FEPSAC position statement: Mental Health disorders in elite athletes and models of service provision

As part of our topic of the month for September here at Physiopedia, I had the opportunity to let my mind wander on the mental health of elite athletes. In this mind-wandering phase I also got to see first hand how even youngsters have to face mental challenges in their sport.

My 11 year old son loves sport, he loves playing it, he loves watching it and he loves talking about it. The last couple of weeks was a bit of a rollercoaster as our summer sport season is starting here in South Africa. With the start of the season for cricket and tennis, he was fortunate enough to be invited to participate in some zonal trials for both sports and he spent quite a few hours either on the tennis court or in the cricket nets.

A couple of months ago, he took part in a tennis tournament, where he unfortunately injured himself, to the extent where he had to withdraw from the rest of the tournament halfway through his third match of the day. By the time we got home, he was really upset, not about being injured, but about not being able to complete the match and then also the tournament. As he hobbled up the stairs, I realised that this young man already has certain performance expectations of himself…

Fast forward a few weeks ahead, and we are on our way to the tennis trials. Coincidentally, he was playing the trials at the same place where the tournament that he injured himself in was held. So…on our way there, he explains to me that he decided to wear exactly the same clothes, socks, etc as he did when he got injured, because he read somewhere that this is a way to face your fears and that the sooner you do it, the easier it will be to go on…And it dawned upon me, that this little chap might be a little fearful… Fearful of getting injured again (although he had his physiotherapy and religiously did his rehabilitation exercises, and never mind the fact that he has had quite a few intense training sessions already with no sign of pain or weakness). But more than that, I realised he was fearful of not matching up to his performance expectations of himself and possibly his coach and even peers.

So if these are fears or expectations of an 11 year old athlete, what mental challenges do our heroes of sport have to endure? Our olympic and international athletes whose sporting abilities blow our minds and leave us astounded. In my mind-wandering phase I came across the FEPSAC position statement on Mental Health disorders in elite athletes and models of service provision.

This statement highlights the unique range of stressors that elite athletes have to endure in the world of top sports. Stressors such as competitive factors (e.g. performance expectations), organisational stressors (e.g, travel, long periods of time away from home) and personal stressors (e.g. family issues). It also provides the reader with a short overview of recent research investigating mental health disorders in elite athletes. Some of these studies concluded that the prevalence of mental disorders in their studies were comparable with the general population in their respective countries. Studies highlighted various mental health disorders or symptoms thereof seen in elite athletes, such as depression, generalised anxiety disorder and eating disorders. Furthermore, these studies indicate that elite sport-specific factors such as injury, excessive overtraining in combination with inadequate recovery, and career termination, may increase vulnerability to certain mental disorders.

Another additional challenge staring our sporting giants in the face is help seeking. Sport’s culture of masculine ideals, valuing strength and mental toughness and encouraging athletes to show no signs of weakness makes it extremely difficult for athletes to ask for help. Given the fact that athletes find help seeking difficult, some sport organisations have started to structure various models of service provision to prevent, discover, diagnose and treat mental health disorders in elite athletes. The position statement highlights certain models of service provision for elite athletes with mental health disorders in European countries.

Last, but not least, the authors give recommendations for practice and research settings. Education of athletes, coaches, support staff, administrators and friends and families is paramount to destigmatise mental health disorders in this specific population. A well defined sport specific approach is necessary in research as well as in treatment protocols and there should be clear pathways provided by institutions and stakeholders. In the United Kingdom, an action plan has been developed to help elite athletes. Austria has also embraced the Strong Minds Programme and has started to implement that among their elite athletes and various sporting bodies.

In conclusion, elite athletes are vulnerable to mental health disorders as a result of the various specific stressors they experience in their sporting environment. Key factors are the impact of injury, overtraining, social media scrutiny and ongoing competitive pressure to perform. Athletes and their support staff need to be educated about mental health disorders and be able to seek help without fear!