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International Journal of Sport and Exercise Psychology
ISSN: 1612-197X (Print) 1557-251X (Online) Journal homepage: https://www.tandfonline.com/loi/rijs20
Athlete mental health in the Olympic/Paralympic
quadrennium: a multi-societal consensus
statement
Kristoffer Henriksen, Robert Schinke, Sean McCann, Natalie Durand-Bush,
Karin Moesch, William D. Parham, Carsten Hvid Larsen, Karen Cogan, Amber
Donaldsen, Artur Poczwardowski, Franco Noce & Jason Hunziker
To cite this article: Kristoffer Henriksen, Robert Schinke, Sean McCann, Natalie Durand-Bush,
Karin Moesch, William D. Parham, Carsten Hvid Larsen, Karen Cogan, Amber Donaldsen, Artur
Poczwardowski, Franco Noce & Jason Hunziker (2020): Athlete mental health in the Olympic/
Paralympic quadrennium: a multi-societal consensus statement, International Journal of Sport and
Exercise Psychology, DOI: 10.1080/1612197X.2020.1746379
To link to this article: https://doi.org/10.1080/1612197X.2020.1746379
Published online: 07 Apr 2020.
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Athlete mental health in the Olympic/Paralympic
quadrennium: a multi-societal consensus statement
Kristoffer Henriksen
a
, Robert Schinke
b
, Sean McCann
c
, Natalie Durand-Bush
d
,
Karin Moesch
e
, William D. Parham
f
, Carsten Hvid Larsen
a
, Karen Cogan
c
,
Amber Donaldsen
c
, Artur Poczwardowski
g
, Franco Noce
h
and Jason Hunziker
i
a
Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, and Team Denmark,
Odense, Denmark;
b
School of Human Kinetics, Laurentian University, Sudbury, Canada;
c
United States
Olympic and Paralympic Committee, Colorado Springs, CO, USA;
d
University of Ottawa, and the Canadian
Centre for Mental Health and Sport, Ottawa, Canada;
e
Swedish Sports Confederation, and Department of
Psychology, Lund University, Lund, Sweden;
f
Loyola Marymount University, and the National Basketball
Players Association (NBPA), Los Angeles, CA, USA;
g
Graduate School of Professional Psychology, University of
Denver, Denver, CO, USA;
h
School of Physical Education, Physiotherapy and Occupational Therapy, Minas
Gerais University, Belo Horizonte, Brazil;
i
Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
ABSTRACT
This consensus statement is the product of the Second
International Think Tank on Athlete Mental Health, held on the
initiative of the International Society of Sport Psychology. The
purposes of the Think Tank were to engage international sport
psychology societies and organisations in a discussion about
athlete mental health as embedded in an Olympic/Paralympic
cycle, and to develop practical recommendations for sport
organisations. An invited group of designated experts discussed
applied experiences working with athletes within an Olympic
and Paralympic environment. The Games and mental health are
interrelated, because athletes committing whole-heartedly to an
Olympic/Paralympic pursuit are at increased risk of
disappointment, identity foreclosure, and high life stress.
Dividing the quadrennial into three main phases (i.e., pre-,
during-, and post-Games) participants discussed three topics for
each phase: (1) the key opportunities and challenges; (2) the
sport environment, and how it can nourish or malnourish
athlete mental health; and (3) collaboration and communication
within expert support teams. Each phase of the quadrennium
presents specific challenges and opportunities, and mental
health screening and support should be administered across all
phases. However, the post-Games period is one of increased
vulnerability, while at the same time, the returning staffis
oftentimes exhausted and unavailable. Ideally, a specialised
collaborative team should handle the post-Games mental health
support. Initiatives are needed to (a) improve the psychological
safety of pre-, during-, and post-Games high performance
environments, (b) reduce unnecessary stress, (c) optimise
recovery, (d) de-stigmatize mental health issues, and (e) increase
help-seeking.
ARTICLE HISTORY
Received 9 March 2020
Accepted 17 March 2020
KEYWORDS
Athlete mental health; sport
environments; responsible
elite sport; Olympic games;
Paralympic games
© 2020 International Society of Sport Psychology
CONTACT Kristoffer Henriksen khenriksen@health.sdu.dk Institute of Sports Science and Clinical Biomechanics, University
of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY
https://doi.org/10.1080/1612197X.2020.1746379
A consensus statement is a summary of the opinions relating to an emerging practical /
theoretical topic, derived from a well-informed panel of experts (e.g., De Boeck et al.,
2014). The present consensus statement is the product of the Second International
Think Tank on Athlete Mental Health, held on the initiative of the International Society
of Sport Psychology (ISSP), this time hosted by the United States Olympic and Paralympic
Training Center in Colorado Springs, during October 2019. The Think Tank was a non-pol-
itical and non-profit entity.
1
The purposes of the Think Tank were to (a) through their
representatives, engage international sport psychology societies and organisations in a
discussion about athlete mental health as embedded in an Olympic/Paralympic cycle,
and (b) develop practical recommendations and strategies for sport organisations. The
current statement represents consensus views of an invited group of designated
experts in the intersecting subject areas of sport psychology and athlete mental health.
Process and members of the Think Tank
A Think Thank is a small cooperative learning group where experienced practitioners and
researchers have the opportunity to discuss not only the science but also the “art”of a
topic. The intention to use this format to globally advance an important topic traces
back in sport psychology to the Redondo Beach Think Tank in 2003 on applying sport psy-
chology in competitive settings, from which the authors encouraged replications (Pocz-
wardowski & Lauer, 2006). The inaugural ISSP Think Tank on Athlete Mental Health was
hosted by Team Denmark and the University of Southern Denmark in 2018, and resulted
in the production of our first consensus statement on improving the mental health of high
performance athletes (Henriksen et al., 2019), in which the authors outlined six prop-
ositions and associated recommendations for sport organisations and researchers. From
the inaugural 2018 Think Tank and consensus statement, we recognised that sport psy-
chology scholars and practitioners have come a long way in understanding athlete
mental health, but at the same time, much remains uncharted in comprehending the intri-
cate and complex interrelationship between mental health and sport performance. Our
discussants also felt that in relation to athlete mental health, many sport organisations
have begun to pave formalised practical strategies, as they go, in response to the chal-
lenges their organisations encounter. Consequently, athlete mental health in sport
requires further attention; the scope of assessments in research and preventive monitor-
ing should be broadened in terms of what is being examined and what methodologies are
used; the role of the sport environment in (mal-) nourishing mental health should be inves-
tigated; and the role of sport organisations, including the potential education, training,
and licensing/certification of a mental health officer in particular, should be clarified.
For the current 2019 Think Tank, a smaller working group narrowed the focus to the
specific context-driven topic (see Schinke & Stambulova, 2017) of athlete mental health
in relation to the Olympic and Paralympic Games (referred to as “Games”throughout).
A group of experts was designated to join the Think Tank, represented diverse organis-
ations, and had extensive experience working with Olympic and Paralympic athletes
and travelling with them to the Games. The group was further diversified to account for
research expertise, global representation, and multiple disciplinary practical perspectives
(mental performance, clinical sport psychology, sport psychiatry, sport organisational
2K. HENRIKSEN ET AL.
psychology, and collaborative medical care). The group of experts represented key sport
psychology societies (the International Society of Sport Psychology [ISSP], the European
Federation of Sport Psychology [FEPSAC], the Association of Applied Sport Psychology
[AASP], Rede Sulamericana de Psicologia do Esporte [South American Net of Sport Psychol-
ogy]), as well as selected sport organisations (e.g., National Basketball Players Association,
U.S.A.) and national Olympic Committees. This process led to the selection of the following
panel of 11 experts, listed alphabetically. Collectively, the group has 167 years of experi-
ence working with Olympic / Paralympic athletes and has attended 43 Olympic/Paralym-
pic Games:
.Karen Cogan (PhD) is a sport psychology practitioner
2
with the United States Olympic
and Paralympic Committee (USOPC) and resides in the United States.
.Amber Donaldsen is the Senior Director of Sports Medicine and Medical Director for the
Paralympics at the USOPC. She is a sports physiotherapist by licensure, and resides in
the United States.
.Natalie Durand-Bush (PhD) is a Full Professor at the University of Ottawa, a sport psy-
chology practitioner, and the co-founder of the Canadian Centre for Mental Health
and Sport. She presently serves as the President of the Association for Applied Sport
Psychology, and resides in Canada.
.Kristoffer Henriksen (PhD) is an Associate Professor at the University of Southern
Denmark. He is a sport psychology practitioner for Team Denmark, a member of the
ISSP Managing Council, the inaugural and current Think Tank co-organizer, and
resides in Denmark.
.Jason Hunziker (MD) is an Associate Professor and the Chief of Division of Adult Psychia-
try at the University of Utah, Department of Psychiatry. He is also the consulting psy-
chiatrist to the Utah Jazz NBA Basketball team, and resides in the United States.
.Carsten Hvid Larsen (PhD) is an Associate Professor at the University of Southern
Denmark. He is also a sport psychology practitioner for Team Denmark, a co-organizer
of the inaugural Think Tank, and resides in Denmark.
.Sean McCann (PhD) is a sport psychology practitioner with the United States Olympic
and Paralympic Committee (USOPC). He represents AASP and resides in the United
States.
.Karin Moesch (PhD) is a sport psychology practitioner with the Swedish Sports Confed-
eration and a researcher at Lund University. She presently serves as a Vice-President of
FEPSAC, and resides in Sweden.
.Franco Noce is an Associate professor at Minas Gerais University. He works as a sport
psychology practitioner with various Paralympic sports, serves as a representative of
Rede Sulamericana de Psicologia do Esporte (South American Net of Sport Psychology),
and resides in Brazil.
.William D. Parham (PhD, ABPP) is a Professor at Loyola Marymount University, Interim
Associate Dean of his faculty, and the Director of Mental Health and Wellness
Program for the National Basketball Players Association (NBPA), who resides in the
United States.
.Artur Poczwardowski (PhD) is a Professor at University of Denver and a sport psychol-
ogy practitioner working with Paralympic athletes as a subcontractor for the USOPC,
and resides in the United States.
INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY 3
Mental health and the Olympic/Paralympic cycle
For athletes in Olympic and Paralympic Sports, high calibre performance represents the
pinnacle of what they hope to achieve. Athletes as well as sport organisations often con-
ceive and plan their activities based on the four year Olympic/Paralympic Cycle, where
funding, talent selection, training programmes, and other practices are planned to
ensure athlete top performance at the Games. The aforementioned quadrennial is thus
a natural reference point to address preparation, performance, and recovery associated
with the Games (Wylleman & Johnson, 2012).
Athlete mental health must be considered a core component of any responsible culture
of excellence (Henriksen et al., 2019). Nonetheless, authors have recently demonstrated
that increasing competitive pressure and training loads in international sport lead to
increased pressure on elite athletes, representing a significant threat to their mental
health. Over the last three years, a number of position and consensus statements on
athlete mental health have been published by the FEPSAC (Moesch et al., 2018), the
ISSP (Schinke et al., 2017), the IOC (Reardon et al., 2019), the Canadian Centre for
Mental Health and Sport (Van Slingerland et al., 2019), the American Medical Society for
Sports Medicine (Chang et al., 2020), and our inaugural 2019 ISSP Think Tank Consensus
Statement (Henriksen et al., 2019).
Alongside a series of scientific reviews and commentaries (Breslin et al., 2017; Gorc-
zynski et al., 2017; Küttel & Larsen, 2019; Poucher et al., 2019; Rice et al., 2016), the
current collaboration bears witness to an increased focus on the topic of athlete mental
health. Together these statements have spanned sub-clinical (Schinke et al., 2017) and
clinical (Moesch et al., 2018; Reardon et al., 2019) discussions. What these statements
share is a compelling recognition that high performance athletes seek to augment their
performances whilst also fortifying or maintaining their mental health. Balancing their ath-
letic career and mental health is taxing, and fluctuations in athletes’mental health are to
be expected. Some of these challenges are related to strenuous training, multiple
demands, increased performance expectations, and numerous transitional events (e.g.,
career advancement to a national team, injury, career decline, de-selection from an
Olympic/Paralympic cycle). Additional challenges, include, but are not limited to family
and other relational pressures, personal identity struggles, political and social issues and
concerns relative to country of origin, financial stressors, and unacknowledged and unre-
solved past adverse childhood experiences (Felitti et al., 2019). The challenges above add
to the mosaic complexity of athletic preparation and performance. These challenges
though often kept private by athletes and intentionally hidden from teammates,
coaches, and even support personnel, nonetheless influence their commitment, engage-
ment, and drive to be their very best. Though some of the focus in these discussions has
been about athlete mental ill health (i.e., mental illness/disorders), this view has been
counterbalanced with a proactive lens to promote athlete mental health (i.e., well-
being), and even the mental health of coaches and staff, illuminating the influence of
healthy external support teams on athlete functioning (see Henriksen et al., 2019).
Although athlete mental health is rapidly gaining importance as a topic in the inter-
national sport psychology community, and the Games is recognised as the pinnacle
event in many sports (Gould & Maynard, 2009; Wylleman et al., 2012), the two intersecting
topics have not yet been considered in unison. Even the IOC consensus statement
4K. HENRIKSEN ET AL.
(Reardon et al., 2019), which presents an impressive state of the art review, neither con-
siders the Games nor the distinct phases of Olympic/Paralympic preparation. This is in
stark contrast to the practical experiences of many sport psychology practitioners who
work in the Olympic and Paralympic environment and who experience the specific
phases in the quadrennial cycle: pre-Games (i.e., preparation), during-Games (i.e.,
execution), and post-Games (i.e., recovery and evaluation). These distinct phases
present distinct mental health opportunities and challenges.
Think Tank Methodological approach
The two-day Think Tank was hosted by the USOPC. The meeting began with our partici-
pants introducing each other, and then, we reviewed and agreed upon the overall
Think Tank objectives. Following this, our working group set out by defining mental
health within the Games perspective as the key focus of the two-day meeting. To structure
discussions, we discussed applied experiences working with athletes within an Olympic
and Paralympic environment during a quadrennial, and subsequently identified
common themes. From the list of themes, we developed three topics: (1) the key oppor-
tunities and challenges for Olympic and Paralympic athletes, as well as for expert support
teams; (2) the sport environment, and how it can nourish or malnourish Olympic and Paral-
ympic athlete mental health; and (3) collaboration (including coordination and communi-
cation within and outside of expert support teams), and how it is and should be structured.
Furthermore, we divided the Olympic/Paralympic quadrennial into three main phases (i.e.,
pre-, during-, and post-Games).
We discussed the three identified topics in small groups, using the three-phase Games
approach, one phase at a time. We started with the “pre-Games phase”, whereby one
group was in charge of “key opportunities and challenges”, another one was in charge
of “the sport environment”, and a third group discussed “collaboration”. Each group brain-
stormed and noted their thoughts, ideas, and main points on flipchart paper, and then pre-
sented these points to the larger group. A general discussion ensued, where participants
could share additional ideas, which were added on the flipchart paper. Once we were all
satisfied with the breadth and depth of information provided, we concluded the discus-
sion and moved to the following phase. During the final afternoon of the Think Tank,
we reviewed all of the ideas shared on the flipchart paper, and generated recommen-
dations. We concluded the meeting by dividing the work amongst each other to transcribe
the content on the flipchart paper and prepare a comprehensive document that was
shared.
Below we present the findings derived from our experiences and knowledge shared
during the 2019 Think Tank. We recognise that athletes, expert support teams, and cultural
contexts significantly differ based on several factors that cannot be comprehensively
addressed in this paper. For example, there are differences between full time professional
athletes and amateur athletes, who often have dual careers; between athletes who are
starting their athletic career and those nearing the end of it; between athletes who
compete in a sport in which repeated Games participation is the norm and those
whose sport only affords them to participate once; between athletes who compete in a
sport in which there are multiple pinnacle events and those participating in a sport in
which the Games are essentially the sole pinnacle event; between athletes living in a
INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY 5
country and doing a sport in which there are high medal expectations and those living in a
country or doing a sport in which participation at the Games is seen as a victory in and of
itself; between male athletes and female athletes; between Olympic and Paralympic ath-
letes; and between athletes living in a country in which there is a well-developed and pro-
fessionalized support system and those living in a country in which they have to
compensate for an underdeveloped support system. While accounting for all of these
factors and differences is beyond the scope of this statement, we believe that the
findings and recommendations will be applicable to several sports and contexts across
countries.
The Pre-Games phase
The pre-Games phase stretches from the initial decision that athletes make to aim for the
Games until the onset of the Games. During our discussions, it became apparent that this
phase comprises sub-phases: The early phase is comprised of roughly the first two or three
years of preparation prior to the Games; the late phase covers the intense preparation over
approximately the last year before the event. Each of these sub-phases are associated with
unique and challenges and opportunities.
Opportunities and challenges
We recognise that the early preparation phase will look very different for athletes who
transition into this phase from previous Games participation than for athletes who have
not yet been to the Games and for whom this phase is a continuation of their normal train-
ing and athletic development. In terms of opportunities, ideally and particularly for ath-
letes who have attended an Olympic or Paralympic Games, the early phase represents a
time for recovery and a time for taking care of physical issues (e.g., injuries, disability)
and mental factors (e.g., anxiety, emotional exhaustion) that they may have neglected
for a long time as a result of their athletic pursuits. This is also when athletes can exper-
iment and develop new ways of training or test new equipment. During the pre-Games,
holistic well-being can be prioritised (i.e., focus on the person rather than just the
athlete, see Stambulova et al., 2020) by staffand athletic programmes (e.g., for dual
career athletes), and athletes are often able to settle into an everyday schedule with
(albeit limited) time for family, friends, and parenthood. These opportunities are important
to restore or maintain mental health.
With regards to challenges in the early phase, “everything is still open”, which can lead
to considerable uncertainty. Athletes can be pondering, “Should I go for another Olympic/
Paralympic run? Should my life be about more than sport? Should I start/continue an edu-
cation? Should I get a real job?”The challenge is that this openness and uncertainty can
lead to stress, particularly for athletes who have focused solely on their sport leading
up to the previous Games. Some athletes face an expectation from their interpersonal
circles that life should be about more than sport now that the Games are behind them.
Many athletes also experience financial challenges during this phase. Sport organisations
frequently have less money in this period (or the same amount of money but many more
athletes to support), which may mean that athletes receive significantly less financial
support than during the lead-up to the Games. Athletes with high athletic identity may
6K. HENRIKSEN ET AL.
suffer a significant loss, if this is the end of their career. Finally, a key challenge relates to
team / staffuncertainty, because coaches and other staffmay be considering whether or
not to pursue another cycle, or their contract may not be renewed by their sport organis-
ation. The latter case has implications for athletes continuing for another cycle, leaving
them to deal with the loss of their support system. All of these are potential threats to ath-
letes’mental health.
In the late Pre-Games phase, athlete selection is a priority, final preparations are under-
way, and team rosters are reduced to those who will attend the Games. For athletes who
are selected, opportunities include additional resources and more individualised and tai-
lored support. This period also gives athletes a chance to learn about performing under
pressure and strengthen resilience, due to increased participation in more high-level
competitions.
Challenges in the late Pre-Games phase, related to athletic preparation and more per-
sonal struggles, are significant. During national trials, there is an expectation for athletes to
be 100% fit, and athletes may hide injuries, and minimise personal struggles. Some ath-
letes are deselected and suffer a loss of identity, support, friends, and life purpose. Athletes
who are selected oftentimes lose friends within the team (athletes who are not selected).
Athletes talk of high performance expectations, increased stress from an awareness of the
Games as a potential life-changing event, and the burden of “representing”their country
and all of the athletes who did not make it. For many athletes, this period comprises a long
period of high competitive demands (e.g., qualifications, trials, specific preparations such
as heat habituation), lack of recovery and self-care, injuries, fear of failure, weight manage-
ment, extensive travelling, and team or coach conflicts. All of these challenges can com-
promise athletes’mental health. Although coaches are key sources of support who are
often on the road with athletes, they often do not have the resources or training to
handle mental health challenges. Many coaches have recognised this, leading them to
advocate for more guidance to manage situations surrounding mental health, particularly
when they are on the road away without access to typical or adequate resources.
The sport environment
To create and promote an appropriate environment that fosters mental health, we need to
understand the environments in which athletes train and compete. Because athletes can
be training in multiple environments (e.g., a club, national team, international training
group), we must be aware of multiple and intersecting larger environmental systems. Fur-
thermore, due to the demands of Olympic training within the Pre-Games phase, particu-
larly in the latter part of it, athletes are typically removed from their home environments,
thus apart from direct support of family and friends. Aside from social support, we need to
consider athletes’age or developmental level as well as trends within their generation,
including the use of social media and technology. Overall, we need to be cognisant of
the influence that the sport environment has on athletes’mental health, as they
prepare to perform at the Games.
Relating to the organisational structure of the sport environment in the Pre-Games
phase, there are often limited finances to support athletes with mental health needs,
unclear structures for help-seeking, and limited access to mental health support. Stigma
around mental health remains evident, and conversations relative to better understanding
INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY 7
its origin and factors that fuel the shame, guilt, and embarrassment often associated with
the experience, are encouraging. Relatedly, cultures of abuse and collusion (Stirling & Kerr,
2009,2013) continue to exist, and ongoing dialogue and research leading to exposing
these practices are required. Environments with toxic cultures, abusive behaviours, and
poor mental health literacy in which coaches and staffneglect athletes’mental health
and self-care, as well as their own, can seriously impede athletes’functioning and ability
to thrive during this period.
There is no doubt that coaches are key stakeholders in any sporting environment and
are instrumental in building and maintaining safe and healthy organisational cultures. The
culture of a sport, team, or club plays an important role in maintaining or breaking down
stigma around mental health, and the environment that coaches create can affect athletes
seeking and accessing mental health resources. Furthermore, all professionals including
management, support experts (e.g., mental performance consultants, psychologists,
sport medicine providers, nutritionists, strength and physical conditioning trainers) can
perpetuate or diminish stigma. The early Pre-Games phase lends itself well to establishing
environments that nourish mental health, as there is typically more time and energy to do
this. Nourishing environments can then be maintained during the late part of the pre-
games phase.
However, due to more limited staffand resources during the late part of the pre-Games
phase, mental health crises can create significant strain within service provision teams,
particularly when they are travelling and managing multiple job responsibilities. Staff
are themselves under considerable pressure, may experience trouble balancing life
demands, and be more or less skilled at self-care, which in turn, can affect their ability
to support the nourishment of athlete mental health.
Coordination and communication
One of the ways that sport environments and mental health can be optimised is through
effective coordination and communication. A well-balanced system for providing immedi-
ate and follow-up mental health services throughout the Pre-Games phase demands a col-
laborative care approach through Mental Health Care Teams (i.e., interdisciplinary and
collaborative mental health care teams integrating certified/registered/licensed prac-
titioners with knowledge and experience in sport, psychology, and psychiatry, see Van
Slingerland et al., 2019). These teams should help establish comprehensive and clear
sport-focused mental health plans for all parties involved (on site and on the road).
They should also be involved in performing baseline mental health screening against
which athletes’fluctuating mental health levels can be compared across all phases of
the quadrennial. Finally, these teams can be involved in facilitating or delivering first aid
training for all parties so that there is a certain level of competency and comfort in addres-
sing mental health challenges. The early Pre-Games phase is an ideal time to embark on
the effective coordination of resources.
There are several structural challenges to coordination and communication regarding
mental health promotion and treatment in the Pre-Games phase. These include but are
not limited to: (a) the size of the country and number of individuals involved in
different sports and Mental Health Care Teams (b) coordination and communication
within internal team members (e.g., athletes, coaches, support experts, NGBs and other
8K. HENRIKSEN ET AL.
administrative staff); (c) coordination and communication with external individuals, prac-
titioners, and stakeholders in the community; (d) coordination and communication while
on the road with teams; and (e) formal regulations and restrictions regarding the means
through which staffcan communicate with athletes. These challenges to coordination
and communication should not, however, stand in the way of building an integrated col-
laborative care system to manage athletes’mental health, particularly as stressors and
pressure increase from the early to late parts of the pre-games phase.
A Mental Health Officer (MHO) can help establish, communicate and coordinate activi-
ties with Mental Health Care Teams, including mental health literacy and first aid training.
The MHO would be involved in performing administrative duties, assessment, and/or
treatment tasks as necessary, including but not limited to: screening for eligibility criteria
and mental health needs; triaging and referring athletes to appropriate practitioners; and
redirecting athletes who do not meet eligibility criteria to community resources. The MHO
should be part of the athletes’Mental Health Care Team. The education, training, and
experience of the MHO are important (e.g., should have knowledge/experience working
in high performance sport, have education and training in sport sciences and clinical/
counseling psychology). The roles and responsibilities of the MHO should be well
defined, and coordination and communication with all parties should be clear and
ongoing throughout the Pre-Games phase.
Recommendations for the Pre-Games phase
Based on the opportunities and challenges, the sport environment, and the coordination
and communication tasks identified above, we provide the following overall recommen-
dations for taking care of athlete mental health in the years leading up to the games.
(1) Establish a collaborative Mental Health Care Team, headed by a Mental Health Officer,
with organisational clarity for efficiently and effectively managing athletes’mental
health (e.g., confidentiality, eligibility criteria, and referral resources).
(2) Perform mental health screening early on in the quadrennial with proper follow-up for
athletes screening positive for mental health struggles.
(3) Provide mental health literacy programmes for athletes as well as coaches and all
expert support staffand management in order to reduce stigma, increase early
help-seeking, and minimise risk.
(4) Promote self-care, resiliency and recovery training for athletes as well as coaches and
expert support staffand management.
(5) Establish healthy, sustainable, compassionate, and psychologically safe sport environ-
ments that emphasize support, allow time for recovery, and reduce unnecessary stress.
During-Games phase
The “During-Games”phase spans the period of participation at the Games (i.e., between
which athletes arrive at and depart from the Olympic/Paralympic Games). Participating
at the Games is not only a rewarding and exciting experience, it is also one of intense
stress, high expectations, and performance pressure (Schinke et al., 2015). Although a
INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY 9
healthy sport environment, sound planning, and effective promotion, screening, and treat-
ment initiatives during the Pre-Games phase reduce the potential problems that can arise
during the Games, there are nonetheless inevitable significant challenges occurring during
the Games phase. It is important to recognise that everything is a performance issue at the
Games (McCann, 2008). Helping athletes manage mental health issues is a moral, ethical,
and professional obligation, as well as a performance enhancement strategy.
Opportunities and challenges
We recognise that the experience of the Olympic/Paralympic event is deeply contextua-
lised and will depend largely on whether or not athletes are first-timers, medal hopefuls,
and successful. With the proper support, the Games can stimulate growth and become a
significant positive life experience. Athletes can strengthen their resilience, refine their
attention regulation skills, and develop an increased understanding of performing
under pressure. For media-exposed athletes, a successful appearance at the Games can
enhance post-Games career opportunities.
However, despite extensive preparation, mental health issues will emerge during the
Games, and practitioners who have travelled with athletes to the Games have experienced
a series of challenges that can arise during this time. The challenges can pertain to an
increased sense of pressure and expectations, intense media scrutiny, increased social
media engagement, heightened emotional volatility, strained relationships, conflicts
within the team, unhealthy comparisons to others, and a decreased ability to sleep. The
Games are like a magnifying glass for both positive and negative thoughts and emotions,
and they are often experienced as an emotional rollercoaster. Athletes often stay prolonged
periods in the Olympic/Paralympic village and experience fatigue managing all of these
thoughts and emotions, and sometimes a decreased capacity for regulating stress due to
cognitive and emotional depletion. Such problems are augmented in the case of sport inju-
ries, lost opportunity to compete or not qualifying for a team or a relay, or learning suddenly
about a family, friend, or other life-related adverse circumstance.
Aside from these common issues experienced at the Games, there can also be more
clinical issues such as panic attacks, depressive episodes, exacerbation of an eating dis-
order or OCD, cutting/self-injurious behaviours, overuse of substances such as alcohol
or sleep medication, and in extreme cases, suicidal ideation and attempts. This under-
scores the importance of having appropriate Mental Health Care Teams at the Games.
The Games environment
From the outside, the Olympic/Paralympic village may seem like an idyllic oasis reserved
for likeminded athletes. However, in reality, athletes often experience life in the village as
stressful, and so, often not conducive to positive mental health. For example, athletes live
in close quarters and have difficulties finding space to be alone. Dining areas, meeting
spaces, buses, and training areas are always crowded. Transportation can be unpredictable
and there is extended security with long wait lines for credential and bag checks. Athletes
who are no longer competing engage in extensive partying and sexual activities. Regard-
less of a seemingly wide array of menu options, some athletes struggle to find food they
like. Athletes also often experience being asked by family and friends about directions,
10 K. HENRIKSEN ET AL.
access to tickets, help with planning their trips, and other logistical demands. Paraly-
mpians, additionally, have varying special needs that quite possibly position them to
experience heightened stress and emotional discomfort.
Moreover, athletes are constantly reminded of the importance of the Games and that
they are there to perform. Everywhere they turn, there is a television screen showing ath-
letes in what is likely the most important competition of their lives. There is a lot of
exposure to other athletes winning and losing and wearing medals or looking disap-
pointed, as well as to star athletes and celebrities. In the village, venues, and in the over-
whelming mixed-zone, athletes experience increased media attention and often from
media people who do not normally cover sports and who may ask unusual and politi-
cally-charged questions.
Finally, athletes may struggle to navigate the Games as the most important competition
of their lives (i.e., requiring full focus and recovery) and the greatest experience of their
lives (i.e., taking in the atmosphere and enjoying the afforded opportunities). They experi-
ence this dilemma, for instance, when they are asked to decide whether or not they will (a)
participate in the opening ceremony where they will stand for hours, which could deplete
them if they are competing the following days; (b) go cheer for teammates and see other
athletes compete; and (c) attend some of the many “by invitation only”coveted events
such as receptions with attendance from royalty or political dignitaries.
Coordination and communication
For many countries and teams, there is typically a high level of support and resources at
the Games. Athletes’performance is prioritised, sometimes at the expense of their mental
health. Ensuring effective coordination and communication is not easy. Credentials are
scarce, and many expert support staffmay not be staying in the village and may only
be able to enter the village and venues on preselected days. Some athletes’personal
coaches, with whom they are used to talking about how they feel, cannot access the
village and venues. Security and access issues can challenge typical operations of
expert support systems. Furthermore, many people in the Olympic/Paralympic environ-
ment (e.g., coaches, support staff) are themselves under increased stress and pressure
and experience a lack of sleep and recovery, and could be at risk of being less attentive
to athletes’mental health, especially as the event proceeds. Nevertheless, a high level
of coordination and communication between athletes, coaches, and all support staff
and management is key to successfully minimising and handling mental health issues
at the Games. At a minimum, there should be a qualified Mental Health Care Team
present at the Games, and protocols for identifying needs and providing mental health
care during the Games should be established and clearly communicated. Ideally athletes
should receive care from practitioners with whom they have already developed rapport
and trust during Pre-Games phase.
Recommendations for the during-Games phase
During the Games, coaches, expert support staff, and Mental Health Care Teams should
remind athletes to trust the extensive preparation they have done, focus on the “control-
lables”, and normalise heightened experiences of stress and pressure. Based on the
INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY 11
aforementioned opportunities, challenges, the uniqueness of the Games environment,
and the importance of coordination and communication, we provide the following rec-
ommendations for addressing athlete mental health during the Games:
(1) Develop a clear support structure and protocol for coordination and provision of
mental health care, ensuring job descriptions and roles are clearly defined for all
staffand athletes. Clarity and coordination includes clear lines of referral to medical
and mental health staff, as well as on-site polyclinics provided by the IOC/IPC and
local hospitals. A crisis protocol should also be integrated that everyone in the del-
egation knows with systematic and confidential record keeping that meets mental
health care regulations.
(2) Ensure that the staffselected has appropriate credentials and a high level of mental
health literacy. When possible, there should be a MHO in attendance at the Games
with a working knowledge of the Games environment. Provide adequate and
sufficient resources for mental health support, and ensure there are frequent oppor-
tunities to check-in and that information is being disseminated to all team members.
(3) Provide physical spaces suitable for mental recovery, as well as confidential and
private spaces for mental health care that meet safe sport requirements.
(4) Teach coaches and expert support staffto be intentional with staffself-care, because
they are themselves under considerable pressure and at risk of unintentionally apply-
ing unnecessary added pressure on the athletes.
(5) Help athletes develop a “friends and family plan”and inform their social circles about how
they wish tobe approached at the Games. Athletes shouldalso be assisted with the devel-
opment of a social media plan that recognises the need to capitalise on the Games while
protecting them from the unnecessary added stress of feeling obliged to post all the time
and helping them avoid reading irrelevant or unsupportive comments.
Post-Games phase
The Post-Games phase comprises the period immediately following the Games and
extends to the time when athletes decide to either continue for another quadrennial
cycle (i.e., at which point they re-enter the “Pre-Games”phase) or completely transition
out of sport, should they decide to retire. We share the classic adage “You never run to
the finish line –you run through it”to highlight the importance of Post-Games mental
health support. We should not see the Games themselves as the “end of the road”, and
instead, include mental health support for the critical time period following it. Whether
athletes have been successful or not, the period following the Games is a challenging
one that can create new or exacerbate existing mental health challenges and illnesses.
Not surprisingly, the post-Games period involves coming to terms with the Games experi-
ence and outcomes, and the time spent away from loved ones. For some athletes, it can
also mean an unwelcome invitation to resume the management of complex and difficult
sport and life experiences that will not simply disappear.
Many national Olympic committees invest extensive effort, resources, and time in the
Pre-Games and During-Games phases. This is in shocking contrast to the very little strate-
gized attention that is often allocated to the post-Games time period. With the multiplicity
12 K. HENRIKSEN ET AL.
of issues and the high vulnerability of athletes to experience the commonly referred “post-
Olympic blues”, the “after Games”phase in the quadrennial cycle must be targeted as a
unique and extremely important time for mental health support.
Opportunities and challenges
Athletes will experience the post-Games period very differently, depending on whether or
not the Games was a successful and/or positive experience, and whether or not they will
continue to pursue their sport, or voluntarily or involuntarily end their career. During the
period immediately following the Games (first days up to several weeks), many athletes
will experience being the centre of attention, being invited as celebrities to attend
events and do media appearances. This can be a stressful but also enriching experience.
During this time, opportunities include capitalising on the Games (e.g., making money
from public speaking, increasing recognition and personal branding, obtaining sponsor-
ships). After this initial period of time, however, the interest often diminishes. Competitive
pressure is usually absent and athletes have opportunities for recovery, self-care, sleep,
personal activities with significant others, debrief and reflection on the quadrennial, and
new or previous hobbies/activities to expand their non-sport identity. Athletes may also
use the time to deal with injuries they have been ignoring, and when required, have
surgery. This period further allows athletes the time to plan for their future career, and
decide whether or not they want to aim for the next quadrennial, go back to school or
work, or perhaps start or expand family. Some athletes find it meaningful in this period
to give back to their sport, for example by coaching, mentoring, organising charity or fun-
draising events, or giving talks to younger athletes.
However, for many athletes, the post-Games period is filled with challenges, and
decreased mood (or the “blues”) is common. Immediately following the Games, athletes
can experience intense emotions and mood fluctuations resulting from winning medals
and/or underperforming (e.g., disappointment, shame, anxiety, depression, euphoria).
After the “hype”wears off, athletes often experience a loss of identity, including a loss
of purpose, meaning and direction. They can experience isolation, loss of daily structure
and routine, and decreased social support and communication. For example, when the
team dissolves and athletes come home ready to re-engage with family and friends,
they are sometimes confronted with the reality that these people have continued living
without them and are busy with their own lives.
From an organisational perspective, a key challenge relates to the lack of specific post-
Games protocols, and extended and ongoing support. Coaches, support experts, and
other staffare themselves tired or even burnt out after the Games, and will often focus
on their own recovery or new tasks, which leaves athletes with little access to professional
support. For many athletes, the Games are not only the pinnacle but also the final event of
their sport career. The end of the Games represents the end of their life as high perform-
ance athletes and the beginning of a potentially difficult career transition. There may be a
lack of funding for mental health support or unclear pathways to this support. Athletes
may feel they are no longer entitled to draw from the sport system (e.g., to access to facili-
ties, support staff, and financial support through assistance programmes). Retiring athletes
may have to move out of a training centre or sport housing system. For Paralympic ath-
letes, the intense focus on sport and “being a top level athlete”may be replaced by a
INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY 13
focus on disability challenges and the notion of “being disabled”. This is often combined
with limited employment opportunities (e.g., compared with able-bodied athletes). Ath-
letes who transition into education or work often talk about the difficulties of starting
“at the bottom”while seeing themselves as skilled and dedicated winners. Some athletes
make the decision to stay in sport, not out of motivation to train and perform, but simply
because all the major life changes seem unmanageable, but these athletes eventually
decline in their athletic abilities, and persistence beyond one’s peak can lead to forced
de-selection (see Sinclair & Orlick, 1993) and athletic identity problems.
The post-Games environment
Unlike life in the Olympic/Paralympic village, there is no common environment after the
Games; athletes go in all directions. Some go back to their local training centres or
clubs to continue life as athletes, while others go on extended holidays travelling the
world, or enter school or the workplace. These environments each have their opportunities
and challenges. Athletes who continue their sport often describe their sport environment
after the Games as very different from before. Returning athletes commonly reference
changes in and expansion of teams of athletes at local and national training centres. Struc-
tures (e.g., expert services, financial support) change or disappear. Coaches may resign or
get fired, and new ones get appointed. Additionally, many athletes may be surprised to
find that it is hard to leverage and make an income based on winning an Olympic
medal, a pathway to finance they initially planned upon.
Coordination and communication
There is no doubt that the post-Games period is one of increased vulnerability and need
for mental health support. Follow-ups are necessary and sport organisations and staff
should be extra attentive to athletes’mental health. Returning stafftypically requires
rest and recovery and time to take care of their personal needs. This creates a “void”
and lack of resources to execute wide scale screenings and attend to athletes in need.
Ideally, dedicated people within the Mental Health Care Team are available during the
Post-Games phase. They, along with the support of sporting organisations, can use mul-
tiple strategies to monitor athlete mental health (e.g., surveys, dialogue with athletes,
families, and coaches). Communicating with existing or new expert support staff(e.g.,
medical doctors, physiotherapists, strength and conditioning coaches) about athletes’
status and needs is paramount for the early identification of mental health struggles
and the timely provision of care. Finally, establishing and communicating clear protocols
for accessing both internal and external mental health resources is important, especially if
resources have been reduced during this period.
Recommendations for the post-Games phase
Recognising that the post-Games period is one of added athlete vulnerability and chal-
lenges to a coordinated supportive environment, we provide the following
recommendations:
14 K. HENRIKSEN ET AL.
(1) Consider the post-Games period as the final (and an equally important) part of the
quadrennial such that the four years are really a “4 + 1 quadrennial”, with the last
year equally requiring mental health support. At a minimum, mental health screening
and services should be available to athletes for 12 months after the Games even if they
are retiring, to augment healthy career transitions.
(2) Develop a system to monitor athlete mental health through multiple methods that are
sensitive to a variety of unique post-Games challenges. Assuming that mental health
literacy training was provided during the Pre-Games phase, it also includes reiterating
and reminding staffand family members of warning signs, symptoms, and available
resources. Mental health support providers should reach out to athletes and not
await their requests.
(3) Make specific plans for post-Games debriefing and assistance with sport re-entry or
career termination. These programmes should ideally be administered by specifi-
cally-prepared support experts, with a dedicated budget, in collaboration with more
long-term support experts. Recognising that the sport environment after the Games
will inevitably change, put in place structures for maintaining some familiarity of exist-
ing daily sport processes (e.g., provide opportunities for continued light training and
team gatherings).
(4) Develop clear policies for accessing mental health support during the post-Games
phase, and clearly communicate these to all parties. These should specify support
rights and access for specific groups of athletes (e.g., medal winners, athletes who con-
tinue or retire), and a deadline by which retired athletes need to ask for assistance
before they are no longer covered by the sport system. These policies should
outline clear referral guidelines and ways to access external resources for those who
do not meet eligibility criteria.
(5) Normalise the emotions associated with the post-Olympic/Paralympic experience, for
example by using past athletes as spokespersons for mental health issues or post-
Olympic experiences, and by communicating the benefits of reaching out for help
and the courage required to do so. Normalisation includes breaking stigma by inviting
athletes to discuss their post-Games experiences and challenges as part of peer-
support groups.
Conclusion
The purposes of this ISSP Think Tank were to (a) engage international sport psychology
societies and organisations in a discussion about athlete mental health, embedded in
the Olympic/Paralympic cycle, and (b) develop practical recommendations for sport
organisations. The current statement represents the collective view of an invited
group of designated experts in the areas of sport psychology and athlete mental
health. Until now, the Olympic/Paralympic games have not been examined from a
specific mental health lens. The present consensus statement is intended to inform
and inspire future initiatives focused on athlete mental health in relation to the
Olympic/Paralympic quadrennial. We would like to conclude this statement with five
postulates that build onto the first ISSP Think Tank consensus statement (Henriksen
et al., 2019):
INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY 15
(1) Athlete mental health is a core component of any culture of excellence. As the career
pinnacle for many athletes, the Olympic and Paralympic Games are not only the most
important event to show excellence but also a potentially life-changing event. When
athletes commit whole-heartedly to an Olympic/Paralympic pursuit, they are vulner-
able and at increased risk of disappointment, identity foreclosure, and high life
stress, which can lead to poor mental health. Thus, the Games and mental health
are interrelated, and understanding this intricate relationship will help sport organis-
ations provide adequate and tailored resources and services. Specialised collaborative
and sport-focused Mental Health Care Teams, led by a qualified MHO, should oversee
and provide mental health services across all phases of the quadrennial.
(2) While stress levels remain high throughout the quadrennial, stress comes from
different sources, and each phase of the Olympic/Paralympic cycle presents specific
challenges and opportunities. Mental health screening and support should be admi-
nistered across all phases of the quadrennial while taking into account the unique
aspects of the specific phases.
(3) The post-Games period is one of increased vulnerability and need for mental health
support. However, immediately post-Games, the returning staffis oftentimes
exhausted and unavailable, and there is a void in support as well as a lack of resources.
The Olympic/Paralympic quadrennial should therefore be extended to a “4 + 1 quad-
rennial”. The post-Games mental health screening and support should ideally be
handled by a specialised team with a dedicated budget.
(4) The mental health of athletes is everybody’s business but should be somebody’s dis-
tinct responsibility. Mental health transcends professional boundaries of interdisciplin-
ary fields (i.e., psychology, counselling, psychiatry, medicine, and mental
performance), and a collaborative approach is key to ensuring comprehensive,
timely, and efficient mental health care. There are inherent dilemmas in maintaining
confidentiality when working within a collaborative support team, and structural bar-
riers for coordinating care (e.g., extended travelling commitments in the pre-Games
period, limited credentials during the Games, and limited resources post-Games) for
which solutions must be developed.
(5) Mental health prevention and promotion should complement mental health care (i.e.,
treatment) across all phases of the quadrennial. Sport psychology practitioners should
teach athletes mental / self-regulation skills to optimise resilience and their ability to
cope with stressful, high pressure environments. However, this strategy should be sup-
plemented by putting in place initiatives to (a) improve the psychological safety of
pre-, during-, and post-Games high performance environments, (b) reduce any
unnecessary stress, (c) optimise recovery, (d) de-stigmatize mental health issues,
and (e) increase help-seeking.
Notes
1. We recognise that the intricate relationships between mental health and Olympic and Paral-
ympic Games preparation, performance, and recovery are too complex a topic for any group
of experts to grasp in their nuanced entirety during a two-day think tank. We also recognise
that, as a result of procedures for selection and invitation, the Think Tank mostly represented
organised systems in modernised societies. Future think tanks on the topic will integrate a
16 K. HENRIKSEN ET AL.
broader diversity of experts. We acknowledge that this consensus statement reflects the Think
Tank participants’collective dialog based on knowledge available at the time the statement
was written.
2. The different represented countries use different titles, including mental performance consult-
ant, sport psychologist, and sport psychology consultant. Fpr simplicity, we here use the title
of sport psychology practitioner as a collective name to describe a person who practices sport
psychology (i.e. consults with athletes). All participants are registered or licensed within their
national systems.
Acknowledgements
The Think Tank that led to this Consensus Statement was supported by grants from the US Olympic
and Paralympic Committee
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
This work was supported by United States Olympic and Paralympic Committee.
ORCID
Kristoffer Henriksen http://orcid.org/0000-0003-2966-7469
Carsten Hvid Larsen http://orcid.org/0000-0003-3309-9417
Franco Noce http://orcid.org/0000-0001-6751-0871
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