COLLABORATIVE MENTAL HEALTH SCREENING AND SUPPORT

mental health stats

• 5 in 5 have mental health (not negative)

• 1 in 5 have a mental health condition

best practices

• create healthy environments that support mental health and promote well being (positive feedback, time away from sport, social media)

• procedures for identification of student athletes w/ mental health symptoms and disorders (mental health screening tools)

• mental health plans that outline referral pathways of student athletes to qualified providers

• licensure of providers who oversee and manage student athlete mental health care

athletic trainer role

• awareness: stigma reduction, policy development, education

• recognition: identify signs, symptoms, screening

• referral: confidentiality, collaboration, counseling

• support: wellness, maintenance, guidance

mental health policy

• policy ensures timely access to mental health resources improving athlete well being (not an EAP bc there is no EAP for mental health)

policy development suggestions

• creation and revision: develop in consultation w/ staff, know resources and limitations, be exhaustive yet simple, patient privacy, release of info, prevention, screening, education

• rehearsal: practice it, mock skill scenarios, reflections and debriefing

mental health crisis

• non-life threatening situation in which individual is exhibiting extreme emotional disturbance or behavioral distress, considering harm to self or others, or unable to be calmed

• thoughts + talking but no direct harm

• talking about suicide and threatening behavior, eating disorders, not taking their prescribed psychiatric medications

mental health emergency

• life threatening situation in which individual is imminently threatening harm to self or others

• act immediately

• acting on suicide threat, homicidal or threatening behavior, self injury needing immediate medical attention

anxiety

• excessive worry or apprehension occurring more days than not at least 6 months specific to an event or activity (work, school, sport)

• difficult control worry

• worry causes: restlessness on edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbances

• causes distress or impairment in social, occupational or other areas functioning

• not induced by drugs, alcohol, or another medical condition

depression

• depressed mood most of day nearly every day (sad, hopeless, empty)

• diminished interest in pleasure in all or almost all activities of day

• physical symptoms: weight loss, weight gain, loss of appetite, insomnia or hypersomnia, psychomotor agitation, fatigue or los of energy

• feeling of worthlessness or excessive or inappropriate guilt

• diminished ability to think or conc, indecisiveness

• recurrent thoughts of death (not just fear), suicidal ideation without specific pain, or suicide attempt or plain

mental health in sports

• anxiety: 12-15% of college student athletes, 31% of secondary school student

• depression: 13-33% of college student athletes

• suicide: 2nd leading cause of death in college student athletes as of 2024 (higher in males)

screening

• screen all patients annually PPE but consider additional time points

• early ID and intervention improve outcomes (reduce long term treatment costs)

• asking someone doesn’t make them depressed, suicidal, or anxious

• plan in place: know how you will screen, gets data, how you will use

pre participation physical eval

• thresholds and cutoffs vary: sensitivity and specificity tradeoffs and appropriate cut points may differ across pops and settings

• burden vs yield: ultrabrief screens (PHQ2 and GAD2) are low burden and may be effcient for large scale screening but less precise

• privacy, anonymity, stigma issues esp in student athlete settings (anonymous or confidential screening)

depression screening tools

• PHQ-9, beck depression inventory 2, CES D, MDQ

• cut score 6 in athletes = referal

anxiety and stress screening tools

• GAD 7, state trait anxiety inventory, sport anxiety scale 2, percieved stress scale

• above 9 is moderate risk

validate suicide screening tool

columbia suicide severity rating scale

sport specific psychological readiness and distress screeners

• APSQ, AFAQ, IPRS, ABQ, RESTQ-Sport, Maslach burnout inventory

• IOC sport mental health assessment tool

sleep disturbance screening tools

• importance of sleep in performance and recovery (quality + duration)

• Pittsburg sleep quality index = most common

• ISI, epworth sleepiness scale, STOPBang (sleep apnea)

eating disorders and disordered eating

• disordered eating = habits

• SCOFF questionnare, EDEQ, FAST, LEAFQ, DESA6, EAT26

• important for wrestling and rowing (weight sensitive) and gymnastics and swimming (aesthetics)

substance use and misuse

• AUDIT/AUDITC, CAGE, DAST10, CRAFFT, TAPS1

• worries about lying

• not trying to cut off but being safe with alcohol

care team

psychiatrist (meds), psychologist, social worker, mental health NPs, counselors, therapists, clinicians, life coach, certified peer specialist, PCP, dietitian, pastoral counselor

referrals

• screening only first step

• positive screens should lead to follow up clinical assessment, not standalone diagnosis

• create comprehensive, interprofessional care team

referral pathways

• mental health emergency: immediate referral, 988 (local mental health team)

• mental health crisis/urgent: appointment required

• mental health nonemergency: appointment rcommended

role after referral

• maintain privacy: do not probe into therapy sessions

• express concern fro welfare and optimal wellbeing

• protect yourself, others, and patient

• assist as requested in communication process w/ professional

• engage coach as needed

prevention and postvention efforts

• warning signs: emotional exhaustion, cynicism, detachment, too much attachment, reduced sense of worth

• to dos: team based load sharing, setting realistic boundaries, normalize help seeking among providers, peer support and debriefing

• organizational strategies: reasonable patient to provider ratios and mental health resources for staff