Yes. Coaches Change, and Save, Lives
NOTE: This post about mental health awareness is relevant to all athletes — and particularly differently wired athletes. More than half of athletes with ADHD, for example, will also struggle with a co-existing mental health disorder (such as depression, anxiety and substance abuse) in their lifetime.
We hear it so often as coaches. “You can change lives.” “You can be the difference.”
It can start to sound cliché.
It’s not.
In fact, coaches don’t just change lives; in some cases they save them.
I recently had the opportunity to share more than four hours on Zoom with an amazing group of collegiate coaches and former collegiate athletes from across the country. The topic that brought us together was heavy and also increasingly important in sports – Mental Health First Aid.
We were being certified as Mental Health First Aiders, trained to spot the signs that an athlete might be struggling with mental health and to ensure that the athlete gets help, professional help if necessary.
Mental health disorders include (but aren’t limited to) conditions that are all too familiar among teens and young adults – depression, anxiety, substance abuse, eating disorders, ADHD and other impulse-control disorders, mood disorders such as bipolar and trauma-based disorders such as PTSD.
The MHFA framework recognizes that coaches are not mental health professionals and are not qualified to diagnose or treat their athletes. The concept is the same as first aid for physical health:
Spot the need for treatment.
Stop the “bleeding” (or whatever the immediate need).
Help secure appropriate treatment.
I would be surprised if these days a coach didn’t have at least a surface awareness of the urgent need for these skills with regard to mental health.
It’s the pros who have brought the issue into the light. Kevin Love wrote passionately about his own mental health after experiencing a panic attack during an NBA game and has continued to advocate tirelessly to defeat the stigma associated with seeking mental health treatment. Michael Phelps has talked openly about his past and present struggles with anxiety and depression, including having desired to end his life, and about the importance of ongoing mental health support and practices. Abby Wambach and Hope Solo have done the same.
Indeed, the list is long.
And the pros we hear about are just the tip of the iceberg, because despite these efforts, the stigma is still very real. Athletes have long been taught to be tough, invincible, perfect or risk losing their edge. Brené Brown and others have begun to popularize the idea of vulnerability as a strength, but old mindsets die hard, especially in the scrappy and often hyper-competitive world of sports.
High school and college kids are at even higher risk. Just being a teenager or young adult is incredibly hard. The brain is changing rapidly and isn’t fully mature until age 25 or even later, especially in boys and especially in differently wired athletes, who are also more likely than their neurotypical peers to experience a mental health disorder.
The 24/7 pressures of social media in particular take an enormous toll on this age group, feeding insecurity and anxiety while simultaneously robbing kids of precious restorative sleep. As Kate Fagan portrayed in What Made Maddy Run, her moving account of the suicide of high school and Penn track star Madison Holleran, even teens who seem to have it all can feel soul-crushingly inadequate and alone when constantly comparing themselves to others’ curated social media images.
Everyone else looks perfect and happy. No one else seems to be struggling.
When really, so many are. The stats are eye-opening.
20% of young adults will experience a mental health disorder in their lifetime.
75% of those disorders will begin by age 24.
50% of those disorders will begin by age 14.
These kids are on your team.
The math doesn’t lie. Say you coach 20 teens per season. An average of two to four of them will be experiencing a mental health disorder during their time on your team. One or two more will be at risk of developing a mental health disorder in the next few years and likely will be exhibiting early warning signs while playing for you.
It’s these early signs that are so critical to notice. Early intervention in mental health disorders dramatically improves long-term outcomes. Diagnosis while the brain is still developing allows for targeted therapies and medications, which improve functioning, which builds confidence, which can head off harmful coping strategies, like substance abuse and self-harm.
Of course, this positive chain runs in reverse when mental health disorders are not caught early. As mental health disorders progress without treatment, athletes can fall into a negative spiral from which it is increasingly difficult to recover. The statistics on ADHD, for example, show without question that kids who are diagnosed and treated appropriately are at significantly lower risk in the teen years for substance abuse, dropping out of school, being arrested and a host of other negative outcomes.
Yet, fewer than 10% of teens will ever receive mental health screening. Those who do are likely to be given a quick form to fill out by their pediatrician, someone they see a few times a year at best, and often with a parent hovering nearby. This is not a recipe for vulnerable disclosure.
Compounding the problem is the natural, and generally healthy, inclination of teens and young adults to shift away from their parents and towards their peers. This separation is necessary for their development into independent and productive adults. But in the presence of an emerging mental health disorder, pushing away parents can be dangerous, even life-threatening, if no other adult has an eye on the young person.
This is where coaches come in.
High on the list of protective circumstances when it comes to kids’ and teens’ mental health is the presence of at least one close relationship with a trusted and supportive adult. For athletes, that person is often a coach. Yes, you.
The responsibility can seem daunting, given the stakes. Rest assured, you already have the tools to make a difference.
You are practiced in understanding and developing your athletes.
You communicate with them both casually and around goals and performance.
You often coach the same kids for years, positioning you to notice subtle changes in behavior.
Your athletes often spend more waking hours with you than with their families.
You command respect and can also be a friend, and you care.
The goal here is not to provide Mental Health First Aid training, although I highly recommend the investment. There you would learn and practice the tools of ALGEE – how to Approach and assess the situation, Listen non-judgmentally, Give reassurance and information, Encourage appropriate professional help and Encourage self-help and support strategies.
You would learn that even a coach who is skilled at connecting and noting when an athlete is “off” will discover that these are hard conversations. And you would learn that some of our natural instincts (like not to ask athletes directly about suicidal thoughts for fear of giving them ideas) are not helpful and can be harmful.
Even without training, your compassion for your athletes and the bonds that you share are gold. They enable you to be that trusted and supportive adult, the one that protects your struggling athletes against far worse outcomes.
They enable you to notice when an athlete is withdrawn or sad or angry. To ask about a change in habits instead of turning a blind eye. To hear in an athlete’s voice when he needs to talk. To circle back with an athlete when she says she’s “fine” and your gut tells you otherwise. To spot the early signs of something treatable.
And maybe to save a life.
Here’s where you can learn more about Mental Health First Aid and training.
Mental Health First Aid USA, operated by the National Council for Behavioral Health: https://www.mentalhealthfirstaid.org/
Whole Health Sport, which provides MHFA training specifically for coaches: https://www.samanthalivingstone.com/mentalhealth