May 28, 2020

Supporting Student-Athlete Mental Health during the COVID-19 Pandemic

By Amanda Muscatell

Supporting Athlete Mental Health During a Pandemic

The disruption of daily life, social restrictions, fear and uncertainty of the future due to the COVID-19 pandemic has had mental health effects on most people. Student athletes face additional stressors related to a loss of identity, navigating online learning, mourning the loss of many things during this season and questioning what will happen in the fall. Athletic trainers (ATs) are health care professionals who, in many high schools and colleges across the country, provide day-to-day care for their student athlete population. ATs who work full time on campuses are privileged a unique and important relationship with their patients. Thanks to daily interactions with students, ATs are able to not only reduce the risk of injury and improve health care outcomes, but also build relationships and keep a pulse on patient’s overall emotional health and well-being.

ATs often have an insider’s look at patients’ lives and are a critical link in the interdisciplinary athletic health care team. Despite the shelter-in-place orders and cessation of sports across the country, ATs continue to provide remote health care to student athletes to monitor physical health and wellness.

On Monday, May 4th, At Your Own Risk hosted a Facebook Live to gain a better understanding of how ATs and mental health professionals are working together to support student athlete mental health in the midst of the pandemic. The live event featured Katie Susskind Susskind Risso, MAT, ATC who is an assistant athletic trainer at Stanford University, Cari Wood, MAT, ATC who is the athletic trainer at Redmond High School, and Dr. Erin Haugen, PhD, LP, CMPC, a licensed psychologist at Assessment and Therapy Associates of Grand Forks.

Haugen described trends in mental health that she is seeing as a licensed mental health provider. Haugen explained that when the pandemic first broke out, there was a lot of anxiety and confusion trying to find stability, and navigating shock and determine what is next. As the pandemic and shelter in place orders progressed, she has seen a decline in motivation and increased grief around the loss of seasons, sports, milestones and the potential loss of loved ones. In some, anxiety and irritability during this time has moved from an acute stressor (something that happens in response to a single event or situation) to a more ongoing, or chronic, state. Haugen notes the potential for increased substance abuse and eating disorders as athletes feel a lack of control in other areas of life during this time. Wood explained that in her high school, many athletes have come to a place of acceptance since a decision have officially been canceled for the remainder of the season, but there is still anxiety surrounding what school and sports will look like in the fall. Susskind Risso discussed some of the challenges that collegiate student athletes faced as they transitioned to online learning and moved back home after being on campus. Students are navigating boundaries at home, pressures to perform academically and a loss of a big part of who they are as an athlete.

Given these things, it is important for student athletes, parents and coaches to understand the signs and symptoms of mental health concerns and how they can support. Equally important is the health care provider’s role in developing new ways to support patients and provide health care from afar.

As part of the athletic health care team, which typically includes mental health professionals, team physicians and other specialists, ATs play an integral role as the primary touch point for many student athletes. Pre-COVID, athletic trainers would implement tactics such as wellness screenings to identify potential mental health concerns and refer to mental health professionals for care. Wood has been using a wellness survey at her school as a way to do a check in with her students for a few years now. She asks questions related to hydration, nutrition, sleep, stress at home and stress at school and follows up or makes referrals if there are any responses that signal that the athlete may need mental health support. ATs also plan for mental health emergencies on campus through mental health specific emergency action plans. Athletic trainers rely on their network of specialists to refer and ensure patients receive expeditious and appropriate health care for their needs, including mental health services.

During the pandemic, ATs continue to fill this role with the use of technology. Susskind Risso and Wood described how they are maintaining connection, either by phone or through Zoom and other apps, to gather data about patient status and ensure patients have access to the support and resources they need. One of the ATs’ most important skillset is observation and gleaning small details, and while athletes are at home, the scope has changed, but the observation powers haven’t. Susskind Risso explained that the advent of video conferencing has provided new insights to the athlete’s home life that the AT doesn’t usually see and this serves as another data point for ATs to assess their patient. In the high school setting, there are more restrictions related to video conferencing with minors that make getting that information more challenging and underscores the vital role that parents and peers play in helping to support athlete mental health at home. Without the facial expressions and body language that ATs typically look for, ATs must rely on technology – such as the wellness survey – to get as much information as possible. Wood has modified some of her survey to to help athletes focus on the positive, such as “what is one thing that you’ve done lately that you’re proud of?”

“ATs are so, so vital to the work that I do, and the data that ATs have is so helpful. Having the interdisciplinary approach really benefits the student athlete and organization as a whole. From the behavioral health and mental health side, it is continuing to keep those lines of communication open and be intentional about scheduling meetings and not putting those touch points off,” Haugen shared.

In addition to connecting patients with mental health services, ATs also play an important role in raising awareness about mental health to key stakeholders. Wood said ATs help educate coaches to know the signs and symptoms of mental health concerns and encourage them to treat a mental health emergency the same as they would a physical injury. Susskind Risso talked about the importance of viewing health care, including mental health, as a data-driven science. By quantifying the mental health needs on campus, ATs can help advocate for more resources or support from school administration as classes and sports resume in the fall.
In considering how parents, family and friends can help support student athlete mental health while at home, understanding the signs and symptoms of mental health concerns is an important first step. “Normally, I would say to look for any changes but that is really hard right now since everything is changing right now,” Haugen explained. She suggested looking at your child’s mood, motivation, appetite, energy levels, sleep and engagement with family and friends. A helpful acronym for people to consider is HALT – are you more Hungry, Angry, Lonely or Tired? Haugen suggests that parents and caregivers “keep your finger on the pulse of these things. While we’re all going to have days where we are less motivated and more disconnected, but is it continuing?”

The more that people can be mindful of the small signals of mental health concerns, the easier it is to arm the student athlete with tools and resources to cope and mitigate some of the more challenging responses that can occur down the road if these concerns are not addressed. One expectation, Haugen emphasized, is if there are any concerns about suicide, self-harm or harm to others, to immediately reach out for help. Call 911 or the National Suicide Prevention Lifeline, 1-800-273-TALK.

If a parent, family member or peer is noticing signs and symptoms of mental health concerns in an athlete, Wood suggested that the parent or child can reach out to their child’s athletic trainer to get access to a teacher who they might have a special connection with, a mental health specialist or the school counseling department. Wood caringly stated, “we love your kids just like our own, and if there is anyway that can help at all, we want to be there. Please reach out.”

Working with collegiate athletes, there is typically less parental interaction between the AT and the parents. Susskind Risso suggests, however, that parents are intentional with their interaction and ask questions like “how is your physical health, how is your mental health?” In a time where everyone is a little off, you have to ask these questions directly.

“Whatever role you are holding, as a parent, coach or athletic trainer, you have to be intentional and ask,” Susskind Risso stated.

Haugen provided the following suggestions for supporting mental health at home. First, try to have some level of structure to your day. Have a standard getting up time and going to bedtime. Structure can help us feel more motivated and centered during the day. Second, prioritize sleep. It is recommended that teenagers get 8 to 10 hours of sleep each night. One study found that only 15% of teens sleep 8.5 hours on a school night. According to the Sleep Foundation, not getting enough sleep doesn’t just make you tired the next day, it can inhibit the ability to learn, lead to poor eating choices and make the body more susceptible to illnesses. Haugen’s third recommendation is to eat well and ensure you’re getting proper nutrition. Fueling your body with the right food at the right time improves athletic performance and can even aid in injury recover. Check out At Your Own Risk’s Facebook Live with athletic trainer and registered dietitian Dana Angelo White, MS, RD, ATC to learn more about fueling your body at home. The forth recommendation is to stay connected, even if it’s virtually. Relationships and feeling connected matter now more than ever. Shelter-in-place and social distancing has lead to increased feelings of loneliness which can be especially hard on youth. It is important to set aside time to connect with family and friends. Haugen’s last tip is to do something enjoyable every day. Being stuck at home can lead to feelings of despair and frustration. Being intentional about doing something fun each day will help boost your mood and increase your motivation.

Additionally, Susskind Risso reminded college students to reach out to the services available through their institution. Most college mental and behavioral health services are still available by phone even during shelter in place orders.

As athletes look ahead and wonder what the fall season may bring, ATs are already busy preparing for a safe return to campus and activities, including mental health. ATs can address some of those concerns by educating students when they return to campus. Haugen said that one of the positive aspects to this time “is that we are talking about mental health very openly and honestly.” Having discussions with coaches, athletes and parents about mental health as school and sports resume will help normalize the wide range of emotional response to the pandemic. Haugen stated that “ATs are prepared” and can inform athletes that there are process in place to get them to specialists, if needed. In anticipating changes to the fall season and returning to campus/return to sports, Susskind Risso explains that ATs will be critical in the process. In addition the mitigation strategies, such as temperature checks and increased sanitation, there is an opportunity for ATs to educate patients on both the mental and physical changes in light of the pandemic. Haugen suggests that ATs integrate a wellness screening as part of the return to sport procedure and making it part of the natural dialogue as students return. Collaborate with mental health services on campus to see if they can provide specific education on how people respond to trauma or stress to increase education and support around these important topics. Ultimately, Haugen suggests that ATs be intentional with providing education and resources about mental health to athletes. This has been a traumatic experience for everyone.

No matter the time or circumstance. Whether it’s vying for a championship spot or enduring a global pandemic, ATs strive to provide the best health care for their patients. When it comes to supporting athlete’s mental health, ATs can never be too overbearing. Mental health professionals would rather be bothered with something that isn’t an issue than not bothered when a patient actually needs help. Susskind Risso says “that’s the burden that we bear [as health care providers]. I would rather be overbearing and insert myself where needed.” Haugen confirms the sentiment by stating, “When in doubt, just ask.”



Dr. Erin Haugen, PhD, LP, CMPC
Licensed Psychologist specializing in Clinical & Sport Psychology at Assessment and Therapy Associates of Grand Forks

Dr. Erin Haugen is a licensed clinical psychologist and sport psychologist at Assessment and Therapy Associates of Grand Forks in Grand Forks, ND. She is also a faculty member at Altru Family Medicine Residency where she is involved in teaching athletic training students and Sports Medicine Fellows in family medicine and physical therapy. She has a PhD in clinical psychology and is a Certified Mental Performance Consultant (CMPC) through the Association for Applied Sport Psychology. Dr. Haugen’s practice is focused on addressing performance and mental health concerns in athletes from over 20 different individual and team sports. She consults with athletes of all levels and specializes in collegiate student-athletes. She works closely with providers of many disciplines, including athletic training, sports medicine, family medicine, and dietetics. She is passionate about improving mental health for athletes and coaches, interprofessional care, professional well-being, and her 3 border collies.

Katie Susskind Risso, MAT, ATC
Associate Athletic Trainer at Stanford University Sports Medicine

Katherine Susskind Risso is an Associate Athletic Trainer at Stanford University working primarily with the women’s lacrosse and sailing teams. She also serves as the primary injury spotter for the football program. Susskind Risso received her BS in Exercise Biology and BA in Psychology from the University of California, Davis in 2009, as well as her Master’s in Athletic Training from the University of Arkansas, Fayetteville in 2012. Susskind Risso believes in a global and functional approach to injury management and prevention by assessing the body and relative mechanics as a whole, in addition to the mental, emotional, and psychosocial aspects of student-athlete well-being. She is passionate about female athlete health care, the intercollegiate health care model, and specific mental health concerns in the student-athlete population. She is active in the profession at the state and district level, serving as the Far West Athletic Trainers’ Association (FWATA) Public Relations Committee Chair. She enjoys participating in community outreach opportunities and educating the public on the role and importance of athletic trainers. In her spare time Susskind Risso enjoys cooking, trying new restaurants, skiing, hiking, and spending time with her husband, family and friends.

Cari Wood, ATC
Athletic Trainer at Redmond High School, Redmond, Oregon.

Cari Wood graduated from Eastern Washington University in 1993 with a Bachelor of Science in Sports Medicine and a Bachelor of Arts in Education-Physical Education/Health. She returned to her home state of Oregon to work as the first Athletic Trainer at Redmond High School in 1994. She built an athletic training program from scratch and has remained in Redmond ever since. Cari served on the NATA Board of Directors from 2012-17 and was President/Director of District 10. Prior to that, she served District 10 as their Secretary, and was the President of Oregon Athletic Trainers’ Society, and had multiple committee assignments over the years. Currently, Cari is the chair of the NATA Specialty Awards Committee. Cari was a recipient of the NATA Outstanding Service Award, NATA Most Distinguished AT, is an OATS Hall of Fame member, and was the first woman inducted into the NWATA Hall of Fame in 2017. She is married to Jon and is incredibly proud of their two children, Bradi (21) and Riley (18).

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