Should elite performance come second?

I want to congratulate Derek Larkin and colleagues for raising awareness of mental health in elite sport ('When winners need help', August 2017). They highlight a range of complex issues, such as pressure, expectation to perform and succeed, and career termination, all of which can impact upon an individual's mental health. Research in mental health in elite athletes is growing, yet it is still in its infancy; researchers so far have considered the benefits of sports participation on mental health and the prevalence rates of mental health amongst athletes. One question to consider: Are we putting elite performance before the health of our athletes?

One of the key points the article identifies is the specific social pressures elite athletes are exposed to. In a 2017 article in Psychology of Sport and Exercise I co-authored, we considered the particular social context elite divers are exposed to and how they conceptualise and perceive mental health. Risk factors and unique stressors found within diving and its environment in relation to the possible development of negative mental health were body image, high risk of injury, and pressure to perform at the elite level. There were some perceptions of putting elite performance above the health and mental wellbeing of the divers.

Larkin et al. prompt us to consider whether it possible to protect elite athletes from 'undue risk'. Or is it a case of increasing athletes' awareness of mental health disorders and effectively supporting them through the help-seeking process? Knowledge is key here. Lack of mental health knowledge generates challenges to obtaining mental health care and possible underreporting of prevalence rates of mental health disorders. Health literacy is briefly mentioned in this article, however mental health literacy is not considered. This is the knowledge and beliefs about mental health that aid the recognition, management and prevention of mental health disorders. Mental health literacy components consider knowledge of help-seeking options and treatments available, as well as knowledge of self-help strategies. Training programmes improving mental health literacy have been shown to increase knowledge of mental disorders, help-seeking behaviour, and confidence and empowerment in providing support to others. Good mental health literacy facilitates positive help-seeking behaviours by identifying early signs of mental disorders, and reduces stigma.

Perhaps by increasing the mental health literacy of elite athletes and coaches, as well as support staff such as sport psychologists, we could reduce stigma, increase help-seeking and adherence to treatment, facilitating the development of positive mental health and wellbeing of our athletes.

Melissa Coyle
Faculty of Sport, Health & Wellbeing
Plymouth Marjon University
 

I read 'When winners need help' with great interest. The piece highlighted an important topic in elite sport, and raised the prospect of further discussing mental health and mental illness in elite athletes amongst a variety of disciplines in psychology. Shakiba Moghadam's letter in the November issue ('Female boxers and mental health') only reinforces a need to further address the stigma that shrouds mental illness in elite sport and often prevents athletes from getting the professional help they may need.

Although Larkin et al.'s piece touched upon the lives of elite athletes and the hardships they may encounter with respect to mental illness, the lives of many other actors involved in the arenas of elite sport went unnoticed. Coaches, medical personnel, staff members, referees: they all play vital roles in elite sport, yet their mental health is rarely thought of or explored. Larkin and colleagues have started a much-needed conversation about mental health and illness in elite sport, but one that needs to go further. I encourage readers to examine work on stress and burnout amongst elite level coaches, mental health problems amongst support staff, and abuse amongst referees. Frankly, there's nothing wrong with our going even further and examining alcohol consumption and addictive gambling behaviours amongst fans and spectators. The list of mental health problems is long, and the actors are many.   

Dealing with mental illness in elite sport is extremely challenging and creating supportive and inclusive environments where people will feel they are able to disclose their problems without shame and seek support will be a monumental task. We're dealing with a complex environment where we need to work to shift people's attitudes about mental illness. In order to help make that happen, we need to recognise that in the world of elite sport, everyone's mental health matters and needs to be discussed, from fans to athletes and everyone in between.

Paul Gorczynski
Department of Sport and Exercise Science, University of Portsmouth