USA TODAY High School Sports and the National Athletic Trainers’ Association have partnered on a monthly column to address injuries, prevention and related issues to help schools, coaches and student-athletes. Here is the latest column from Scott Sailor, the president of NATA.
One of the great concerns that parents have is for their child’s health. If a child experiences a sports-related injury or an illness that impairs health, well-being or performance on the field or classroom, a parent would seek the assistance of a health care professional such as a physician or athletic trainer. However, parents should be just as vigilant about the mental health and wellness of their child.
Studies show that one in every four to five adolescents and adults met the criteria for a mental health disorder within the past year. These disorders are across the spectrum of mental health challenges, but primarily anxiety and depression. Certainly, adolescence is a challenging time for a teenager for many reasons, and being a student athlete does not make one immune to experiencing the stressors or exposure to being that one in four to five who is affected by a mental health issue.
The thought of suicide is one area of mental health that has many people concerned. Suicide is the second leading cause of death for youths age 10-24, with approximately 4,700 young people dying of suicide annually in the United States. Unfortunately, secondary school student athletes are among these statistics. Adding to this concern is the stigma that is still somewhat attached to those experiencing a mental health challenge. So, how do we address the public health issue that has many parents of all walks of life concerned?
One of the first places to start is acknowledging that there is a problem and trying to address mental health issues early in the disorder. If you notice signs and symptoms, it is important to encourage intervention early so that depression or anxiety can be managed and does not progress to a more advanced stage where the student athlete may be contemplating or acting on suicide thoughts. In other words, do not let a mental health disorder progress and worsen when early detection and care could make a positive difference. What indicators might signal that an adolescent may be experiencing a mental health challenge? Part of the answer lies in observing the student athlete for behaviors that may indicate any thoughts of suicide.
The teenage years are challenging. Add in the stress of competitive athletics, and a student athlete may be at increased risk for developing a mental health disorder or exacerbating an existing condition. Being injured, demoted from the first-team, pressure from a well-meaning coach or parent or simply not living up to unrealistic personal athletic expectations can all be triggers for a mental health concern, including suicidal thoughts. Athletic trainers, coaches, school nurses, team physicians, guidance counselors and parents are in positions to observe and interact with students on a regular basis. It is important to ensure a team approach – the athletic trainer, school nurse, school counselor and team physician should collaboratively identify a potential psychological concern and refer the athlete to the appropriate mental health professional (clinical psychologist, psychiatrist or licensed social worker).
The pre-participation physical examination is an optimal time to ask about a history of mental health problems and to screen for related conditions.
Here are some of the behaviors to monitor when there is a concern for someone’s mental health and well-being:
- Depressed mood
- Recklessness, including alcohol and substance use
- Anorexia, over-exercising, or over-concern with weight
- Forgetfulness, poor grades
- In extreme conditions, self-harm such as cutting oneself, or harming others through assaults on family members, teammates, friends or classmates
- Talking of death or suicide.
If these behaviors are observed, the next step would be to approach the student athlete, especially if he or she has expressed such thoughts. Simply asking, “How are you doing today” is an effective open-ended question to get the conversation started. You can also follow up with questions regarding your concern based on the behaviors observed. If the student expresses concerning thoughts, know how to access mental health referrals through the school or primary care physician.
While seeking assistance, here are three important points when having a discussion with someone who has thoughts of suicide:
- Ask the student athlete if he or she is having thoughts of committing suicide.
- If the person expresses these thoughts, ask about “TIPA”: Thoughts of suicide; Intention of harming themselves; Plan of self-harm; and Access to things to harm themselves. Someone who has these “TIPA” items in place is at greater risk of self-harm.
- Do not leave the person alone. Stay with him or her until an ambulance, security or police arrives, or take the person to the hospital or mental health care facility. Know the mental health care emergency plan at your school.
Talking openly and honestly with student athletes and adolescents about mental health and wellness is an important step in preventing suicide or thoughts of it. While approaching the student athlete with a concern may be uncomfortable, remember that the health and wellness of that individual is critical. Be sure to have accurate facts before meeting with the student, and remain empathetic when the meeting occurs. Encourage the student to talk about his or her situation and to have a mental health evaluation. Discussing that stress is a normal expectation in life, and developing effective coping mechanisms to deal with it are important.
Sports participation is a great avenue to develop positive characteristics in an adolescent. Athletic trainers, among other sports medicine team members, are on the front lines of this public health problem, working daily to educate and refer student athletes with mental health issues. They help them work towards identifying and preventing events that threaten the athlete’s life and well-being.
The National Athletic Trainers’ Association has created a resource that offers additional information on suicide awareness. Also, visit atyourownrisk.org for additional sports safety tips for athletes and parents.