Dr. Carla Edwards, MD — SSportsPsychiatrist, Synergy Sport + Mental Health

Personal health information is protected by legislation in many nations globally. For the most part, an individual has a right to access their personal health information and must provide specific, informed consent for this information to be shared with other individuals. In high-level athletics, athletes either sign a waiver allowing the medical and training staff to inform the organization (collegiate, national, professional) of physical ailments, injuries, and health status; or have a clause in their collective bargaining agreements to that extent. I have had an established practice in Sport Psychiatry since 2012 and have always made it clear to both athletes and organizations that consent to share information regarding mental health and illness cannot (and should not) be implied within other consents.

Although society has made strides within the last decade regarding the acknowledgement of mental illness and reduction of stigma, mental illness remains highly stigmatized in society and within the sport world. Numerous high-level athletes have shared their personal stories about mental illness, but still more hide in the shadows and are reluctant to seek help when they need it. Some of this reluctance is rooted in stigma, as well as fthe ear that they will be viewed as “weak” and penalized from a performance opportunity perspective. In addition, cases of locker room bullying, harassment and intimidation have been widely publicized.

I work with athletes and organizations at the collegiate, elite, national team, Olympic and professional levels. Sometimes the athletes connect directly with me for support, while other times it is the national sport organization or team that seek my assistance with the athletes. Regardless of the level of competition, it is understood that any information that will be shared with the team (coaches/administrators) or organization will be highly discretionary and pertinent for purposes of suitability to train and compete. Treating mental illness in athletes should optimally be done in coordination with the athlete’s interdisciplinary support team to ensure that the health of the whole athlete is comprehensively addressed. This can be done without the athlete’s full history of mental health and illness being disclosed to the organization or coaching staff.

It is important to recognize what information is pertinent to be shared with the organization or coaching staff. Diagnoses, medications, safety concerns and precautionary issues should absolutely be shared with the athlete’s medical team in order for the athlete to receive safe, comprehensive and timely medical care. Some diagnoses (i.e. bipolar disorder) may require consideration for travel and sleep schedules in order to prevent relapse. It is important for organizations and coaching staff to know the athlete is able to manage travel, competition and high levels of stress. When mental illness jeopardizes the athlete’s ability to manage those elements safely, that information is deemed pertinent to be communicated to the organization and coaching staff.

The concept of safety is extremely important and requires further discussion. Having a mental illness diagnosis (current or past) does not deem someone unsafe, unsuitable to work or somehow devalue their performance. In 2018, depression prevalence in American adults over the age of 20 was reported at 8.1 percent (NCHS, 2018), and the lifetime prevalence for American adults having any anxiety disorder at some time in their lives was reported at 31.1 percent (NCS-R). Research has suggested that mental illness occurs at the same rate in athletes as it does in the general population. This does not mean that everyone who experiences mental illness at some point in their lives cannot function or manage stress (although many who have moderate to severe disease experience functional impairment and disability). Even individuals who have experienced severe episodes of illness can achieve full remission and functional recovery. Very often athletes who are in the midst of an illness episode can still find a way to perform in their sport.

In addition to legislation for the protection of personal health information, workers in the United States are also protected by the Equal Employment Opportunity Commission. In this case, individuals are protected from discrimination from their employer if they are believed to have a mental impairment that is not “transitory” (lasting or expected to be six months or less) and minor (even if they do not have such an impairment).

When professional sport teams want to be informed about the history of mental illness in their athletes, we have to ask why. With the application of medical ethics under current consent laws, pertinent information could (and should) be shared by the treating medical team, as necessary. It is unnecessary for the organization to have complete disclosure of the individual’s mental health history. Professional athletes should be protected by the same laws that protect the rest of the working public. Certain professions should require more complete disclosure of mental health history (including those who drive or pilot commercial or passenger vessels); however, this is unnecessary for professional athletes. In sport, athletes would be at significant risk for discrimination based on their history of mental illness, as this could translate into lower draft value, less favorable contracts, reduced performance opportunities or even being released from teams.

The NBPA should be commended for protecting the rights and privacy of their players. Instead of pushing to get full disclosure of mental health histories from their athletes, sport organizations should be ensuring that they have appropriate staffing on the medical team to address mental illness and health in their players. Some would argue that mental health is at least as important, if not more important, than physical health, however, very few organizations have a sport psychiatrist available for their athletes.

The fact, that mental illness in athletes is being discussed is a very positive thing. Let’s steer the conversation to enhance support for the individuals who need it and continue to create environments in which they can seek help and achieve wellness. Collection of health information can be done ethically for medical purposes, but should not be attached to an athlete’s worth, potential or opportunities.