CSCAA Newsletter // January 2020
CSCAA Newsletter // January 2020
Welcome, 2020. I’m grateful to be back with you, diving deeper into the conversation around mental health. As the intensity picks up in the pool this January, so too does the intensity of our conversation around mental health and mental illness. In this month’s newsletter, I’m going to help you identify the risk factors and warning signs for depression and suicide, as well as provide concrete suggestions for what you can control.
Statistically, it’s safe to assume that all of us have experienced suicidal thoughts at some point in our lives and/or know someone who has. These topics can be heavy and hard to talk about, so please honor the feelings that come up for you. If you need to take a break, please do. There’s a reason flight attendants tell us to put on our oxygen mask first before helping others. And, if you can, please come back when you’re ready.
I’m in this with you - both as a mental illness warrior and as a coach working with emerging adults. My goal in pulling together this piece isn’t to be an alarmist; it’s to empower all of us to turn toward these hard conversations with evidence-backed facts. Because staying silent comes with a high cost.
We can do hard things. Even this kind of hard.
// Painting the Picture //
Before we dive into risk factors and warning signs, I want to briefly revisit the construct of mental health and mental illness. Mental health isn’t something reserved for a select few; we all have mental health. Our bodies don’t actually know the separation between “mental” and “physical” health; those are human-made categories. Everything is interconnected. Health falls on a spectrum.
In our lifetime, we’re challenged by “physical” injuries and illnesses, and sometimes healing requires the help of professionals. The same is true for “mental” injuries and illness. One of the biggest differences is that mental injuries and illnesses are often invisible. On top of the invisibility there is stigma — especially in the athletic arena.
Statistically, 1 in 5 college and university students is navigating anxiety and/or depression. Among populations of student-athletes, there are concerns of underreporting:
The question of how responding impacts reporting on self-report questionnaires is always an important question for researchers and may be particularly critical in measuring depression among college athletes. Anecdotally, athletes tend to portray a picture of psychological strength when assessed for depression symptoms. There appears to be a tendency to put considerable effort into appearing ‘‘fine’’ or ‘‘okay’’ and ready for the next competition or challenge. This is inherent to the culture of athletics, as confidence often is regarded as a necessary state of mind for completion. However, it creates significant difficulty for sports medicine professionals attempting to access an athlete’s state of mind accurately. Further research into depression in athletes ideally should take into account the concern for underreporting of depression symptoms, especially if the study relies on selfreported data. ( Wolanin et al., American College of Sports Medicine, 2014)
Of those who are navigating mental illness, according to a report published by the University of Michigan School of Public Health in 2014, only 30% engaged in mental health services.
Do you know what the number drops to in populations of student-athletes?
10%
Can you imagine having 6 severely, physically injured athletes on your team of 30 — and not one asked for / sought help?
{No wonder you’re feeling the weight of it all.}
There are things we can do to continue chipping away at this stigma.
On the flip side, I’ve talked to coaches who have many athletes engaged in mental health services. Even though it may feel frustrating to not-know the ins and outs of what’s going on, it may be helpful to know that early intervention is a strong predictor of recovery and well-being.
Whatever the current landscape of your team, I believe the following will help you gain awareness and regain a sense of agency around the things you can control.
MAJOR DEPRESSIVE DISORDER AKA DEPRESSION
We all have depressive lows and periods of sadness. Depression is not sadness. Major depressive disorder is a type of mood disorder that lasts for at least two weeks, affects people’s ability to carry out their work and daily activities and keeps people from having satisfying personal relationships.
When our ability to live, love, laugh and/or learn are impacted by our mental health problems, it’s a good indicator that it’s time to seek out help.
Signs and Symptoms of Major Depressive Disorder
It’s important to remember that our role isn’t to diagnose. As coaches, our role is to notice and be the bridge to resources — another reason why we want to normalize struggle. ALL of us will navigate hard times at some point in our lives — getting help isn’t a sign of weakness. If an athlete presented with signs of a physical injury, we wouldn’t sit and second guess the signs or try to diagnose; we’d recruit the appropriate help.
Identified Risk Factors in Athletes:
short + long-term injury
identity foreclosure
over-training
career termination
elite performance
The following are signs that an individual may be navigating depression:· An usually sad mood
· Loss of enjoyment and interest in activities that were previously enjoyable
· Lack of energy and tiredness
· Feeling worthless or guilty when they are not really at fault
· Thinking about death or wishing to be dead
· Difficulty concentrating or making decisions
· Moving more slowly or sometimes become agitated and unable to settle
· Having sleeping difficulties or sleeping too much
· Loss of interest in food or sometimes eating too much
· Changes in eating habits, which may lead to either weight loss or weight gain
At home, young people may:
· Complain of tiredness, even if sleeping more than usual
· Have difficulties doing household chores, either forgetting to do them or not doing them thoroughly
· Withdraw from family [roommates], spending a great amount of time in their bedroom
· Snap at family members, behave irritably, or pick fights with parents or siblings
· Avoid discussing important future events, such as decisions about further education or work opportunities
In school, young people may:
· Show a decline in school grades because they did not complete work, do not do as good a job as they used to, or miss school [or practices]
· Fail to engage in classroom discussions or struggle to understand and communicate
· Snap or start fights with other students or engage in vandalism
· Struggle to work effectively in the morning, but do better in late afternoon classes
In social setting, young people may:
· Avoid spending time with friends altogether
· Spend more time with friends who appear to be depressed as well
· Become ostracized from their usual social group, either because they continually refuse invitations or friends find the individual difficult to spend time with.
· Use alcohol or other drugs to deal with emotional symptoms
While not everyone who is depressed becomes suicidal, depression is a high risk factor for suicide, which is why they are often coupled together in conversations around mental health.
SUICIDAL THOUGHTS + BEHAVIORS
In December, two athletes I work with privately (between ages 15-25) shared that they were having suicidal thoughts. In both conversations, I picked up on language like burden, trapped and a feeling of permanence. Here’s why I’m sharing: Despite our close relationship, they would not have shared this information if I hadn’t asked.
If you don’t have personal experience navigating depression, the images captured here on The Mighty are powerful and may be eye-opening. In almost all deaths by suicide, there are warning signs. This picture captures what many suicide survivors say about reaching out for help:
We know that in the athletic arena, self-reported data can be skewed.
One of the most harmful and pervasive myths about suicide is the belief that if we bring it up, we’re going to plant seeds in their mind. Just the opposite is true. In fact, asking the question: “Are you having thoughts of killing yourself?” can be a life saving question.
Though, culturally, we don’t talk about it, suicidal thoughts are “normal.” AND, they must be taken seriously.
You might be wondering, what next? What do I do if they say yes?
The next steps are to assess for urgency and then bridge to the appropriate resources which may be 911 or crisis hotline or encouraging appropriate professional help.
This is a skill we build in Mental Health First Aid — if you haven’t thought about it yet, we’d love for you to join us in Chicago for this training. Similar to CPR, we learn how to assess for risk of suicide and non-suicidal self-harm; listen non-judgmentally; give feedback and reassurance; encourage professional help; and encourage self-help and other professional supports. We also talk about the next steps and building out protocols.
From 2007-2017, the number of deaths by suicide in youth age 10-24 increased by 56% (CDC, 10/2019). It’s now the second leading cause of death among teenagers and young adults, second only to accidents.
I encourage you to ask your athletic director for a plan and next steps. If they don’t have one yet, demand one.
I can’t stress enough — if you have an intuitive pull that something is “off” — gather the helpers you need to support you, and turn toward it.
Signs and Symptoms of Suicidal Thoughts + Behaviors
In 1994, AM Smith and EK Millner published a report in the Journal of Athletic Training found the following to be contributing factors to suicidal behavior among athletes with injury:
a serious injury necessitating surgery
an extended rehabilitation process (6 wk to 1 year)
reduced athletic skills despite adherence to rehabilitation
a perceived lack of competence upon returning to sports when compared with pre-injury levels
being replaced by a teammate at their given position
Risk Factors of Suicide:
Risk factors are characteristics that make it more likely that someone will consider, attempt, or die by suicide. They can't cause or predict a suicide attempt, but they're important to be aware of.
· Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders, and certain personality disorders
· Alcohol and other substance use disorders
· Hopelessness
· Impulsive and/or aggressive tendencies
· History of trauma or abuse
· Major physical illnesses
· Previous suicide attempt(s)
· Family history of suicide
· Job or financial loss
· Loss of relationship(s)
· Easy access to lethal means
· Local clusters of suicide
· Lack of social support and sense of isolation
· Stigma associated with asking for help
· Lack of healthcare, especially mental health and substance abuse treatment
· Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
· Exposure to others who have died by suicide (in real life or via the media and Internet)
Warning Signs:
Some warning signs may help you determine if a loved one is at risk for suicide, especially if the behavior is new, has increased, or seems related to a painful event, loss, or change.
If you or someone you know exhibits any of these, seek help by calling the Lifeline.
· Talking about wanting to die or to kill themselves
· Looking for a way to kill themselves, like searching online or buying a gun
· Talking about feeling hopeless or having no reason to live
· Talking about feeling trapped or in unbearable pain
· Talking about being a burden to others
· Increasing the use of alcohol or drugs
· Acting anxious or agitated; behaving recklessly
· Sleeping too little or too much
· Withdrawing or isolating themselves
· Showing rage or talking about seeking revenge
· Extreme mood swings
A note about Depression in Athletes: Prevalence and Risk Factors (American College of Sports Medicine, 2014):
“Athletes may present with atypical signs and symptoms, such as anger and irritability, and engage in healthy or less healthy coping mechanisms, such as substance abuse or overtraining. Beyond the traditional indicators of depression, athletic trainers and sports medicine teams should maintain increased awareness that (given the nature of the athletic culture) athletes may be likely to deny depression symptoms. Education of sports medicine professionals and the athletic care network is key to the optimal evaluation, management, and outcome of depression in athletes.”
From the Coach’s Seat // Controlling the Controllables
It’s hard not to turn away when we start to feel uncomfortable, unsure and unsteady in our decisions. Are we doing the right things? Are we saying the right things? What is our role? What can we do?
To help you regain a sense of agency at a time when your plate is overfilled with responsibilities, here are five things you CAN control:
One: Your Attitude Toward Mental Health
Adopting an attitude of acceptance means respecting a person’s feelings, culture, personal values, and experiences as valid even if they are different from your own or you disagree with them. You can have an attitude of acceptance and uphold boundaries around what behaviors are OK and not OK within your team dynamic.
Two: Aligning Your Words With Your Actions
Genuineness means that what you say and do shows the young person that they are accepted — paying attention to both your verbal and nonverbal cues. This means not holding one set of attitudes while expressing another. An important note: Suicide survivors and families who’ve lost loved ones to suicide want us to move away from the language of ‘committed’ — no one “commits cancer.” Mental illness is an illness, not a choice.
Three: Cultivate Empathy
Practicing empathy means being able to connect to the human emotions underpinning an experience. If you missed the downloadable gift on what empathy is / is not, head over here to the July newsletter to get a copy.
Four: Build Bridges to Professional Help
Do your athletes know about the resources available to them on campus? (How do you know?) There are a variety of health disciplines that can provide help to athletes who are navigating mental health challenges, including but not limited to: primary care physicians; nurse practitioners; youth workers; psychiatrists; psychologists; mental health care providers; and social workers.
We wouldn’t be in this profession if we didn’t believe in the power of coaching. Why is it any different when we onboard the help of therapists (read: I consider my therapist to be a coach!) who help us navigate our internal world?
Five: Practice + Encourage Self-Help
As coach, you lead by example. If you were to step back and reflect on your self-care practices, what would you see? What do your athletes see?
There are certain factors that can moderate depression and help youth and young adults be successful despite mental health challenges they may encounter. Some of these include: having a good social support; having good problem solving skills; having a healthy diet and good health practices; believing that they can control their own life; parental and familial support. In addition there are self-help strategies that may be beneficial including: relaxation; mindfulness; avoiding alcohol, tobacco and other drugs and proper nutrition and sleep.
You can find all five of these controllables as well as ‘what not to say’ on this month’s free printable on How To Talk To Someone Who’s Navigating Depression. Be sure to download your free copy below.
HERE’S YOUR CHALLENGE FOR THIS MONTH:
Pick up the phone and make a call to your mental health services team on campus. Introduce yourself, if you haven’t done so already. Schedule in a time to grab coffee. Ask them what resources they have available for students. Ask them to come say hello to your team — invite them to be as visible as the athletic training staff. If you don’t have a dedicated mental health team on campus, make the call to health services and ask the same questions.
The second challenge? Register for the Mental Health First Aid training at the CSCAA Conference in Chicago. I’ll be co-facilitating with Lynn Hennighausen, a national instructor for the National Council of Behavioral Health — and a three sport collegiate athlete.
We’re stronger together.
One final note — I’ve included another free downloadable gift for you this month: “How To Talk To Someone Who’s Navigating Depression.” Please print it out for you and your staff — and share with your team. A quick Google search should help you find the phone number for your local crisis team if you don’t have a plan in place already.
If you want to learn more about anything mentioned in this article and/or want to read original sources, please don’t hesitate to reach out.
I love hearing from you — and look forward to writing again in March!
Best,
Samantha
Sources
Mental Health First Aid USA + Mental Health First Aid Instructor Training
National Alliance on Mental Illness
Samantha Arsenault Livingstone is an Olympic Gold Medalist, high-performance consultant, mental performance coach, speaker, educator and entrepreneur. She is the founder of Livingstone High Performance, LLC., the two, multi-module online courses — inspiring, empowering and equipping athletes, coaches and female leaders with the skills they need to become more mindful, courageous, resilient leaders. In addition to private and group coaching, Samantha consults with teams and organizations on athlete wellness, Mindful Sport Performance Enhancement (MSPE), leadership, strategic planning, rising skills and developing high-performance cultures.
Join Samantha in the I AM CHALLENGE private community space to link arms, connect + participate in her free challenges.
A mama of heart warrior and mama of twins, Samantha and her husband, Rob, live in the Berkshires with their four girls. To learn more about her offerings, go over to www.samanthalivingstone.com or email her at samantha@samanthalivingstone.com.