your student-athletes, or to review rules associated with these types of services.

2.  Build relationships

  • •    Contact your state psychology licensing board (http://www.ceunit.com/psychologistsstateboards.htm) to help identify individuals who could serve as competent referral sources for your student-athletes on your campus and in your community.
  • •    If your campus has a counseling center or other mental health service for students, arrange to meet with the director. Consider asking some of the following questions to get the conversation started:
    • How often do student-athletes use the campus counseling center?
    • Given identified student-athlete needs related to mental health, what do you recommend to better meet these needs?
    • What is the average wait for a student to get services?
    • Have you had specific counselors identified as liaisons to certain areas of campus?
    • Is there anyone in the center who has a background in athletics, or who would be interested to learn about the unique culture of athletics?
    • If a particularly high-profile student-athlete needed to receive counseling services, is there any provision you could offer to protect his/her privacy?
    • Would someone on your staff be willing to provide outreach programs to our student-athletes, or at least come and introduce yourselves to our student-athletes each year?
    • How do you handle psychotropic medication referrals?
    • What kind of psycho-educational assessment services do you offer?
  • Whether working with an on-campus resource (such as the counseling center or psychology department) or an off-campus provider (such as a private practitioner), make sure the provider has the following traits:
    • They are a licensed mental health professional.
    • They have expertise and/or credentialing in clinical AND performance services.
    • They understand and appreciate the unique needs of student-athletes.
  • Initiate interactions with the mental health provider and your student-athletes when there is not a need for service. These non-clinical interactions will establish a rapport between the provider and your student-athletes, which will make it easier when the provider’s services are needed. Some non-clinical interactions include:
    • Presentations about sport psychology to teams.
    • Attending staff meetings with coaches, academic counselors and sports medicine personnel.

3.  Make a plan

  • Before an incident, develop a general plan to address mental health issues and make sure your staff is aware of it. Your plan should be written into your policy and procedures. The plan should include:
    • Flexibility.
    • How to refer and triage.
    • How to educate staff.
    • What to do after hours.
  • Know your school’s policies and procedures for on-campus mental health issues. Ensure that your plan and program are consistent with the campus’ general student population.
    • Know your school’s “duty-to-report” policy on mental health issues.
    • Know how your school manages “conflict of laws.”  For example, do licensed mental health providers on your campus follow HIPAA or FERPA?
  • Establish a liaison between the mental health care provider and the athletics department.

Checklist No. 2

Managing a Nonemergency Mental Health Issue

When student-athletes come to you in emotional distress and they do not present an immediate threat to the safety of themselves or others:

1. Demonstrate compassion

Some helpful tips for calming the student-athlete and demonstrating compassion are:

  • Remaining calm yourself — maintain calm body language and tone of voice.
  • Listen to the student-athlete. Allow him/her to express his/her thoughts. Provide him/her a forum in which he/she can be heard. It’s OK to have a moment of silence between you and the student-athlete.
  • Avoid judging the student-athlete.
  • Provide unconditional support. You do not have to solve his/her problem.
  • Normalize the student-athlete’s experience and offer hope.

2.  Gather information

  • Ask questions, including questions of safety (“Are you thinking of hurting yourself?” and “Are you thinking of suicide?”)
  • Asking the important questions will NOT plant the idea in his/her head.
  • By asking questions about suicide, you will receive valuable information. If he/she hesitates or confirms, you know to elevate the intervention (see “Managing an Emergency Mental Health Issue” checklist).

3.  Make a referral

  • Present the student-athlete with treatment options.
  • When you identify a student-athlete who would benefit from mental health services, but he/she doesn't appear to be aware of this need:
    • Inform the student-athlete matter-of-factly that you believe he/she would benefit from counseling. Base your recommendation on his/her behaviors, or identify specific behaviors that you have noticed and are concerned about.
    • Ask the student-athlete how he/she is feeling, how his/her actions are affecting his/her life, and if he/she has done anything about it so far.
    • Leave open the option for the student-athlete to accept or refuse the recommendation.
    • Encourage time to “think it over.” But, remember to follow up.
    • If the student-athlete refuses to attend counseling, leave the issue open for possible reconsideration.
    • Notify the student-athlete’s team athletic trainer, the director of sports medicine, and the mental health provider affiliated with your department.
    • If the recommendation is accepted, help create a plan to schedule an appointment, and follow up with the student-athlete in a timely manner. You may call the mental health provider with the student-athlete. If you call with him/her, you will know that an attempt to schedule has been made and when the student-athlete’s appointment is, which can assist you in follow-up.
    • Inform your mental health provider that a referral had been made.

4.  Respect boundaries and abilities

  • Know what you’re comfortable doing and what you’re not comfortable doing.
  • Don’t promise secrecy. If necessary, you can say to the student-athlete, “It took courage for you to disclose this information to me. And, by telling me, it says you want to do something about what is going on. The best thing we can do is to inform someone else, such as a mental health provider, who can give you the care you need.”

Checklist No. 3

Managing an Emergency Mental Health Issue

1.  Identify whether there is an immediate threat to safety

  • To identify whether the situation is an immediate threat to safety, ask the following:
    • Am I concerned the student-athlete may harm himself/herself?
    • Am I concerned the student-athlete may harm others?
    • Did the student-athlete make verbal or physical threats?
    • Do I feel threatened or uncomfortable?
    • Is the student-athlete exhibiting unusual ideation or thought disturbance that may or may not be due to substance use?
    • Does the student-athlete have access to a weapon?
    • Is there potential for danger or harm in the future?

2.  Manage immediate risks

  • •    In the case of an immediate risk to safety:
  • o Keep yourself safe — do not attempt to intervene.
  • o Keep others safe — try to keep a safe distance between the student-athlete in distress and others in the area.
  • o Get help from colleagues.
  • o If the student-athlete seems volatile or disruptive, alert a co-worker for assistance. Do not leave the student-athlete alone. However, do not put yourself in harm’s way if he/she tries to leave.
  • o Call 911 or campus security, or have the person taken directly to the emergency department at the nearest hospital.
  •      ◊ When you call, be prepared to provide the following information:
  •             ○ Student-athlete’s name and contact information.
  •             ○ Physical description of the student-athlete.
  •                 ♦ Height, weight, hair and eye color, clothing, etc.
  •             ○ Description of the situation and assistance needed.
  •             ○ Exact location of the student-athlete.
  •             ○ If the student-athlete leaves the area or refuses assistance, note the direction in which he/she leaves.
  •             ○ Follow campus and department protocols and policies.
  • •    If possible, offer a quiet and secure place to talk.
  • o Listen to the student-athlete; maintain a consistent, straightforward and helpful attitude.
  • o If the student-athlete is expressing suicidal ideation:
  •      ◊ Listen.
  •      ◊ Show your genuine concern.
  •      ◊ Emphasize risk to safety.
  •      ◊ Do NOT leave the person alone.

 

 

How to ask about suicide:

“Are you/Have you been thinking about suicide?”

“Are you/Have you been thinking about killing yourself?”

“Sometimes when people are (your observations), they are thinking about suicide. Is that what you’re thinking about?”

 

How NOT to ask about suicide:

“You’re not thinking about suicide, are you?”

 

 

3.  Contact a mental health care provider

•    Make arrangements for appropriate university intervention and aid.

•    Call the mental health provider to initiate next steps of care.

•    If medical care seems appropriate, head to the nearest hospital or call 911.

•    If the student-athlete is expressing suicidal ideation, make a referral for a suicide risk assessment.

    o On-site mental health professional.

    o Local hospital.

    o Local crisis line/mobile assessment team.

        ◊  Suicide hotline: 1-800-784-2433 or 1-800-273-Talk.

 

 

 

Checklist No. 4

After Managing a Mental Health Issue

 

1.  Initiate follow-up care

•    Identify what is needed for follow-up care.

•    Identify available resources.

•    Initiate continuity of care:

    o How is the mental health issue going to be managed within the athletics department?

    o If the issue is not to be managed within the athletics department, how do you make appropriate referrals and

    transitional steps to ensure the safety and well-being of those involved?

 

 

2.  Debrief and plan for the future

•    Schedule a meeting with athletics department staff involved with the intervention and athletics department staff who will be involved moving forward. While maintaining appropriate confidentiality:

    o Identify the strengths of the intervention approach.

    o Identify what did not work with the intervention approach.

    o Identify what improvements could be made to the departmental protocol for prevention, early detection and

    management of mental health issues.

 

 For more resources, see www.NCAA.org/health-and-safety/sport-science-institute