Athletes at all levels experience mental health concerns and are exposed to a set of unique stressors in their sport. There is no doubt that athletes experience stress and mental health concerns, so who do they have to support them?
It’s crucial that athletes are able to seek professional support from appropriately credentialed physicians and other mental health providers in a collaborative care model. Sports and performance psychiatrists play a key role in supporting an athlete’s mental health through assessment, diagnosis, and treatment planning.
To be a sports and performance psychiatrist, it’s not enough to like sports or have seen one athlete in one’s practice setting. They should be certified and have extensive clinical experience and sports and performance psychiatry knowledge.
Back when sports psychiatry first came about, the focus was on the diagnosis and treatment of common mental disorders in athletes; however, the field rapidly expanded into consulting with teams and organizations, as well as helping parents, improving performance, and addressing the psychological factors surrounding physical injury recovery.1
It’s imperative for physicians and other providers working with athletes to have a thorough understanding of the diagnostic and therapeutic issues that this population faces. According to Reardon et al., sports psychiatry “focuses on diagnosis and treatment of psychiatric illness in athletes in addition to utilization of psychological approaches to enhance performance.” 2
The functions of a certified sports and performance psychiatrist:
- Diagnosis of Mental Health Conditions: Sports psychiatrists are skilled in comprehensive assessments, including clinical interviews, and can use rating scales to gather objective information regarding symptoms. Psychiatrists are well-equipped to conduct psychiatric assessments and formulate diagnoses.
- Treatment of Mental Health Conditions Through Medication Management: Once a diagnosis is made, sports psychiatrists can utilize their unique skill set and educational background in medicine to determine the best pharmacological option for an athlete. It’s imperative that psychiatrists working with athletes are certified in working with this population, as tremendous consideration is given to potential side effects and how this could potentially impact an athlete’s performance. When treating attention-deficit/hyperactivity disorder (ADHD) in athletes, it’s also important to understand the prohibited substances in various teams and sporting leagues, as well as the process to complete a therapeutic use exemption (TUE) when a prohibited substance is indicated to treat a medical or psychiatric condition.
- Treatment of Mental Health Conditions Through Psychotherapy: Depending on the institution in which a psychiatrist completed their residency and fellowship training, there are varying degrees of comfort and skill amongst psychiatrists in providing psychotherapy. Many psychiatrists have years of clinical experience and knowledge in various psychotherapies. Sports psychiatrists specifically have a comprehensive understanding of the various stressors and pressures that athletes face. They are well-equipped to provide psychotherapy using various modalities to optimize athlete mental health and enhance personal and professional performance.
- Team and Organization Culture Development to Promote Wellness, Inclusion, and Cultural Awareness in All Settings: Sports psychiatrists thoroughly understand communication and interpersonal skills that can contribute to teams and organizations fostering a positive culture and promoting wellness throughout their players, coaches, and staff.
- Providing Guidance in Crisis Situations, Developing Emergency Action Plans, and Providing Support: It is imperative that teams and organizations develop mental health emergency action plans that define urgent versus emergency mental health crises, outline the appropriate referral pathways, and provide the contact information for the personnel that should be notified in an emergency situation.
- Lifestyle Interventions to Cope With Stress and Enhance Performance: Sports and performance psychiatrists who have the appropriate training and clinical expertise are able to work with elite athletes and high-performers on not only medication management but also on lifestyle modifications that can allow them to make sustained lifestyle modifications to enhance their performance personally, professionally, and athletically. Through learning new skills, athletes can gain tools to cope with stress in a healthy way.
- Collaboration With Health and Performance Staff, Other Medical Professionals, and Mental Health Providers, When Indicated: Sports psychiatrists are often a part of the sports medicine team and integrated into the health and performance staff when working with an athletic team or organization. It is required to have a thorough understanding of the ethical considerations when providing mental health services to athletes, as confidentiality must be upheld unless there is an emergent safety concern.
- Provide Education to Athletes, Coaching Staff, and Key Stakeholders: Sports psychiatrists, when working with a sports team or organization, should be providing education to various members of the organization, including key stakeholders. It can be helpful to provide education on potential signs and symptoms of mental health conditions, as well as how to communicate with the athletes in a way that fosters a positive culture, including an organizational culture that promotes and supports athlete well-being. It’s also important to provide education on the mental health emergency action plan, clearly outlining what defines a mental health crisis and emergency, as well as the appropriate responses.
The American Board of Sports and Performance Psychiatry (ABSPP) was founded in 2023 to credential psychiatrists who have demonstrated proficiency in the specialized knowledge and skills essential for the field3.It’s crucial that the sports psychiatrists working with athletes are trained and certified in this subspecialized field of sports and performance psychiatry.
Sports and performance psychiatry is a distinct sub-specialty of psychiatry that focuses on assessing, diagnosing, and treating mental health conditions in athletes and high-performers that can enhance one’s performance personally, professionally, and athletically. Many of the mental health symptoms and disorders seen in elite athletes and high-performers occur in the general population as well.
However, a sports and performance psychiatrist has a greater understanding of all of the treatment considerations that must be addressed when providing medication management and psychotherapy to this population.