The NFL is in no hurry to introduce psychological support for players

When Damar Hamlin, a Buffalo Bills security officer, went into cardiac arrest and passed out during a Monday Night Football game in Cincinnati on January 2, Carrie Hastings, who was half a continent away, immediately realized what she needed to do. .

“I had a few guys that I immediately knew I had to test,” said Hastings, a Los Angeles Rams sports psychologist and psychiatrist. “A couple of spouses and other significant persons too.”

Hastings’ familiarity with the Rams staff, and that players could be emotionally traumatized after watching Hamlin’s shocking medical emergency, was the result of her spending six seasons at the club — getting to know the athletes, meeting the newcomers when they first arrived, and became a regular presence at the Rams facility.

There is no such continuity of care in the NFL. The league is working to create mental health support for its players, coaches and staff where a range of counseling is standard and readily available.

Just over three years ago, in 2019, the NFL implemented a formal program to manage the mental health needs of its employees. This became part of the new collective bargaining agreement after the NFL Players Association actively pushed for one. Among other things, the agreement requires each team to have a licensed behavioral health professional on staff.

But individual franchises still have a lot of leeway in implementing this directive. Some have in-house sports psychologists; others are hiring part-time doctors, and some are contracting with third-party providers and providing them to players, Hastings said. And no sports education is required of clinicians, which some sports psychologists see as a critical shortcoming.

“It’s a very specialized area,” said Sam Maniar, a counseling psychologist for the Cleveland Browns and formerly the team’s staff clinician. “The athletics environment, especially at the highest level, requires specialization, and not every doctor brought into the NFL has it.”

Hastings was a sprinter and hurdler during her student days at Notre Dame, has extensive professional experience working with athletes, and is on the U.S. Olympic and Paralympic Committee’s Sports Psychology and Mental Health roster. She runs her private practice a short drive from the Rams’ training facility in Agoura Hills, northwest of Los Angeles, and although she’s technically a part-time job, Hastings said she visits the facility three or four once a week “and mostly on call”. 24/7 during the season.

In this capacity, Hastings has worked to build a foundation of trust among elite athletes, who often think of a sports psychologist only in terms of preparing them for competition.

“It’s often the case that a player comes in about something performance-related, and that opens the door to conversations about other areas of mental health,” she said. “Relationships are deepening.”

Doctors say this ingrained presence on teams is critical, especially as some athletes have begun to speak more openly about the mental and emotional issues they face and implicitly encourage their peers to be more open to getting help.

Tennis sensation Naomi Osaka, Olympic champions Simone Biles and Michael Phelps, NBA stars Kevin Love and DeMar DeRozan have publicly discussed their mental health issues over the past decade, and some of them have launched awareness campaigns. “I’m grateful to them for speaking up about their concerns and how much they benefited from accessing the help that was available to them,” said Maniar, who runs the Ohio Sports Achievement Center and works with football teams. college and high school teams. Browns.

The NFL is a difficult arena for these kinds of conversations. Players in the league are used to dealing with all kinds of pain and injury almost like a job, and for most of the league’s existence, its athletes have, in fact, been trained not to show vulnerability.

The league-wide implementation of the program, while a milestone, has not radically accelerated the pace of change. “I think the NFL is still a dinosaur in that regard,” Green Bay Packers defenseman Aaron Rodgers told The New York Times two seasons ago. “There is a stigma around talking about feelings, struggles and dealing with stress. There’s a lot of vernacular that seems to label this as a weakness.”

The players’ union has become more aggressive in tackling the problem. “NFL players are often seen as the pinnacle of masculinity, and because looking after your own mental well-being and seeking support has not historically been associated with masculinity, far too many of us don’t prioritize that aspect of our health,” Union President J.C. Tretter, an eight-year NFL veteran, wrote in a 2021 blog to players urging them to use available resources.

Hamlin’s highly unusual emergency, in which he required CPR on the field before he was taken to the hospital from a Cincinnati stadium where the Bills and Bengals played, “really caused concern for some players and provoked others” Hastings said. In addition to reaching out to several players individually, she sent out a message throughout the Rams organization reminding athletes, coaches and staff that she was ready to talk.

“Many of them were susceptible,” Hastings said. “The elephant in the room is mortality. Players know they can get hurt and they’ve all dealt with injuries, but that included an element they couldn’t control.”

The Bills and Cincinnati Bengals stood in stunned silence as Hamlin lay on the field. A few days later, the Buffalo players were still trying to express their feelings. “This scene plays over and over again in your head,” defenseman Josh Allen said during a press conference, holding back tears. “It’s hard to describe how I felt and how my teammates felt at that moment. This is something we will never forget.”

Hamlin’s subsequent progress, including his discharge from the hospital to recuperate at home, “will help mitigate some of the trauma players have endured,” said Dr. Joshua Norman, an Ohio State University sports psychiatrist who often works with athletes on emotional processing. . “But even though they are trying to separate things, these players have witnessed a serious injury. Some of them will have a strong reaction.”

Dr. Claudia Reardon, a psychiatrist at the University of Wisconsin, said the term “assisted trauma” applies here. “The original traumatic event did not happen to you personally, but it is experienced as traumatic if you witnessed it or learned about it,” Reardon said. Reactions range from fear and helplessness to nightmares and flashbacks, she said, and some athletes try to avoid “people, places or things that remind them of the trauma they have witnessed.”

“I wouldn’t be surprised if some players retire early,” Maniar said. “And a big concern is a player who comes on the field and plays hesitantly or in fear. It’s a sure way to get injured in a sport like football and contracts are not guaranteed in this league. You’ve heard the saying “NFL means not for long”. The players feel that pressure.”

Clinicians say the NFL’s best chance of making big headway in mental health insurance may be due to the simple fact that it is constantly recruiting and developing new talent. “The younger generation is just more sophisticated about mental health, period,” Norman said. “They come to a college campus often already having some connection with their mental health needs through counseling or other means. They are more open to the idea of ​​taking care of their mental health.”

Work continues inside the franchise complexes. Both Hastings and Maniar were hired by their NFL teams years before the league made a doctor mandatory, and both made sure they had an office away from the training center for those players who were uncomfortable seeing them at work. But lately, as Hastings said, that too is changing.

“Players are more likely to discuss issues like this with each other, and they do it very publicly,” she said. “In many ways, we have been developing our mental health protocol since I was invited in 2017.” In the NFL, this turns out to be a slow turn.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Foundation.