Human Performance, Performance | Aug 6, 2020
Kate Hays and Sam Cumming of the English Institute of Sport describe the collaborative approach that saw mental health and wellbeing come into focus during the start of the pandemic.

“People approached it really collaboratively and immediately asked how we could all work together around this common problem,” says Dr Kate Hays

By John Portch

Hays, the Head of Psychology at the English Institute of Sport [EIS], is discussing her organisation’s response to sport’s worldwide shutdown in March, which ultimately led to the 12-month postponement of the 2020 Tokyo Games.

She is joined by her colleague Sam Cumming, who has served as the EIS Mental Health Manager since March 2019. The duo have logged on to meet the Leaders Performance Institute on Microsoft Teams, which has been the preferred medium of communication at both organisations since face to face meetings were abruptly taken off the table.

Hays’ experience of working in Olympic and professional sport extends back to 2003. Previously she spent three seasons in performance support at Harlequins, beginning in 2011, and took a role at British Diving that saw her support the British team at the 2008 Beijing and 2012 London Games. She took her current psychology-focused EIS role in 2015 and closed out her work with British Diving at the 2016 Rio Games.

“The manner in which the EIS’ Psychology, Mental Health and Performance Lifestyle Teams came together was pretty immediate,” says Cumming, who previously spent six years with GB Rowing. “At a leadership level we were catching up every day as we recognised that this was an area where we could provide significant benefits across all sports by working closely together.”

When the UK entered lockdown in late March, Hays says that the focus shifted from performance to what she describes as the ‘psycho-social’ considerations for the phased return to action across the 40 Olympic and Paralympic sports which the EIS works alongside.

“We have been asking how people have been managing the psycho-social elements around their current context and assessing their wellbeing and support needs.”

What are psycho-social considerations?

“There was potential for this to be such a grey area,” says Hays of the concept. “There are some things that are definitely the realm of the Psychology team, the Mental Health team, and the Performance Lifestyle team, then there’s this grey area in between where the people in those teams have similar and transferable skillsets; and if we hadn’t collaborated we ran a real risk of several people trying to do the same job.”

The EIS Performance Lifestyle Team primarily works with athletes through the transitions they face, whether that be into, through or out of high performance sport. “Their work also includes helping athletes to establish more rounded identities so that they’re the person before the athlete,” says Hays in explanation. “It can be any number of things that contribute to greater wellbeing and positive mental health.”

With those bases covered, the Psychology Team is more focused on athletes’ thoughts, feelings and emotions, and how they translate to performance. “How you think and feel influences your behaviour and vice versa. That could be anything, from the obvious in this current context: anxieties; it could be coping mechanisms, it could be developing resilience, it could be confidence. It could be all of those things you’d expect in addition to growth areas and personal development.

“When we talk about a return to training, the psychological piece is predominantly how the individual is managing that and the resources that they have. The social piece is then how that is viewed within their environment and their context. In the return to training, there are so many considerations. For example, you may have an athlete or a staff member who in returning to the training environment, actually increases risk for their household.”

Purposeful and restorative reintegration

The aim was for purposeful and restorative integration for athletes. “The restorative phase comes from a crisis response model we used in planning our offer of support for this significant period of adjustment,” explains Cumming. The EIS used a crisis response framework currently used by the UK’s National Health Service to consider the psychological responses to the pandemic. “After the impact phase,” he continues, “is the heroic phase where everybody is able to muck in, then the honeymoon phase where people are able to focus on the positives. Then there’s the disillusionment phase when frustration or low motivation creeps in; you then come back to that reintegration phase which we recognised as the return to training  process.  At this stage support needs to be restorative.

“It’s about bringing people back together with a purpose, being completely clear about why we’re coming back, how is it going to happen and what the expectations are. When bringing people back together they need to understand why that’s happening; people are going to be at different stages of readiness to return and it’s great that an approach has been taken that’s less prescriptive and more of an opt-in process.”

The model described above defines three primary needs for athletes when it comes to reintegration: accessing, affirming and reconnecting. ‘Accessing’ comes with the opt-in process, which allows athletes to consider their changing environmental or personal circumstances so that they can make informed decisions on their possible return. Should they return, there will then be an opportunity to establish mutual expectations from the point of view of the athlete and the sports themselves.

However, is there not a risk of putting undue pressure on athletes to return? “I can’t tell you how many times I’ve been asked that question!” replies Hays with a smile. “I think it’s a glaringly difficult thing that needs to be accounted for. Can you totally mitigate against that? I don’t think you can. The best chance you have is really taking an individualised approach to this and giving people the opportunity to tell their story and process their experiences because there are a multitude of reasons why people might feel a multitude of things, from fear to guilt to enthusiasm.

“We’ve got circumstances where if an athlete opts out then their coach doesn’t have anybody to coach, it’s such a complex area but the thing that you can control is being consistent around the messaging, emphasising that this is a non-judgemental process, you are in control of your own destiny, you are in control of how this looks for you, we want to hear your stories, we want to understand your experiences. You can control that, you can control the amount of support that you provide not only to the athletes and staff that are on the receiving end of that process, but also those that are delivering it and taking people through that process.

“Then you can provide levels of support for the initial conversation, after the initial conversation, and proactively as they transition back into that environment or not, to help them work through and process their experiences, thoughts and feelings.”

Helping athletes with their self-care

The second need, ‘affirming’, largely concerns self-care. Both Cumming and Hays noted that athletes were relatively well-prepared for the lockdown, which some viewed as akin to a training camp. “Having strategies developed from times when they’re remote from family or support network may provide a unique strength for some athletes” observes Cumming. “Having been a bit more independent in how they look after themselves it’s fair to say that many already had familiar coping skills coming into lockdown. Self-care is something that the EIS Mental Health team have pushed through our mental health awareness programme and these strategies can certainly be applied to the lockdown situation”

Additionally, an EIS document on Psychosocial Guidance for Returning to Training, encourages practitioners to help athletes and others to ‘accept alternative experiences to your own and be willing to hear a perspective that may not align to yours’. It also highlights that ‘individual responses and readiness to return will be fluid, changeable and nonlinear.’

“On reflection, I think really focusing on self-care is something that coaches and support staff can find challenging” says Cumming. “But maybe through this situation there’s been some forced focus on it and that might be a positive thing for some people.”

Processing your experiences

The third need around reintegration is ‘reconnecting’, which is largely concerned with feedback loops and ongoing conversations around the athlete’s decision to opt-in.

The EIS encourages both group and individual debriefing and has devised a structure that takes its inspiration from research into hostage debriefing. “The purpose of it in essence is to help people to deal with the experience and to process that,” explains Hays. “There’s different areas of it and each one has got a different goal; but the purpose is to help people explore their experiences, to get to the facts of what they’ve experienced and focus on some of the things that have been critical for them. That’s simply a way of just sharing personal experiences; so not necessarily doing anything with it but just giving people the opportunity to talk and tell their story. That is very individualised and there would be a mixture of things for each person.

“After moving through the facts, it’s a focus on what are the thoughts that you have around this? What sense have you made of this situation? What reflections have you had? While some of this will be positively framed, there’s likely to be some negative reactions in there also. We’re just giving people an opportunity to walk through those.

“It may well be a whole range of things from hopelessness to guilt, to sadness, anxiety, irritability, as well as some positive emotions around new contexts moving through growth areas, personal reflections etc. Then there’s a piece around normalising and acknowledging impact of the experience, any reactions that that individual’s had; discussing their reactions to lockdown, the abnormality of the experience.

“Then how we can look forward, giving the opportunity to tell stories, to process some of that information, to reflect on it and take the good, the bad and the ugly, and then incorporate that into future planning. So what are the coping mechanisms that allow that person to move through? What’s their self-care look like? How can we take some of the learnings and reflections and utilise them in a positive way moving forward? Those are the kind of things we’re trying to get to in debriefing conversations.”

Psychological first aid

The EIS Healthy Adjustment and Transition document also refers to ‘psychological first aid’ and the Leaders Performance Institute is intrigued by the notion. “We built some of our training  on that concept to support for the Psychology and Performance Lifestyle teams specifically,” explains Cumming.

“One of the things we set up early was specific training to help people feel more comfortable having supportive conversations with a focus on mental health. The EIS Mental Health Expert Panel (a small group of highly experienced Sports Clinical Psychologists and Psychiatrists) provides our system with guidance specifically related to mental health.  We engaged the Panel to develop and deliver a session on supporting healthy adjustments and the main area of focus in that training session was psychological first aid.

“It is important to note that psychological first aid is different from mental health first aid. Psychological first aid is really about making sure people’s basic needs are being met from a psychological perspective, focusing on what they need specifically in their environment.”

The future

Both Hays and Cumming agree that the lockdown reinforced the value of collaborative work, connection and the combined focus on performance, mental health, psychology and wellbeing. The hope is now that the EIS and its sports can take these lessons forward.

“It would be too easy whenever there’s any semblance of normality for new growth behaviours to disappear,” says Hays. “We know that the most recently adopted behaviours will be the first ones to go so it would be really exploring what are some of the barriers in place to stop some of this really good stuff and how we pre-empt that to ensure that it doesn’t happen. Because as much as this has been an extremely difficult time for everybody in some respects, there has been an enormous amount of positivity to come from it also.”

Looking for more performance insight?

Performance 21 is available for download now and leads with a selection of insights lifted from our At Home With Leaders podcast series, which has featured the likes of England Rugby’s Eddie Jones, the Toronto Blue Jays’ Mark Shapiro, and Chelsea’s Emma Hayes speaking directly from their home offices.

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