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Turning the Last Stone: The Enigma of Mental Health

Psychologist Ramel L. Smith says that mental health is easily ignored but that teams should be doing more to support their athletes and coaches.

Ramel L. Smith is a Licensed Psychologist and President of BLAQUESMITH Psychological Consultative Services. Between 2014 and 2016, Smith also served as the Team Psychologist of the NBA’s Milwaukee Bucks and was warmly received as a speaker at the 2015 Leaders Sport Performance Summit in New York City. Here, he addresses the stigma of mental health and suggests ways in which sports organizations can turn what many consider to be the last stone in high performance.


By Ramel L. Smith
  • Why has Mental Health been Ignored?
  • How to Begin a Mental Wellness Program.
  • What is a Sports Psychologist?
  • Everyone Needs to Remember!

Why mental health is easy to ignore

First, the issue of mental health is easy to ignore in sports, because it is easily ignored in the general population; moreover, the conversation on mental health disproportionately focuses on mental illness. Couple this with the ultra-intense and fierce world of competitive sports, and you have a topic that is at best tolerated, at worst denied altogether. Mental illness has an invisible component. Mental illness is hard to quantify. Mental illness does not comply with a traditional medical healing schedule. Mental illness is a riddle that frustrates medical professionals.

Second, in some circles it is talked about; however, the walk does not match the talk. In fact, it’s ironic that it’s ignored in the world of sports because we often hear quotes such as “the sport is 10% physical and 90% mental.” Another classic is “The most important part of a ballplayer’s body is above the shoulders.” We hear this frequently, however, very few clubs and teams devote even a fraction of that that amount of time towards mental preparation.

Third, people believe money should be a panacea for all of life’s problems. Fame often removes your privacy. Money, sadly, exacerbates the pre-existing issues in a majority of the cases. The myth of fame and fortune being an elixir to life’s problem has long been exposed as fraudulent; yet, it is still believed by many. Lastly, Old School Rules: we never had it in the past!

Why we can’t ignore it any more

First, True School Rules: There has always been someone to help players with emotional, as well as performance issues. The coach, athletic trainer and/or the GM became de facto mental health consultants. And, it should be noted that Coleman Griffith, America’s first sport psychologist, worked with the Chicago Cubs back in 1938.

Second, more and more athletes are discussing their issues with mental health. In 2015, ESPN quoted an unnamed team executive from the National Basketball Association [NBA], who stated “we don’t do a very good job with mental health.” Adonal Foyle, a retired NBA player, wrote a brilliant article in The Players Tribune’ in the same year that detailed the need for those in charge to understand the mental game to help those inside the locker room suffering in silence. In 2018, the NBA named Dr William Parham, the NBA’s first Director of Mental Health and Wellness. There have been cautionary tale after cautionary tale on athletes that cover the gamut from financial disaster to marital discord to imprisonment and death. It does not matter if we continue to look the other way or close our eyes, the problems will continue to exist. Third, it works, when applied correctly. Whether it be individual or team sports. Countless athletes have credited their clinician or performance coach for part of their success. Mental wellness is an important part of the puzzle to provide true holistic care for the new millennium athlete.

Where to begin

It always starts at the TOP! Every sport has an organizing body— though some are more organized and regulated. The Commissioner of each governing sporting body from amateur to professional sports have created certain rules and standards to allow for discipline, order and structure. For example, the stringent rules on strength enhancing drugs was created because of the damage it was doing to athletes and the integrity of the game. Mental Health is the new Steroids. It can’t be ignored. The National Alliance on Mental Health state that approximately 18.5% in the United States experience a mental illness in a given year. The World Health Organization [WHO] state that 27% of the adult population in the European Union has experienced at least one significant mental health disorder. WHO stated in Asia that mental health is still trivialized and highly stigmatized. In 2017, Global health estimates state that there are 322 million diagnosable cases of depression and half come from Asia.

With worldwide trends showing that roughly one in four people suffer from some type of mental disorder every year, the sports community must realize that players, coaches, support staff and executives are not exempt from these numbers. Pragmatically, it would seem prudent to be more proactive in their approach to mental health.

For a mental health program to be successful, there must be a significant buy-in from leadership that will allow this program to be financed and staffed adequately. The realm of coaching can be territorial; therefore, it is imperative the coaching staff have some ownership in the process and selection of the Mental Wellness Team. This poses even bigger questions: what does a Mental Wellness Program look like?

What is a sports psychologist?

There are actually three directions a team can go to create a healthy Mental Wellness Team. Sports psychology is as complex as the parable of the three blind men touching different parts of an elephant. The first interpretation of this “elephant” is a Performance or Mental Skills Coach [CMPC], as defined by the Association for Applied Sport Psychology. This individual is uniquely qualified to deal with the Performance issues of elite athletes (e.g.,yips, performance anxiety, visualization). The second interpretation is a Licensed Clinician [LC]. This person has a terminal degree in psychology, is licensed and is trained to deal with diagnosable clinical mental health disorders (e.g., Depression, Anxiety, Psychoses). The third type of interpretation is an Industrial and Organizational [I/O] Psychologist. Often times, executives and coaches focus on the mental health of the player; but, they would be served to have someone who can help maintain the emotional wellness of their organization. Vince Lombardi stated: “The achievement of an organization are the result of the combined effort of each individual.” Teams that enjoy perennial success have a defined culture that permeates throughout the entire organization. Ideally, a comprehensive Mental Wellness Program would have all three types of disciplines inside the organization.

A lot of individual sport athletes suffer in silence and experience symptoms of mental illness more than those in team sports, according to Jeffery A. Whitney, President of the Sports and Entertainment Group, PLLC.  Whitney stated: “it is important that those of us working with individual athletes create an environment to support their mental wellbeing and take steps necessary to destigmatize mental health issues.”

Bridge and a vault

When I was hired by the Milwaukee Bucks, I discussed with the General Manager the absolute importance of Confidentiality. He agreed and so did our Head Coach. I told our Executives, I would be a bridge and a vault. There would be some occasions where mis-communications and structural breakdowns would occur. In these cases, I would be a mediator, or a bridge, to help restore the organizational and interpersonal equilibrium. However, in other cases, information disclosed that was not germane to the team would be locked in a vault. And, information in the vault would not be released without the consent of the athlete.

There is a bridge that helps to facilitate conversation when there is discord between players and coaches.

When I had my first group session with the team, the players looked at me confused and with an extreme sense of trepidation. Most had never had a Team Psychologist. I told them frankly, you can trust me four reasons: 1) Trust the team has vetted me and my qualifications just like the team pilot; 2) I understood trust was fragile and if I broke it, no one else would confide in me; in addition, my professional reputation could be tarnished in a matter of minutes with one of their powerful tweets; 3) If I did something unethical or illegal, like disclosing confidential information, I would lose my license from the state; and 4) and lastly, simply just because my Word was my Bond!

 

 

Small thing to a giant

The Chinese Bamboo Tree is planted and watered daily for five years, with no outward results. However, within a span of five weeks after the fifth year, this strong tree grows to 90 feet. In the world of elite sports, most executives and fans do not want to—and will not— wait for five years. A good Mental Wellness program will show results immediately; but, it will take some significant time to securely embed itself within the culture of the organization. The Mental Wellness Program will be like the Bamboo Tree. It will take time to cultivate. It will take someone with patience and a strong sense of delayed gratification to do the grunt work, daily!

Each organization has to assess the internal needs to understand, do I need an I/O, a Performance Coach or a Licensed Counselor? Do we want this person here full-time, part-time or in a consultant role? Each has its pros and cons. There are several rules that will allow one to navigate the mental health mine field of elite sports: 1) Trust your instincts; 2) Be unafraid to make a mistake; 3) Know and play your role; 4) Be a professional (not a fan); 5) Learn continually; 6) Keep your word and 7) Self-Care.

 

 

I had list of resources, clinical and personal, to help the organization navigate through critical issues. We had a team and organization that had a true spectrum of diversity. I had to learn to be a chameleon while still being authentic and genuine. I observed the culture of the team and moved slow before introducing an intervention. During practices and road trips, I asked question of all the team professionals to understand their responsibilities and roles. I spoke with experts in the field like Drs. Harry Edwards and Chris Carr. I attended educational and professional conferences with other experts in the field from various parts of the world. Finally, I was a man of integrity. Even for those who did not understand— or agree— with my role, they had respect for the way I carried myself, as a professional.

 

 

The enigma of mental health is not hard to solve. Each organization can solve it in two words: Trust and Respect. In my first month with the team, I noticed there was no American flag on the practice court. I went to the General Manager and stated, it would be a good touch to put up a US flag, but we should also put up smaller flags to represent the other countries of our international players. In this small gesture, trust and respect was represented in our team culture. The executives trusted the recommendation of a new staff member. When the international players saw their home flag, it let them know they were respected as individuals. This was a small gesture, but a way to slowly begin to address the mental health puzzle.

What everyone needs to remember

Curt Flood, centerfielder for the St. Louis Cardinals once stated he was a “well-paid slave.” His litigious actions eventually led to modern day free agency, which allows an athlete to have more control over their career.  Even today, many players have self-branded themselves over the team and league. The executives in the clubs must remember and understand that talk of “family,” is met with a sense of cognitive dissonance from players in this new millennium, as they see and feel the disconnect between the words and actions.

Players understand the business of sport; but, they fear the lack of humanity toward the modern day athlete. As a result, many remain quiet on mental health issues. Certified Mental Performance Consultant, Empower2Perform and Psychologist at Brighton & Hove Albion FC, Shameema Yousuf stated “Performance should not be at the expense of well-being.”

She later added “Coaches and other staff members too require support in their performance and well-being. Derek Suite, MD has created a clinical utopia in Bronx, New York that provides direct care to clients, educational outreach to the community and a confidential clinical area that works specifically with athletes and other entertainers. Teams would be smart to find and partner with agencies like Full Circle Health in their area. The clinical support should extend beyond the playing field and days.

It should also extend to the entire population of the organization. More importantly, the team should remember their role in society. They have a social accountability and responsibility to their fanbase. Executives must remember the revolutionary power of sports. It has the ability and power to destigmatize mental health in society by normalizing it within this specific culture.

Parents and youth leagues need to remember to incorporate mental wellness into their programs, early and often. Universities and feeder programs need to remember to reach out to leagues, teams and agents of their former players to secure continuity of care. Clinicians need to remember to be proactive and persistence; yet, patient for team cultures to acclimate to this change. Clinicians must remember that teams do not care if it is a physical or emotional injury, if it keeps an athlete off the field, the athlete loses value— period. Everyone must remember athletes in elite sports have a short window to perform and maximize their financial potential.

Players need to remember it is up to them to take advantage of the resources the club provides. Players must remember that they have to take personal accountability for their emotional and physical health.


 

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