Supporting athletes throughout their journey in sport has led to many insights into the work and dedication that they need to succeed.

As a medical practitioner working in performance sport, you first meet athletes after their nomination by their sport. That initial consultation is a chance to discuss health matters, to look at how impactful their health is on their ability to train and compete and to get a one-to-one discussion on the rules of clean sport. It is also the opportunity to screen for areas of health that could have an impact on them as a person (first and foremost) and as an athlete in their chosen sport. 

There are many ways to screen for health issues and the science behind screening is constantly changing. Some tests are very sensitive but not specific to a particular health problem, others are very good at identifying a health problem but can be less sensitive, leading to a higher proportion of people having a 'false positive' result. 

In mental health, there are a few well-researched questionnaires and after much discussion among peers, the use of a modified version of the General Anxiety Disorder questionnaire (GAD) and the Patient Health Questionnaire (PHQ) provides a useful screening tool. A shortened two-question version of these tools can help screen a larger population of patients. Depending on the results, the additional five (making up the GAD 7) and seven (making up the PHQ 9) questions can be asked. The results of the questions generates a score and a plan to be put in place to support the patient.

As with any testing process, it is never black and white and the story the patient tells alongside their demeanour provides useful clinical information. As a doctor, this is very much part of the consultation with a patient. Athletes are no different and the consultation is key to providing support, diagnosis and creating a plan moving forward.

Athletes can suffer from a variety of mental health issues. As with everyone else in society, anxiety and depression are the most common and this is not surprising, given the stressors and goal-focused challenges that athletes face. 

When normal life stressors at key times of life are added in, many find it hard and can develop symptoms that are distressing and scary and can have a long-term impact. One in five people in the general population suffers from anxiety or depression. In high-performance sport, that number rises to one in four. For some sports, such as para sports, the real impact of mental health is not known as people’s life stories can bring on significant mental ill health. 

Mental health issues have been monitored and treated since the start of the medical support structure at the sportscotland institute of sport 20 years ago. What has changed is that we now look for issues proactively and ask the key health questions on a regular basis. What has also grown over 20 years has been the people working within the performance sport system.

From the outset, the collaboration between Performance Lifestyle practitioners and the medical team has supported athletes at times of greatest need. This has been enhanced over the years with experienced clinical psychology colleagues, sport psychology practitioners, a growing healthcare team of sport medicine doctors and physiotherapists and coaches becoming more aware of mental ill health. Key to providing mental health support is teaching the performance team how to recognise mental ill health and how to promote a more positive culture within a sport.

The science and medicine teams in performance sport have a duty to protect and support athletes, especially when they are at a vulnerable stage of their lives. In-house tutorials, case discussions (within the confines of patient confidentiality) and sharing learning opportunities with partners, with UK Sport networks and external partners like SAMH, all lead to people development. Supporting athletes involves being able to access the right practitioner at the right time, but also being able to signpost the athlete to the numerous resources available within the NHS and voluntary sectors.

Our sporting environment, where we practise, is possibly one of the last areas to develop. While people and processes have evolved, the infrastructure of where athletes train, compete and travel to has steadily changed but there could be improvement to make it a more positive environment where athletes and staff alike can feel more included in a sporting journey. The culture of a sport and the environment where that takes place is a delicate balance between results-focused, driven processes that deliver outcomes but keeping a watchful eye on the people side of the equation, where athletes can feel they can flourish, learn life lessons and yet deliver on a world stage. 

Mental wellbeing and positive mental culture in sport are key to supporting the journey of the athlete from first nomination as a 14-year-old to winning gold in a major Games against top-flight athletes. Sport was the first joy of the 14-year-old and should remain across that journey. 

As a performance support network, our goal is to help support and manage any key health challenges, to identify the risks of developing health issues and how to mitigate those risks. It involves respecting patient confidentiality but also learning as a system when there is clear desire to make mental health awareness more prominent. It is always better to talk about it.