NBA’s new mandatory requirement of a psychiatrist sets precedent for not only professional sports, but for all professional organizations, and society at large

I remember in June 2010, when the Lakers won their last back-to-back championship, seeing Ron Artest aka Metta World Peace thank his psychiatrist on live television. In 2012, I remember hearing about Keyon Dooling checking into a psychiatric hospital. More recently, in November 2017, All-Star Kevin Love had a panic attack, and in February 2018, All-Star @DeMar_DeRozan tweeted “This depression gets the best of me…”

It’s no secret that professional sports create stressful situations. But the fact is, professional athletes are people too, and they, just like us, have mental health issues. I was so thankful that these players all courageously came out and spoke about their issues. Their articles in The Players’ Tribune were so vulnerable, touching, and eloquently delivered. And they went viral. The conversation gained momentum, and more players were able to open up. More people, in general, were able to open up. The topic became less intimidating, but far from comfortable. 

According to The Athletic’s Sam Amick’s report today, the NBA has set an expectation that all NBA team’s must:

-       retain a mental health professional

-       identify a psychiatrist available to any players to manage any mental health issues

-       and enact a written policy for any mental health emergencies   

This move, while logical for a league with such high visibility (especially in the age of social media, where 2 of the NBA’s top players, @kingjames and @stephencurry30, have a combined 76 million Instagram followers), is ahead of the game compared to some of the other professional sports. It is clearer in its expectations and does not beat around the bush.

According to a Wall Street Journal article in 2018, 26 of the 30 MLB teams employed sports psychologists or “mental-skill coaches.”  

In the NFL’s report in May 2019, the “The NFL and NFLPA will also now formally mandate that each team retains a Behavioral Health Team Clinician focused on supporting players' emotional and mental health and well-being. Each Team Clinician must possess certain minimum qualifications and be retained and jointly approved by the NFL and NFLPA by the start of training camp for the 2019 season.”

Let me highlight the importance of specifying that a psychiatrist is required in this picture. If you are training the highest-level athletes, don’t you want the most highly trained doctors. If you have the most specialized trained physicians for your athlete’s bodies, don’t you want the most specialized trained physicians for their mind as well? It’s great, and necessary, to have a “mental-skills coach” or a sports psychologist to talk to, but the best person to identify the needs of an individual is a well-trained psychiatrist.  

When is this a stress issue that needs counseling? When is this a relational issue that needs psychotherapy? When is this an anxiety issue that needs cognitive-behavioral therapy? When is this a chemical issue that needs a medication? When is this a medical issue that is affecting both your body and your mind? Do you really want to explore every option available to you? A well-trained psychiatrist can decipher and provide all of the above.

By clearly stating that each NBA team must “identify a licensed psychiatrist (M.D. or D.O.) to be available to assist in managing player mental health issues,” the NBA is clearly stating that they want the best, for their best. They are not using softer language, such as Behavioral Health Clinicians or “mental skills coaches.” They are clearly stating that mental health issues are serious medical issues that need to be evaluated by the most highly trained individuals.

Let me put it like this to you: 

Behavioral Health Clinician (Master’s Degree) – Total School (4 years for Bachelor’s Degree plus 1 to 3 more years for Master’s Degree)

Psychologist (PsyD) – Total School (4 years for Bachelor’s Degree plus 4 to 6 more years for PsyD)

Psychologist (PhD) – Total School (4 years for Bachelor’s Degree plus 5 to 7 more years for PhD)

Psychiatrist (M.D.) – Total School (4 years for Bachelor’s Degree plus 4 years of medical school plus 4 years of additional medical/psychiatry training)

The NBA is clearing the path for their players to say “I am seeing my psychiatrist,” without having to face any consequences. Will their still be stigma? Sure. That is why for the longest time, we, not just the NBA, would still prefer to say “mental health coaches” or “behavioral health clinicians.” But the language is changing.

Wouldn’t it be nice, if not just the NBA, but every major organization in the world, told their employees “you have a psychiatrist available to you to manage your mental health issues.” Or maybe your organization already does have a psychiatrist available to you, but you just don’t know about it. That’s one of the problem. We don’t talk about it enough. Or it is too costly for your organization to talk about it or make it readily available.

The problem with getting mental health care right now, at least in America, is not just the stigma associated with getting treatment, it is that getting access to adequate mental health care is incredibly frustrating and challenging, especially if you do not have the means to pay out of your own pocket. You still likely have to navigate your insurance, and find a provider that takes your insurance. Then, your provider only has a certain amount of time to talk to you and figure out what you need. Then, your provider changes every few years because they are sick of spending more time with paperwork than with their patients. All of those steps have more to do with insurance companies making more money as opposed to finding you, the customer/patient, the best care for your needs.

Having insurance in America does not mean that you will get good mental health care.

The reality is that while professional athletes undergo a lot of pressure, stress, and are held under high scrutiny, we all deal with stressful jobs, situations, and relationships. We are just as likely as they are to need mental health treatment.  We just need to stop looking at it like treatment is a bad thing, but more like assistance. If your knee is overstressed, you get physical health treatment or assistance.

While the MLB, the NFL, and NBA are progressively talking about mental health in a more clear language, I am curious to see how exactly they make this help available to their players. I am also hopeful that these professional leagues, like their players, use this momentum and their platforms, to inspire other professional organizations (finance, technology, legal, politics, to name a few) to speak more openly about their desire to make mental health assistance more directly available to their employees. Do they not realize that according to Forbes, “Mental Health and Substance Abuse cost US Businesses between $80 to 100 billion annually?”

Wouldn’t it be nice for stigma, if the highest ranking office in our country, let’s say the White House, also put out a similar memo, stating “All members of Congress must have a licensed psychiatrist identified to be available for their mental health issues.” It doesn’t matter who your local politician is, I’m sure their job is stressful. Wouldn’t you want them to easily seek top-notch mental health assistance if they needed it?  Wouldn’t it be nice if you could also get excellent mental health care easily as well? Well, we are not quite there yet. But thanks to the NBA, the conversation is moving in the right direction.

TL;DR version - Athletes are people and suffer from mental and physical ailments just as we do. Mental ailments, just like physical ailments, require high level diagnosis and treatment. Getting mental health treatment is not easy, between the stigma and the business of mental health care. More professional organizations should take after the NBA, and speak out in support of getting their employees accessible mental health assistance.

© [Yu-Heng Guo] and [www.GuoMDPsychiatry.com], [2019]. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to [Yu-Heng Guo] and [www.GuoMDPsychiatry.com] with appropriate and specific direction to the original content.

The Feeling of Powerlessness

Being diagnosed with a medical illness. Having your house destroyed by a Hurricane. Being in an abusive relationship. Being down 10 points with 1 minute left. Having to discharge a patient to a shelter. Being homeless. Losing a parent or child. Watching children get murdered.

I use these examples not to compare them, but to illustrate a deep, common, helpless feeling that can be experienced at one point in life or another.

However, it is precisely at this moment that you can actually be the most powerful. It is at this moment that you can choose to focus your attitude on making the best, most helpful decision you can make. Everyone likes a good comeback story, because everyone has come back from something devastating (at least seemingly so) at one point or another.

You can choose to eat healthier. You can choose to look into social work services. You can call a crisis line. You can slow the game down and take it one play at a time. You can call your supervisors and advocate. You can talk to someone. You can vote.

I am not saying it is easy to overcome the feeling of powerlessness. But I am saying, that those that recognize it, and learn to overcome it, have done it by taking it one moment, and one decision at a time.

The person that went into cancer remission after changing their diet. The survivors of trauma that become leaders and inspirations in their communities. Angelina Jolie. Lady Gaga. Dwayne “The Rock” Johnson. Tyler Perry. Oprah. Reggie Miller versus the Knicks in 1995. The Miracle at the Meadowlands. The 2018 elections.

I am not saying that getting back up is easy. I am not even saying that things will ever be normal again. I am just saying that at that this moment, I have to make the best decision I can to improve my situation, and live to fight another day. To give time for the cavalry to arrive.

In order to overcome the feeling of powerlessness, I have to find a way to focus on the moment and what I can control. If I can be powerful now, I can always be powerful, and this was the most powerful decision I’ve ever made.

 

 

Yu-Heng Guo, MD

November 3rd, 2018. Prior to the 2018 elections.

 

© [Yu-Heng Guo] and [www.GuoMDPsychiatry.com], [2018]. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to [Yu-Heng Guo] and [www.GuoMDPsychiatry.com] with appropriate and specific direction to the original content.