What it means to provide mental health care at the Olympics

Jeremy Faust is editor-in-chief of MedPage Today, an emergency physician at Brigham and Women’s Hospital in Boston, and a public health researcher. He is the author of the Substack column “Inside Medicine.” to follow

Emily Hutto is an associate video producer and editor at MedPage Today and is based in Manhattan.

In this exclusive video interview, Jeremy Faust, MD, Editor in Chief of MedPage Today, speaks with Jessica Bartley, PsyD, Senior Director of Psychological Services at the United States Olympic & Paralympic Committee, to discuss providing mental health support to athletes at the 2024 Paris Olympics.

Below is a transcript of their remarks.

Bartley: I’m Dr. Jessica Bartley, the senior director of psychological services for the United States Olympic and Paralympic Committee, and this will be my third Olympic Games.

Fausto: A question I hear a lot is, “What are some common injuries you prepare for?” But you’re thinking a little differently.

Bartley: Yes. We’re doing a lot of precautionary measures as well as crisis response. Someone might need a little booster shot before they go out and compete. So we’re taking a little bit of precautionary measures at this point.

And we have a lot of resources targeted at a phenomenon called “post-Olympic blues.”

Faust: Okay, tell me about that.

Bartley: I think it’s a much bigger problem than post-Olympic blues. We support Olympic and Paralympic athletes, and when we think about the Games as a whole, we find a lot of depression, anxiety and a whole range of mixed emotions, to be honest.

I think what’s really happening is, what were your expectations and why things didn’t line up, and simply processing the emotions and experiences that arise and really being able to understand what happened in this competition, and that’s exactly what we’re doing.

Faust: It sounds like it’s a process that doesn’t happen overnight.

Bartley: We actually started to really address this during the onboarding phase, where when someone gets selected to the U.S. team, we talk about what it’s like to go to a game, what it’s like to be a part of the U.S. team, what are the expectations, goals, dreams, etc.

And I think we try to make sure our players know that there are resources available to them. We provide mental health and mental performance resources. We play games and we also work on a whole bunch of different things. [after the games].

The two big themes I will be addressing after the match are how to make decisions – whether that be retirement, my next step, what I want to achieve next – and how to process the emotions from this special experience.

Faust: We always think about staying, but no one really thinks about leaving, especially since these people have probably been thinking about this their whole lives.

Bartley: Yes. So there are a lot of thoughts, feelings and emotions that come up around that. Do you want to talk to your family, your coaches? How do you feel about yourself? Did you achieve the goals that you had hoped for? Did you accomplish everything that you wanted to achieve? Was this the experience you had hoped for? How does that affect the decision of what to do next? So it can be a pretty complicated decision.

Faust: Are you also active on the performance side? Are you very involved in that aspect as well?

Bartley: Yes, our psychological services monitor mental health and mental performance.

We look at this as a spectrum, like two sides of a coin, and when we think about this, we often look at the mental health part where something has happened, and I think a lot of times it’s maybe you’ve fallen below baseline, you’ve fallen below baseline, and we’re just trying to get back to baseline.

And when we think about sports psychology and mental performance, it’s often about pushing the boundaries of good to great — honing some skills or maximizing your physical capabilities and not letting the mind get in the way.

So there are different ways of thinking about the difference between mental health and mental performance.

Fausto: Probably, you get to know the players better over time. Are there situations where you’re worried and they’re not worried? Like, you feel like, “Oh, they’re not doing so well,” but they deny it or they think, “Oh, I’ve been through everything. I’ve been to the Pan-Pac.” [Pan Pacific]I have been to the World Championships [World Athletics Championships]So it’s going to be OK at the Olympics,” but you’re looking at them wondering if something bad is going to happen.

Bartley: Right. And I think we’re trying to have a really open conversation there.

I think, “I’m going to do this interview three hours before the game.” Have you ever done that before? Have you ever done a media interview right before a game? So, if I have the experience and the expertise, I’m usually able to pitch in. To be honest, sometimes I’ll bring in a more seasoned athlete if there’s something I’m particularly worried about.

If you’re concerned about someone and what they’re doing in the game and trying to make the most of every activity and opportunity, are you practicing enough? Are you getting enough sleep? How are you eating? [And they say]”No, no, it’s okay. Everything is fine.”

And again, there are often opportunities to have those conversations and try to clarify, “Well, here’s what I see. Here’s what I think.” And, again, I think they’ve already reached this point, so it’s always a little bit of a balance.

Fausto: Yeah, and about sleep, you’re right, I’ve never spent time in the Olympic Village, but I just walked around and I see the gods walking around. Everybody looks healthy. They’ve been waiting their whole lives to get here. They want to meet the athletes. This is a social experience, and it should be. How hard must it be for them just to get a night’s sleep?

Bartley: Well, there’s a lot of stress and stuff going on. There’s a lot of really great opportunities. There’s really great activities in the village. When you want to go to a game, you think, ‘I’d love to go to the women’s football quarter-final today.’ And you often have to make decisions about what you want to be involved in and what’s best for your performance and your health.

So I think it’s really interesting to problem-solve with athletes: “Okay, what happens if I do this? How much walking will I have to do? How long will it take to get around? When will I be sleeping? Will I be able to eat when I’m out?”

Fausto: Going to a quarter-final soccer match might be great for some people because it clears their head.

Bartley: Yes.

Fausto: But for others, it can cause complete panic.

Bartley: Yes. We had one athlete who came in and asked us to do some nail polish on some of the other medical team members’ nails. It was just a nice distraction for her. It was a nice place for her to not be so focused on pre-competition stuff and stuff like that.

It’s really amazing that they’re all human and trying to soak up everything through this experience, [she] She didn’t want to go out or stand up, so she enrolled in our sports medicine department.

Faust: And when someone, and as you said nicely, what got them here worked out for them. But this is different, right? I mean, there’s that perception.

Do you and other sports doctors feel like there’s a little bit of a reluctance to do something a little bit different than what you’ve been doing up until now? Are there people who are having trouble sleeping and are changing how they approach their sleep hygiene, or are they just reaffirming what they know?

Bartley: My strategy is to reaffirm what they know. And again, I think it’s a balance. I think a lot of times, because we’ve had a long-standing relationship, I can point out, “Hey, this actually looks different. We might need to change some things,” or, “Your best self is…” And again, I can highlight that to them or have a little discussion about it.

But outside of that, a lot of times I’ve been called in before big events and they’ve said, “Talk to this player, fix this player,” and I just ask, “What got you here? What got you here? What are we going to do? What are you going to think about it?” Because a lot of times they can’t even focus on it.

So just reminding them, asking questions, having a conversation about why they came here and really getting them to talk about why they came here is what I try to do.

Fausto: Besides yourself, what other mental health resources do you have on your team? Who can you turn to? What kind of infrastructure do you have?

Bartley: We’re psychological services providers for the United States Olympic and Paralympic Committee. They work with these athletes on a daily basis. We have nine here, eight in the Paris area and one in Tahiti supporting surfing. We’ll have more leading up to the Paralympic Games.

Our team is made up of 15 people in total: one service coordinator, 14 providers, and we often use contractors because we have over 300 registered providers. We have a lot of contractors here. We have about a dozen contractors in Paris across different sports. They work with certain teams, travel with them, work with a few athletes, so we have a number of contractors like that here.

And we know that many of our health care workers are on call in their home countries. They have psychiatrists in their home countries. So a lot of them are just a phone call away. We’ve been able to do a lot of things remotely. And we’re on call 24/7, so if anyone needs anything, we have on-call rotations. We’ve coordinated that really well so we can help right away when they need it.

Faust: People like Simone Biles, who famously put her mental health first at the Tokyo Olympics and then of course played a heroic game again, do you think people like Michael Phelps have really changed the conversation for athletes across all sports?

Bartley: I think so. I feel like well-known athletes are speaking out, whether it’s the Olympics, professional sports, collegiate sports, I hate to say this, but I think anyone who has a platform to talk about mental health, whether they’re famous or not, is really normalizing the conversation around mental health.

The way I see it, people who have these platforms and use them to share even a little bit about their mental health are really helping us to destigmatize ourselves.

Faust: When I ask other physicians what has changed in sports medicine over the last 10 or 20 years, they tell me the field has undergone a major transformation. Can you elaborate a bit more on those changes?

Bartley: Yes. When I was an athlete,

Faust: Well, what did you do?

Bartley: Soccer. I was a soccer player. I didn’t have the resources. I actually feel like I was led to play soccer. I didn’t have the resources. I was really lost in college. I got injured and I lost my identity as a soccer player.

So I thought, I just didn’t have these resources, and that’s always been one of my goals. So what are these resources? How can I create them? How can I continue to play sports or think about things differently?

And again, I wouldn’t change the path that I took because the injuries and the setbacks got me to where I am today, but I do want these resources to be available to athletes that are competing now, and for it to be more normalized in the sporting experience and in the sporting environment to talk about mental health and mental performance, because that was something that I never experienced.

Faust: Okay. So if anyone wants to participate, how can they do that?

Bartley: Specifically on the mental health and mental performance side, as I mentioned, we actually have a register. We’re currently accepting applications, and we’re accepting them on an ongoing basis. So providers can actually apply to be on our register. We require that they have been working with athletes and mental health, athletes and mental performance for at least five years.

But we’re very fortunate that there are many resources outside of the United States Olympic and Paralympic Committee that give our athletes many options and allow them to find one that is a great fit for their services.

Source link