Transcript Slide 1

There is No Health without Mental Health
NCAA Regional Rules Seminar
Spring 2014
Session Goals
• To present findings and best practice guidance
from the 2013 NCAA Mental Health Task
• To look at how mental health issues factor into
athletic and academic performance and
lifelong well-being.
• To identify strategies to engage with mental
health providers and to assure identification
and referral protocols are in place.
Today’s Panelists
• Tom Paskus, Ph.D.
Principal Research Scientist, NCAA
• Scott Goldman, Ph.D.
Director of Clinical and Sport Psychology for the
University of Arizona’s athletic department
NCAA GOALS study– Open-ended question
“If you could change one thing about your studentathlete experience, what would it be?”
Division I Men
Nothing
Track / XC
Basketball
Baseball
Soccer
Swimming
Football
(FBS/FCS)
22%
24%
23%
16%
13%
14% 21%
3%
4%
3%
3%
6%
5%
7%
2%
4%
4%
2%
1%
4%
1%
13%
7%
8%
6%
9%
5%
11%
4%
5%
7%
10%
18%
5%
3%
20%
17%
27%
27%
25%
31% 24%
4%
4%
1%
3%
1%
1%
2%
2%
3%
3%
2%
4%
1%
2%
9%
9%
3%
6%
12%
16% 10%
4%
8%
7%
12%
1%
3%
4%
NCAA GOALS study– Open-ended question
“If you could change one thing about your studentathlete experience, what would it be?”
Division I Men
Track / XC
Basketball
Baseball
Soccer
Swimming
Football
(FBS/FCS)
Nothing
22%
24%
23%
16%
13%
14% 21%
School Choice
3%
4%
3%
3%
6%
5%
7%
Major/classes
2%
4%
4%
2%
1%
4%
1%
Work Ethic
13%
7%
8%
6%
9%
5%
11%
Coaches
4%
5%
7%
10%
18%
5%
3%
Time
Demands
20%
17%
27%
27%
25%
31% 24%
Health
4%
4%
1%
3%
1%
1%
2%
Facilities
2%
3%
3%
2%
4%
1%
2%
Finances
9%
9%
3%
6%
12%
16% 10%
Success
4%
8%
7%
12%
1%
3%
4%
NCAA GOALS study– Open-ended question
“If you could change one thing about your studentathlete experience, what would it be?”
Division I Women
Track / XC
Basketball
Softball
Soccer
Swimming
Rowing
Nothing
12%
13%
10%
12%
12%
15%
School Choice
2%
5%
5%
6%
1%
1%
Major/classes
1%
4%
2%
1%
2%
1%
Work Ethic
7%
5%
5%
8%
5%
4%
Coaches
16%
11%
16%
12%
16%
14%
Time
Demands
23%
25%
36%
30%
31%
44%
Health
8%
5%
5%
4%
2%
1%
Facilities
1%
1%
1%
3%
2%
1%
Finances
8%
2%
3%
4%
3%
1%
Success
5%
10%
3%
6%
2%
2%
Time Demands
Average Hours Spent Per Week In-Season on
Athletic Activities in 2010 (SA Self-Report)
Division I
Athletic Hrs
Baseball
Men’s
Basketball
Football
(FBS/FCS)
All Other
Men’s
Sports
Women’s
Basketball
All Other
Women’s
Sports
42.1
39.2
43.3 41.6
32.0
37.6
33.3
31.3
34.2
31.7
29.2
29.8
28.9
Division II
Athletic Hrs
39.0
37.7
37.5
Division III
Athletic Hrs
34.8
30.8
33.1
Note: Green = Decrease of 2+ hours on athletics from 2006;
Red = Increase of 2+ hours on athletics from 2006.
Average Sum of Hours Spent Per Week In-Season on Academic
Activities and Athletic Activities in 2010
(SA Self-Report)
Division I
Ave. Sum
Baseball
Men’s
Basketball
Football
(FBS/FCS)
All Other
Men’s
Sports
Women’s
Basketball
All Other
Women’s
Sports
73.7
76.5
81.3 79.8
68.0
76.5
73.4
67.6
71.6
73.1
68.8
71.1
72.0
Division II
Ave. Sum
71.8
73.5
74.2
Division III
Ave. Sum
70.4
65.6
71.0
Note: Green = 2+ hours less on academics/athletic sum vs. 2006;
Red = 2+ hours more on academics/athletic sum vs. 2006.
Percentage of Student-Athletes Reporting As Much or More
Time on Athletic Activities in Off-Season than
In-Season in 2010 (SA Self-Report)
Division I
% same/more
Baseball
Men’s
Basketball
Football
(FBS/FCS)
All Other
Men’s
Sports
Women’s
Basketball
All Other
Women’s
Sports
77%
69%
70% 70%
61%
46%
57%
63%
54%
55%
46%
38%
34%
Division II
% same/more
79%
68%
70%
Division III
% same/more
55%
59%
62%
Note: Green = Decrease of 5% or more from 2006;
Red = Increase of 5% or more from 2006.
Percentage of Student-Athletes Who Say They Would Prefer
Less Time In College on… (2010 Self-Report)
Division I
Athletics
Baseball
Men’s
Basketball
Football
(FBS/FCS)
All Other
Men’s
Sports
Women’s
Basketball
All Other
Women’s
Sports
18%
10%
23% 20%
15%
29%
26%
7%
20%
18%
8%
15%
10%
Division II
Athletics
10%
9%
15%
Division III
Athletics
8%
10%
11%
Note: Green = Decrease of 5% or more from 2006;
Red = Increase of 5% or more from 2006.
Identity as Student vs. Athlete
Academic and Athletic Identity
(GOALS 2010)
Men (Percent)
Athletic
Student
DI
DII
DIII
High
High
53
53
52
High
Low
27
24
18
Low
High
7
9
13
Low
Low
13
14
17
Women (Percent)
Athletic
Student
DI
DII
DIII
High
High
62
61
61
High
Low
13
12
8
Low
High
14
16
20
Low
Low
11
12
11
Relationships with Coaches
I would have attended this college even if a
different coach was here.
(% Responding Agree or Strongly Agree)
Division I
N
Baseball
Men’s
Basketball
52%
42%
Football
All Other
Men’s
Sports
Women’s
Basketball
All Other
Women’s
Sports
59%
58%
43%
58%
59%
49%
59%
69%
65%
73%
Division II
N
47%
41%
52%
Division III
N
61%
58%
60%
Note: Endorsement of top two scale points on 6-point scale. GOALS 2010 study.
My head coach can be trusted
(% Responding Strongly Agree)
Division I
N
Baseball
Men’s
Basketball
52%
50%
Football
All Other
Men’s
Sports
Women’s
Basketball
All Other
Women’s
Sports
56%
51%
39%
48%
57%
44%
47%
59%
47%
56%
Division II
N
49%
42%
63%
Division III
N
55%
53%
66%
Note: Endorsement of top scale point on 5-point scale. GOALS 2010 study.
My head coach puts me down in front of others
(% Responding Somewhat Agree or Strongly Agree)
Division I
N
Baseball
Men’s
Basketball
27%
31%
Football
All Other
Men’s
Sports
Women’s
Basketball
All Other
Women’s
Sports
22%
20%
25%
21%
15%
32%
17%
16%
27%
14%
Division II
N
26%
34%
15%
Division III
N
16%
26%
12%
Note: Endorsement of top two scale points on 5-point scale. GOALS 2010 study.
Student-Athlete Mental Health and the Coach
(GOALS 2010)
Men
DI
DII
DIII
I would feel comfortable talking with coaches and
team personnel about mental health issues
48%
50%
51%
Coaches are concerned about my mental health
and well-being
55%
57%
60%
DI
DII
DIII
I would feel comfortable talking with coaches and
team personnel about mental health issues
37%
38%
43%
Coaches are concerned about my mental health
and well-being
52%
52%
61%
Women
Percent agree or strongly agree (top 2 points on 6-point scale)
Social Environment / Support
Networks
Team Environment
Men
Women
Most people can be trusted
29%
28%
I trust my teammates as much as anybody in my life
42%
45%
My teammates have my back regardless of the situation
54%
52%
My coaches can be trusted
63%
68%
% Agree or Strongly Agree with the following…
NCAA Study of Social Environments, 2012
Living Arrangements
Current living situation
Division I
Division II
Division III
Men
Women
Men
Women
Men
Women
Exclusively w/ teammates
or other SAs
53%
49%
44%
39%
33%
21%
Mix of SAs and others
23%
26%
27%
30%
39%
45%
Alone
6%
4%
8%
6%
6%
6%
Parents or family
5%
4%
9%
10%
9%
8%
13%
17%
12%
15%
13%
20%
Non-athlete students or
non-students only
Division I
Agree or Strongly Agree
Division II
Division III
Men
Women
Men
Women
Men
Women
Satisfied with current
living situation
68%
74%
63%
70%
72%
79%
Satisfied with friends
outside athletics
69%
76%
70%
79%
74%
83%
Connections with the School
Men
Women
I am satisfied with my current social environment at this school.
70%
78%
I have friends here who share my interests and values.
80%
89%
I am sometimes lonely at this school.
22%
21%
% Agree / Strongly Agree with the following…
NCAA Study of Social Environments, 2012
Help-Seeking
Who would you 1st seek out for
help/advice/support with the following?
Men
Women
Romantic relationships
Parents (44%)
Parents (33%)
Loneliness
Parents (52%)
Parents (54%)
Personal substance abuse
Parents (42%)
Parents (39%)
Discrimination of self/others
Parents (31%)
Parents (38%)
Hazing & bullying
Teammate (27%)
Parents (29%)
Teammate’s romantic relationship
Teammate (64%) Teammate (71%)
Friend’s substance abuse
Teammate (37%) Teammate (33%)
Teammate’s negative behavior
Teammate (36%)
Coach (41%)
Topics for Discussion With the Team
Coach/athletic department education
topic:
Men
Women
Discussed
Want more
Discussed
Want more
Conducting self appropriately on
campus and in community
90%
29% (#2)
94%
31% (#3)
Drinking/substance use
87%
25% (#3)
93%
32% (#2)
Respecting diversity
83%
21%
78%
26%
Diffusing/avoiding confrontations
83%
22%
79%
26%
Responsible use of social
networking
Speaking up when you see things
around you that aren’t right
Appropriate treatment of
members of the opposite sex
80%
19%
82%
27%
80%
35% (#1)
77%
47% (#1)
80%
16%
66%
19%
Hazing/bullying
78%
16%
74%
20%
Interacting with the media
73%
16%
71%
17%
Relationship violence
67%
13%
54%
18%
Other Student-Athlete Well-Being Issues Identified in
NCAA Research
• Substance use
• Transitional issues (e.g., retirement/separation from sport, dealing
with injury)
• Eating and body Image
• Sleep
THERE IS NO
HEALTH WITHOUT
MENTAL HEALTH
Scott Goldman, Ph.D.
Director of Clinical and Sport Psychology
University of Arizona
IS PSYCHOLOGICAL SERVICES
CLINICAL OR PERFORMANCE?
Note: Busch , M & Busch, P. (2008). “Between the Water and the Wood”[Motion Picture] . USA:
Busch League Entertainment
2010 NCAA MANAGING STUDENTATHLETE’S MENTAL HEALTH
ISSUES: FOLLOW-UP
QUESTIONNAIRE
• Almost 85 % of ATCs
indicated that anxiety
disorders are currently an
issue with student-athletes
on their campus
• 83 % indicated that eating
disorders and disordered
eating are an issue.
• Mood disorders (77.0
percent), substance-related
disorders (68.9 percent)
and management and
treatment issues (46.6
percent) also were listed as
current issues on campus.
Note. Information was extracted from 2010 NCAA Managing Student-Athlete’s Mental Health Issues
Follow-Up Questionnaire
SLEEP AND PERFORMANCE
But you don’t realize that
you are getting worse.
Van Dongen et al., 2004
CAUSES OF SUDDEN DEATH
IN NCAA STUDENTATHLETES, 2004 TO 2008
2% 1%
1%
2% 2%
3%
6%
7%
51%
9%
16%
Accidents
Cardiac
Suicide
Cancer
Homicide
Other Medical
Drug Overdose
Unknown
Sickle Cell
Meninigitis
Heat Stroke
Harmon, K.G., Irfan, M.A., Klossner, D., & Drezner, J.A. (2011). Incidence of Sudden
Cardiac Death in National Collegiate Athletic Association Athletes. Journal of the
American Heart Association, 1594-1600
IT BEGS THE
QUESTION. . . .
“Fatigue makes cowards of
us all”
--Vince Lombardi (1959)
“I think the biggest thing is
student-athlete mental health.
We have a task force coming
that is going to address that at
multiple levels ranging from
depression and anxiety to how
student-athletes identify
themselves to violence,
suicide, and sexual abuse. “
Dr. Brian Hainline, Chief Medical
Officer, NCAA
SO, IS SPORT PSYCHOLOGY
CLINICAL OR
PERFORMANCE?
• Truth Lies in the Common Language
• According to Ohio State University’s Sport
Psychology Program (2005):
• Only 1 out of every 4 athletes seek
performance enhancement only
• 52.8% clinical
• 37.1% combined clinical and
performance enhancement
• 90% of treatment included clinical
• 10% performance enhancement only
Note. Information was extracted Maniar, Sam, and Carter, Jen. (2005) Ohio State Sport Psychology
Services Year-End Report
CONTINUUM OF PSYCHOLOGICAL ISSUES &
TREATMENT OPTIONS
Debilitati
ng or
dangerou
s
psycholo
gical
disturba
nce
Severe
symptom
s
resulting
in
impaired
relations
hips,
judgment
,
thinking,
mood
and
functioni
ng
Serious
symptom
s,
moderate
difficulty
in social,
occupati
onal, or
school
functioni
ng
Psychiatrist
Clinical Psychologist
Moderate
to Mild
symptom
s, some
difficulty
in
normal
daily
activities
&
relations
hips
Normal
psycholo
gical
functioni
ng: a
little
stressed,
unbalanc
ed, and
occasion
al dips in
functioni
ng
Very few
symptom
s,
involved
in a wide
range of
activities,
effective
socially
&
vocationa
lly.
Desires
to
improve
further
in
specific
areas of
life. May
still be
hindered
by
certain
life
problems
.
Good
functioni
ng in
daily life–
problems
approach
ed with
relative
ease. De
sires to
become
more
effective,
or to
experienc
e more
joy or
satisfacti
on
Highlevel
functioni
ng. Life
is
approach
ing a
balanced
,
satisfacto
ry state.
Seeks to
improve
performa
nce in
multiple
areas of
life.
Seeking
enhance
d
satisfacti
on and
success.
Balanced
living &
excellent
psycholo
gical
functioni
ng…
finding
significa
nce,
meaning,
and
success
in many
life
domains.
Seeking
optimal
performa
nce.
Counseling Psychologist
Sport Psychology Consultant
Adapted from Moore, S. N. (2010, April). Using our heads by making a move: Creating an
action plan to enhance student-athlete mental health and performance. Presentation at the
NCAA Gender Equity & Issues Forum, Chicago, IL.
HOW MANY MENTAL HEALTH
PROVIDERS ARE AT THE NCAA
LEVEL?
In House
• Washington, Kansas, Virginia Tech, New Mexico, Oklahoma, James
Madison, Virginia, Colorado, Iowa, Kansas State, Ohio State, Ole Miss,
Louisiana State, Southern California, US Naval Academy, Minnesota,
Texas, Arkansas, Missouri, Vanderbilt, Michigan, North Carolina
State, Tennessee- Knoxville, and Arizona
Contracted with Athletic Department
• Stanford, Oregon State, Indiana, North Carolina, Purdue, Providence,
Rhode Island, Rutgers, Western Connecticut, Wisconsin, Clemson,
Pittsburgh, Nebraska, Furman, Presbyterian, San Diego State
Affiliated Positions on Campus
• UCLA, Auburn, Harvard, California-Berkeley,West Virginia, Indiana
State, Montana, San Diego, Oklahoma State, Mass-Dartmouth, Akron,
St. Mary’s. Florida, Nebraska, Colorado State, Mass-Amherst,
Georgia, Delaware, Emory, California-Davis, Boston, Villanova, Notre
Dame, Iowa State, Maine, Texas A&M, Nevada- Reno, Ball State,
Abilene Christian, Illinois State, Northwestern, Virginia
Commonwealth, California State-Fullerton, Bigham Young, Maryland,
Davidson, Regis, Williams
SO, WHAT IS
BEST
PRACTICE?
DEVELOPING A TREATMENT
ACTION PLAN
Develop a general plan
• Include flexibility
• A written document to be included in your policy and
procedures
Educate staff how to refer and triage
Establish communication lines
Establish boundaries and limits of care
• Release of Information
Establish after-hour plan
Know university policy
• Duty to Report
TREATMENT PHILOSOPHY
• Patient Centered Care
• Treatment Team Perspective
TREATMENT TEAM
• Patient
• Psychologist
• Athletic Trainer
• Team Physician
• Director of Sports Medicine
• Life Skills/Academic staff
• Coach
• Dean of Students
• Parents
ROLE OF PSYCHOLOGIST
University &
Community
Outreach
Direct Patient
Care
Athletic
Department
Outreach
Sport
Medicine
Consultation
Athletic
Department
Consultation
A SLIGHTLY DIFFERENT
PERSPECTIVE ON
CONFIDENTIALITY
• Health Insurance
Portability and
Accountability Act
(HIPAA) and Family
Educational Rights and
Privacy Act (FERPA)
Compliant
• An essential element for
effective treatment is
trust
A SLIGHTLY DIFFERENT
PERSPECTIVE ON
CONFIDENTIALITY
• Trust is established by informing
the patient in the first session
• What can be discussed in session
• Who has access to the information
• Why those who have access are
informed
• When are others informed
• Emergent: Eminent harm or danger
• Non-emergent: Disordered eating that
results in various medical and
performance issues
INFORMED CONSENT TO
PATIENT
INFORMED CONSENT TO
ATHLETIC DEPARTMENT
Dear Athletic Department:
I am signing the recent attachment to the letter received from you
that indicates my understanding of what the NCAA and the University
of Arizona expects of Athletics Department employees related to
reporting known violations. By my signature, I commit to report
violations I may become aware of through means outside of my
professional role as a licensed psychologist. However, if I become
aware of a violation during my work in my role as a psychologist, I
will not violate my legal and ethical obligation to maintain
confidentiality of my patients.
Thus, I submit this attachment to indicate that aside from information
I may have learned through confidential communications while
practicing as a licensed psychologist, I am unaware of any NCAA
rules violations.
Respectfully,
Scott Goldman, Ph.D.
Licensed Psychologist, AZ 3929
SHOULD STUDENT-ATHLETES
BE TREATED DIFFERENTLY?
“What are you running
away from?”
SHOULD STUDENT-ATHLETES
BE TREATED DIFFERENTLY?
• Surveyed 1992 Olympic MEDALISTS:
• Who reported being happiest?
• Who reported being second happiest?
• Who reported being third happiest?
• Why?
• “No one remembers who wins 2nd”
• 2nd” is the first loser”
• Silver medalists focused on the one person who
beat them rather than the 6 billion people on the
planet whom they outperformed on that day
SHOULD STUDENT-ATHLETES
BE TREATED DIFFERENTLY?
12
10
8
Maturity
Arrested Development
6
Normal Development
4
2
0
1
3
5
7
9
11
13
15
17
19
Age
When did you first get noticed for your athletic ability?
When did you start getting attention from others for being good at your sport?
SHOULD STUDENT-ATHLETES
BE TREATED DIFFERENTLY?
• Because their interactions with the
world are different
AND
• Because the world interacts with
them differently
BE A SMART CONSUMER
Must be a licensed professional
Must have clinical AND sport training
Must have appreciation for treating a specialized
population
Ask about their theoretical orientation
Ask about therapeutic style
Ask about their level of comfort in collaborating with
athletic department staff
Research and Consult
Scott Goldman, Ph.D. 520-621-9533 or
A GREAT RESOURCE
http://web1.ncaa.org/web_files/library/sports_scie
nces/mental_health/2007_managing_mental_health.
pdf
ADDITIONAL RESOURCES
General Mental Health
www.mentalhealth.samhsa.gov
www.stepupprogram.org
www.ulifeline.org
www.halfofus.com
www.whatadifference.samhsa.g
ov
www.realwarriors.net
www.ncaa.org/health-safety
www.mentalhealthscreening.org
ADDITIONAL RESOURCES
Depression/Suicide/Self-harm
www.dbsalliance.org
www.suicidepreventionlifeline.o
rg
www.selfharm.org
www.jedfoundation.org
Question, Persuade, Refer: Training
www.qprinstitute.com/athletics.
htm
Nathan’s Story
http://web1.ncaa.org/web_vide
o/health_and_safety/NathansSto
ry/index.html
ADDITIONAL RESOURCES
Eating Disorders
www.nationaleatingdisorders.org
www.aedweb.org
Substance Abuse
http://ncadi.samhsa.gov
www.hazelden.org
www.smartrecovery.org