Editor's note: In honor of National Athletic Training Month, NATA is conducting a twice-weekly blog series throughout March that showcases how ATs use the five domains of athletic training to improve the health and well-being and their patients. This blog post highlights domain one, Injury and Illness Prevention and Wellness Promotion, and how members are embodying this year’s NATM theme, “ATs Impact Health Care Through Action.”
One-fifth of all Americans have any mental illness (AMI), which is described as “a mental, behavioral or emotional disorder … [that] can vary in impact, ranging from no impairment to mild, moderate and even severe impairment,” according to the National Institute of Mental Health.
Fifteen to 20 percent of Americans will have an episode of depression at some point in their life. Depression is the most common mental illness a sports psychiatrist treats, according to the NCAA.
So where in the cycle of a patient’s care, intervention, prevention and rehabilitation does mental illness fit in for an athletic trainer? Although ATs are not mental health care providers, they play a role in assisting a patient to find the correct help they might need.
A story ATs are all too familiar with: A patient opens up to them about some personal issues happening at home, in school or generally in their life. The patient might not even realize they are revealing this much information, but they are comfortable around the AT and feel as if they are a trustworthy resource because they’re a health care provider, and mental health is a part of health care.
“I’d say that just about every athletic trainer has experienced a patient coming to them for mental health issues,” said Timothy Neal, MS, ATC, CCISM, NATA liaison to Mental Health America and member of the ATs Care Commission. “I’ve been through that dozens of times. I would dare say there isn’t one athletic trainer who hasn’t been working a year or longer who hasn’t had that issue come before them.”
Once the patient leaves, the AT is left wondering what they could do to better the situation for their patient. They can’t treat the patient’s mental health issue, but they can be a branch of the health care system to help find them the best solution.
“Without a good mental health, you can’t have full health,” Neal said.
Identifying a Potential Issue
Sometimes it’s not a patient’s verbal confirmation that they are working through a mental health issue, but the way in which they present themselves. Athletic trainers work with patients daily, which allows them to get to know their patient’s personality and interests. Neal said there are signs an AT should look for in their patient that might suggest they are having mental health issues.
- Always aggressive, agitated or angry
- Feeling of shame or guilt
- Continuous mumbling
- Perfectionist
- Withdrawn
- Always hurt or sick
- Abuse of drugs or alcohol
- Monitoring weight all the time
- Taking undo risks (including sexually)
It’s important to remember that symptoms are on a continuum.
“What you’re looking for primarily is you get to know your patient, and then if their behaviors are odd from what you know, then that could be a warning sign,” Neal said. “Someone who is gregarious or outgoing suddenly becomes quiet. Someone who is quiet but then talks and acts real manic or aggressive, then that could also be a sign something is going on.”
However, recognizing these symptoms are not the sole aspect to identifying a possible mental health issue. Athletic trainers should be educated on mental health in general to understand the who, what, where, when, why, how and because of certain diagnoses. Neal offered some advice about where to obtain learning materials related to mental health:
- The 2013 and 2015 interassociation consensus statements, which includes how to develop a plan to identify psychological concerns in athletes at the collegiate and secondary school level
- NCAA resources dedicated to the well-being of college athletes, such as data and research studies on multiple topics involving mental health and sports, educational resources, best practices, fact sheets and workshop kits.
- Mental Health America, a nonprofit dedicated to promoting mental health and addressing the needs of those with mental illnesses, has a long list of research and reports related to mental health. They also provide information on various diagnoses and statistics about mental health as well as numerous other resources.
- The Mental Health Month series on the NATA Now blog, which talks about ATs supporting players, destigmatizing mental illnesses, overcoming psychological barriers and more.
- The ATs Care Commission also offers resources for mental health, such as an infographic about helping patients in crisis.
- NATA has infographic handouts pertaining to mental health as a whole as well as more specific illnesses and issues, such as suicide, sleep and stress.
“What an athletic trainer should be educated on is having a background knowledge of mental health and studies and information on mental health in general,” Neal said. “They should have an appreciation for various stressors that athletes are under in terms of their time, focus, studies, other family members. Sports is a year-rounded endeavor.
“The next thing an athletic trainer should be aware of is behaviors to monitor. Someone displays a different behavior could indicate that something is going on. The next thing an athletic trainer should do is develop their ability to approach and have discussions with their athlete or patient relative to their mental health, which I find as probably one of the most challenging parts for many people because it’s uncomfortable to talk to someone about their mental health. Know the signs and symptoms of suicide ideation, and the referral mechanism by which you can get an athlete or patient into the institutional mental health plan. In addition, you need to know your referral mechanism on campus or off campus of the practitioner who you work with to refer athletes.”
Lifelong Learning
As passionate as ATs are about health care, mental health can be a sensitive topic for many people, and it’s important to understand where the line is for an athletic trainer when dealing with mental health.
“You’re not treating the student athlete,” Neal said. “You’re not a mental health care professional unless accredited. You’re not treating them for depression, anxiety or anything else. You’re referring them onto mental health care professionals. Also, with suicide ideation, always err on the side of caution, and get them some place or activate your emergency plan.”
Collaborating with mental health care professionals is important, Neal said, especially before you need them. Neal personally checks in on his network of mental health care professionals from time to time to see how they are doing. Sending a note here and there, or even gear, can keep that connection and relationship fresh, he said.
“Be a lifelong learner on this topic,” Neal said. “Educate athletes on the importance of mental health. Be really good at recognizing issues and have an effective referral system to go into. I encourage athletic trainers to look for ways to push themselves to get uncomfortable because once you get used to dealing with uncomfortable situations, it’s easier for you to approach people about their mental health. Getting out of your comfort zone will better serve your patients.”
For more information regarding mental health, visit the NATA Mental Health resource page.
Continuing Education Opportunities
Log into the NATA Professional Development Center, and search for the following courses that relate to domain one, Injury and Illness Prevention and Wellness Promotion. You can also explore upcoming webinars to earn additional CEUs within the PDC.
Mental Health Series: Stigma Prevention
Mental Health Series: Recognizing and Managing a Potentially Suicidal Patient
Mental Health Series: Current Mental Health Issues Affecting Secondary School and Collegiate Athletes
