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The mind game of games

Destigmatizing the mental health struggles of athletes in Olympic sports.

This piece was previously posted on the Health Feed blog.

The Olympic and Paralympic Games are recognized as the pinnacle of success for an athlete. Every two years, the world tunes in to watch 11,000+ athletes representing 206 nations compete in 33 different sports. Every two years, Olympic and Paralympic athletes compete on the biggest stages of their career, where they are, at the very least, expected to perform their absolute best.

What if that does not happen? What if an athlete gets physically hurt or tests positive for COVID-19? What if an athlete is struggling with something that we can’t see, like their mental health?

As the Tokyo 2020 Olympics and Paralympics begin, it’s time we bring mental health to the podium—not only for the benefit of athletes but for the coaches, staff, teams and spectators.

When it comes to athletes and mental health, Jason Hunziker, M.D., division chief of adult psychiatry at the Huntsman Mental Health Institute, is an expert. Recently, Hunziker was on a panel at the second International Think Tank on Athlete Mental Health, held on the initiative of the International Society of Sport Psychology. During this panel, Hunziker and many other top minds in the field created a consensus statement on athlete mental health specifically in the Olympic/Paralympic quadrennium. Hunziker’s career as a psychiatrist has exposed him to the culture and stigma of mental health in elite athletes.

According to scientific research reported by the International Olympic Committee, “mental health disorders affect up to 35% of elite athletes at some point in their career.”

—International Olympic Committee


Hunziker joined us for a brief Q&A about the culture of mental health on the Olympic stage, what teams and countries can do to ensure athletes are supported both physically and mentally and more.

In your experience of working with elite athletes, how does competing at the highest level impact their mental health?

Every athlete is different in how they handle the stress of competing at the highest level. Olympic/Paralympic athletes from the United States have many challenges as they are considered amateur athletes. The United States government does not provide support for Olympic athletes and therefore money comes from donations, part-time employment, advertisers and family members, which can create additional stress as they are trying to train. The intensity of training, nutrition and good sleep all impact stress load, which can impact mental health. Overall, there is a tremendous amount of stress on Olympic athletes, which can lead to increasing mental health issues such as depression, anxiety, OCD, eating disorders and substance use disorders.

Are elite athletes at a higher risk of struggling with mental health compared to others?

There are challenges when trying to understand the prevalence of psychiatric disorders in elite athletes for several reasons (cultural differences, lack of reference groups, differences, instruments being used and others). So, depending on what information you look at, you will see different numbers. However, as seen in the general population, gender appears to play a role in the prevalence of mental health issues and elite athletes. As you might guess, female elite athletes have a higher prevalence of eating disorders than their male counterparts. Male elite athletes who participate in team sports have a higher rate of anxiety and depression than male athletes who participate in individual sports. As of today, there’s no comprehensive framework or model of care to support and respond to the mental health needs of elite athletes.

Do you think it is important and beneficial to include mental health professionals on elite teams and Team USA?

Absolutely. I think athletes at every level should have just as much access to mental health services as they do medical/sports medicine services. I think there should be a requirement that all athletes be screened so that there is a good baseline of their overall mental health. If concerns are recognized, they should be referred immediately for more extensive evaluation. It also makes sense that if there is a change in the normal day-to-day life of an athlete (family emergency, change in financial resources, event loss, injury/surgery and others), they should also be required to have mental health intervention. I think being proactive rather than reactive is the right course of action.

The Tokyo 2020 Olympics are unprecedented. The pandemic and other global issues have challenged athletes like never before, yet the fans expect the same level of performance. Do you think that this is an opportunity to make some changes in the way we address mental health and Olympic-level athletes? If so, what should change?

The pandemic clearly has changed the way the world views many aspects of “normal” life. We have seen some of the athletes test positive for COVID-19, and now those athletes are going to miss the Olympics, which they have been training for their entire lives. The pressure on these athletes—including potentially feeling like they have let down their family, country and teammates—is enormous. Perhaps they lost their chance to compete again in the Olympics, all because of the coronavirus. There should be a designated mental health officer for every Olympic team. There should be more access to mental health providers in all aspects of training for the Olympics.

It does look like the International Olympic Committee has set up a 24-hour helpline for athletes competing in Tokyo to help them deal with the “bubble” atmosphere. I think that is a good idea, particularly since it looks like they will get six structured sessions along with three months of support after the games.

Why the Olympics are important in the world of mental health

Training your brain is just as important as training your body. Mental endurance and physical endurance are synonymous with success. Many elite athletes have access to physical therapists, nutritionists, sports physicians and coaches—why is having a trained mental health professional not normalized? As discussed at the International Think Tank on Athlete Mental Health, “helping athletes manage mental health issues is a moral, ethical and professional obligation, as well as a performance enhancement strategy.”

As Tokyo 2020 continues and the Paralympics are around the corner, we are seeing a shift of athletes speaking openly about their mental health. By being open and vulnerable about their struggles, these athletes, whether it being apparent or not, destigmatize the conversation around this topic. Athletes can use this unique platform to speak about their mental well-being, which could lead them to become the spokespeople for mental health. As we all know, the world is watching.