For years, NFL teams hired psychologists to care for players or deliver mental skills training, but there was little consistency from one team to the next. Now, that’s changing. A joint initiative of the NFL and NFL Players Association (NFLPA) is standardizing behavioral health care and creating a culture of prevention across the league, spurred by a growing recognition of the need for a holistic approach to athletes’ health.
As a result, each team has hired a licensed behavioral health clinician—about three-quarters hired psychologists—who spends 8 to 12 hours a week at the team’s facility. In addition to spotting and treating mental health concerns, they teach players and coaches about good mental health and create action plans for handling mental health crises. The NFL/NFLPA initiative is also developing a suicide prevention effort as well as educational programs for players, their families and team personnel.
“The implementation of this initiative emphasizes the inextricable link between mental and physical health and performance,” says psychologist Nyaka NiiLampti, PhD, the NFL’s vice president of wellness and clinical services. “It also expands the care that is currently being provided to players, helping to normalize and destigmatize building positive mental health.”
Normalize Mental Health Care
Professional athletes face a number of challenges related to their work, including high injury rates, public scrutiny, short careers and high-stakes contract negotiations, says psychologist Scott Goldman, PhD, the team clinician for one NFL team. Other common challenges include confidence issues, relationship problems with spouses and family, and conditions such as depression, anxiety and substance misuse.
Even for teams that already employ an on-site behavioral health-care provider, the NFL/NFLPA initiative represents a meaningful change, says Chris Carr, PhD, team performance psychologist and behavioral health clinician for one NFL team.
“It takes mental health out of the shadows and elevates the clinician as an important part of each organization’s success,” says Carr, who works as part of an integrative support team that includes sports medicine physicians, athletic trainers, dietitians, player engagement staff, and strength and conditioning specialists. In addition to providing comprehensive mental health assessments, Carr also offers treatment and referrals to specialized providers—such as a marriage and family therapist—when needed. Through presentations, he teaches team members skills such as goal setting, managing pre-performance anxiety and refocusing in the face of distractions. Carr also provides support and education to coaches and other team personnel and conducts mandated educational sessions on the hallmarks of anxiety, depression and substance misuse, as well as how to seek help.
“Having psychologists embedded in this space allows teams to move away from a crisis-management approach … to one that focuses on prevention and early intervention,” says NiiLampti.
In a separate but related initiative that involves psychologists, the NFL and NFLPA also required each team to appoint a pain management specialist, typically a physician, before the 2019 season began. This specialist may prescribe medication but also collaborates with behavioral health providers and other team personnel to offer non-pharmacological aids for rehabilitation, recovery and managing pain, such as cognitive behavioral therapy. Goldman says the integration of behavioral health and pain management into his team’s model of embedded care has already helped normalize psychological treatment as part of an athlete’s overall health.
“The stigma quickly vanishes when people recognize that learning to manage stressors and eliminate distractions provides a huge performance advantage,” he says.
Training Psychologists for Athlete Care
As psychologists’ role in the NFL and other professional leagues such as Major League Baseball and the National Basketball Association continues to expand, experts say it’s essential for providers to obtain specialized training in sport psychology.
“I’ve watched clinicians enter sport environments with very little understanding of team culture,” says Carr. “Unfortunately, they just further stigmatize our role.”
Important skills to master include establishing a visible presence with the team in group settings and navigating a complex organization of coaches, athletic trainers and other providers, says Bradley Hack, PhD, sport psychologist and president of APA’s Div. 47 (Society for Sport, Exercise & Performance Psychology). For those interested in obtaining specialized training, Div. 47 offers continuing education webinars and a proficiency in sport psychology and is developing professional practice guidelines.
The NFL will also continue to seek avenues for improvement and will evaluate the effectiveness of the new initiative at the end of this season. In the future, the league hopes to expand its support network to offer additional services for all members of NFL organizations.
“We know that the health of the players is tied to the health of the entire organization, so our ultimate goal is to continue expanding the focus to help change an entire culture,” says NiiLampti.