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Why is it difficult for high performance athletes to ask for help?

In the competitive world of sports, athletes continually push their limits in pursuit of excellence. High performance athletes who are training for events like the Olympic and Paralympic Games face unique stressors throughout the 4-year cycle, from the pressures of competition to the post-Games “blues” to uncertainty about future cycles (Henriksen et al., 2020). As a result, high performance athletes, although they are perceived as healthy and fit, are at risk of mental health challenges. For example, nearly 32% of Canadian national team athletes training for the 2020 Summer Olympic Games reported symptoms of depression, while 19% reported symptoms of moderate to severe general anxiety (Poucher et al., 2021). 

Resources like Game Plan, Canada’s athlete wellness program, provide high performance athletes with tools to foster long-term personal, educational, and professional development in and beyond sport, including mental health support. But despite the availability of resources like Game Plan, their use remains limited, with only a few athletes accessing them (Brassard et al., 2022; Kola-Palmer et al., 2020; Kraus & Tibbets, 2022). Understanding and addressing the factors that influence an athletes’ willingness and ability to reach out for help is crucial for effectively supporting high performance athletes’ mental health needs. 

What’s stopping athletes from reaching out for help? 

Mental health stigma (negative and often unfair beliefs associated with mental health) is considered a recurrent barrier to help-seeking among athletes. Athletes may fear judgment from others (King et al., 2023), or feel pressured to ‘be strong’ and ‘handle things’ on their own (O’Keeffe et al., 2022).  

Likewise, cultural norms, referred to as shared, accepted and expected behaviours, values, beliefs and practices with a group, can also act as a barrier to help seeking. Some athletes describe being treated as “machines” (Habeeb et al., 2022). As a result, they feel a need to be tough and not show any signs of vulnerability (Miller et al., 2023). The pressure to conform to tough ideals can therefore hinder athletes from reaching out for support (Wood et al., 2017). Similarly, fear of judgment from peers, such as being perceived as weak if they seek psychological support, and feelings of embarrassment, are highlighted in several studies (Delenardo & Terrion, 2014; Gulliver et al., 2012; Lopez & Levy, 2013). This fear of being seen as a weak athlete might be a possible consequence of stigma in sport (Wood et al., 2017). 

Another significant barrier is the lack of education and mental health literacy in the sport community. This includes challenges in recognizing mental health symptoms and accessing available resources (King et al., 2023) or lacking awareness of support services, hindering the athlete’s ability to seek help effectively (O’Keeffe et al., 2022). For example, some athletes report having to make constant physical efforts for their sport and therefore find it difficult to distinguish fatigue due to physical exhaustion from that caused by anxiety or depressive symptoms (Delenardo & Terrion, 2014; Gulliver et al., 2012). Athletes facing such challenges may struggle to recognize when to reach out for help, especially if they lack awareness about available support services. 

The lack of education and mental health literacy may be linked to the accessibility of mental health or psychological support, care, or therapy. Key obstacles related to accessibility include cost, lack of time, and lack of knowledge about mental health resources. High performance athletes are heavily invested in training, which may contribute not only to the limited income sources, making continued mental health services financially challenging, but also the time constraints (O’Keeffe et al., 2022). Additionally, research shows that many athletes lack knowledge of where to access help (Miller et al., 2023). 

How can we encourage athletes to seek help if they need it? 

Normalizing conversations about mental health is key to reducing the stigma associated with mental health. Athletes emphasized the impact of online platforms, where sharing experiences reduces the feeling of isolation and increases awareness (Miller et al., 2023). Role models within the sporting community also play a significant role in normalizing mental health discussions. Renowned athletes such as Simone Biles, Michael Phelps, Bianca Andreescu, and Kelsey Mitchell speaking openly about their struggles encourage others to seek help without fear of judgment (King et al., 2023; Miller et al., 2023). Media campaigns further amplify this message, breaking down taboos and encouraging athletes to take charge of their mental well-being (King et al., 2023). 

In addition, educational initiatives can provide athletes with the necessary knowledge and tools to navigate the complexities of mental health. These include organized and structured efforts aimed at providing information, knowledge, and resources to individuals and communities with the goal of raising awareness about mental health issues, enhancing mental health literacy, and promoting positive mental well-being. In one study, athletes emphasized the importance of early exposure to mental health support, suggesting that such initiatives could lay a strong foundation for future help-seeking behaviours (King et al., 2023). An exemplary program in Ireland offers jockeys free sport science support, including mental health consultations, equipping athletes with essential knowledge about mental health (King et al., 2023). Educational interventions such as presentations, videos and webpages have also shown positive effect on stigma related to mental health (Gulliver et al., 2012; Kern et al., 2017). 

Finally, social support networks, a person or a group of people with whom an individual maintains various social connections and relationships, play a crucial role in help-seeking. For example, one study showed that when athletes know that their teammates or peers are seeking mental health support, they are more likely to seek help for themselves (Kola-Palmer et al., 2020). Coach-athlete relationships are also an important factor in how likely an athlete is to reach out for help. Coaches who foster trust and understanding play pivotal roles in encouraging athletes to seek help when needed (Habeeb et al., 2022). However, it’s family members who may exert the greatest influence. For instance, research has shown that athletes may be more willing to seek help when recommended by a family member rather than a coach or teammate (Wahto et al., 2016). 

Practical recommendations for sport organizations and administrators 

  • Highlight available resources: Make sure high performance athletes know about the resources that are available to them in Canada, such as Game plan, Own the Podium, the Mental Health Strategy for High Performance Sport in Canada (Durand-Bush & Van Slingerland, 2021), the Canadian Centre for Mental Health and Sport (CCMHS). 
  • Cultivate a supportive culture: Create and foster a culture in which athletes feel comfortable addressing mental health concerns openly and without fear of judgment. Prioritize destigmatizing help-seeking behaviours and the process of seeking support from mental health professionals within the athletic community. 
    • By promoting communication: Encourage open dialogue and active listening among athletes, coaches, and staff members to create a supportive environment where mental health is viewed as an integral part of overall well-being. 
    • By implementing initiatives such as peer support programs, mental health awareness campaigns, and regular check-ins to reinforce the importance of mental health and promote a culture of care and understanding. 
  • Implement comprehensive health and wellness strategies: Develop and include mental health plans alongside of the athletes’ physical and nutrition plans to prioritize overall well-being. These plans should include regular assessments of mental health status, personalized interventions, and ongoing support tailored to the individual needs of each athlete. Establishing protocols for communication and collaboration between mental health professionals, coaches, and other members of the athlete’s support team to ensure coordinated care and effective implementation of wellness strategies could be valuable. 
  • Educate athletes’ support network: Provide education for coaches, support personnel, and family members on mental health awareness to equip them with the necessary knowledge to identify potential mental health issues. Additionally, empower them with the skills to guide high performance athletes to the appropriate mental health services while offering basic ongoing support. 

Conclusion 

While athletes do value psychological support, significant barriers such as stigma, a lack of mental health literacy, time constraint and access continue to impede their use of resources. Addressing these issues requires a multi-faceted approach involving timely access to services, educational initiatives, and cultural shifts within sports environments to foster a more supportive atmosphere for help-seeking regarding mental health. 

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