BJSM Online First, published on November 30, 2015 as 10.

1136/bjsports-2015-095570
Editorial

The stigma of mental health in ( physiology and biomechanics) of young

athletes to the exclusion of developing

athletes: are mental toughness and their healthy ‘software’ (mental health
and performance psychology).3 The chal-

mental health seen as contradictory lenge is to close the gap between where
we are—focusing on ‘hardware’ and

in elite sport? where we need to be—focusing on both

‘hardware’ and ‘software’.
From personal and professional
N James Bauman experience, I see growing organisational
support for addressing athlete mental
health and performance psychology.
BRIEF HISTORY sport organisations and people within These efforts include (1) college athletic
Mental illness and the stigma attached to those organisations; departments, USA Olympic Committee,
those suffering from its affects have been ▸ Financial gain or loss for all involved; US Olympic Governing Bodies and pro-
part of human existence throughout ▸ A multitude of media outlets that fessional sport organisations are hiring
history.1 Despite efforts to bring more glorify those who succeed and are more full-time mental health profes-
awareness to the causation and effective critical of those who fail. sionals who are embedded within the
treatment of mental health issues, this These all fuel an additional expectation organisations and working directly with
stigma persists both socially and in the for athletes who have been championed to athletes, coaches, other support staff
athletic culture. Long established beliefs be ‘mentally tough’. Mental toughness and and administrators, (2) the National
have proven to be as challenging to mental health are seen as contradictory Association of Athletic Trainers has pub-
change as many of the other discrimin- terms in the world of elite performance. lished a consensus4 that addresses the
atory practices receiving media attention, Sports culture has been slow to respond to growing concern for mental health
political dialogue and legal debate (eg, athletes seeking psychological treatment. issues in athletes and provides recom-
race, gender, religion, sexual orientation, Seeking help may expose an athlete to mendations for development in this
gay marriage, immigration, legalisation of risks of losing playing time, their starting area, and (3) the NCAA published
recreational drugs). Although these other role or even their contract to compete. Mind, Body and Sport5 identifying the
issues have their own set of challenges Therefore, the incentives to ask for help need for college athletic departments to
that inhibit healthy social change, a thread and potentially get better are essentially address this growing concern and also
of historical stereotyping is common to all outweighed by the negative consequences providing guidelines for implementing a
of them, including mental health. of appearing mentally weak. dedicated response to assist
The life an elite athlete is not easy. The student-athletes.
pressure to perform on demand, injuries We need to ensure a new norm—an
PREVALENCE OF MENTAL HEALTH and the stress of feeling overloaded are part environment where athletes are free to
ISSUES of sport. However, today’s athletes face a ask for help, without negative conse-
The US Department of Health and different set of stressors than athletes in pre- quences and receive that assistance from
Services (USDHS) reported in 2012 that vious generations. The differences are seen expert mental health professionals. When
1 in 5 adults (20%) experience a mental in a growing number of complex and more that happens, a new and healthier culture
health issue each year.2 USDHS also intense mental health challenges. These will replace the existing one where ath-
reported that rate increased to 30% in the include, but are not limited to, mental letes and mental health issues are ignored,
age group 18–25 years, yet less than health issues beginning at earlier ages, a hidden or discarded.
one-third of those in this age group wider range of mental health issues, athletes
received treatment. This age range encom- being channelled into specific sports at Competing interests None declared.
passes many athletes in high school, colle- younger ages, a change in sport and life Provenance and peer review Commissioned;
giate and professional athletics. demands, young athletes with fewer psy- internally peer reviewed.
chological coping skills, rule changes by the To cite Bauman NJ. Br J Sports Med Published Online
National Collegiate Athletic Association First: [ please include Day Month Year] doi:10.1136/
SPORT CULTURE REGARDING MENTAL (NCAA) and professional sport that permit bjsports-2015-095570
HEALTH recruiting young athletes at an earlier age, Accepted 11 November 2015
The stigma attached to athlete mental
and often a decreased emphasis on young Br J Sports Med 2015;0:1–2.
health issues are driven by many factors
athletes independently and effectively doi:10.1136/bjsports-2015-095570
including:
resolving their own life issues or expecta-
▸ Social history;
tions to be an active participant in resolving
▸ Sport organisations motivated to be
their mental health issues. Unidentified or REFERENCES
profitable;
ignored mental health issues that began in 1 Porter R. Madness: a brief history. Oxford University
▸ People within those organisations who
the earlier ages become more evident when Press, 2002.
are driven to be successful; 2 US Department of Health and Human Services,
athletes are faced with the stressors asso-
▸ Individual athletes who are expected Substance Abuse and Mental Health Services
ciated with elite sport.
to be successful by a parent, relatives, Administration. Results from a 2011 National Survey
on Drug Use and Health. Mental Health Findings
(NSDUH Series, H44, HHS Publication No. (SMA)
Correspondence to Dr N James Bauman, 13401
CHANGING SPORT CULTURE 12–473). Rockville, MD, 2012.
Dumas Road, Mill Creek, Seattle, WA 98012, USA; Sport continues to primarily focus on 3 Bergeron MF, Mountjoy M, Armstrong N, et al.
jbauman@virginia.edu improving the competitive ‘hardware’ International Olympic Committee Consensus statement

Bauman NJ. Br J Sports Med Month 2015 Vol 0 No 0 1

Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.
 Editorial
on youth athletic development. Br J Sport Med and refer student-athletes with psychological concerns 5 NCAA Publication. An Introduction to Mind, Body,
2015;49:843–51. at the collegiate level: an executive summary and Sport—Understanding and Supporting
4 Neal T, Diamond A, Goldman S, et al. Inter-association of a consensus statement. J Athl Train Student-Athlete Mental Wellness. 2014. http://www.
recommendations for developing a plan to recognize 2013;48:716–20. ncaapubliation.com (accessed 1 Aug 2015).

2 Bauman NJ. Br J Sports Med Month 2015 Vol 0 No 0