The Mental Health Awakening Has Reached the Sports World — Now What?

We all expected Simone Biles to be the story of the Tokyo 2020 Olympics. The greatest gymnast of all time, seeking yet more hardware on the world's biggest stage. Before the Games, it seemed like the narrative was already written, and the only question on people's minds was about how high, exactly, her scores would soar.

Sometimes, though, reality doesn't follow the script. After one vault attempt in the team final, Biles was forced to withdraw as she battled the twisties, a mental block that causes gymnasts to lose track of their bodies in the air while attempting twisting elements. Later, Biles would cite it as a safety and mental health issue, calling the experience "petrifying." She ultimately withdrew from the all-around final and several event finals as well, finishing the Games with a team silver medal and a bronze on beam.

It certainly wasn't the Olympics the gymnast had envisioned, but it had, arguably, an even bigger impact than if she'd performed in typical Biles fashion. Her decision to prioritize herself and her mental health had a palpable ripple effect. The world of elite sports — notorious for its rigid expectations for athletes to "push through" any obstacle — was confronted with a woman who would not, or could not, put competition above her own well-being.

Over the past few years, the conversation around mental health in sports has become impossible to ignore. More and more athletes — and women athletes, in particular — are standing up for their mental wellness. Naomi Osaka has spoken openly about her anxiety since 2018 and even took a break from tennis to focus on her mental health in 2021. In the face of disappointment during the 2022 Beijing Winter Olympics, skier Mikaela Shiffrin chose honesty and self-compassion while opening up about her grief after the sudden death of her father. Gymnast Suni Lee has shared candidly her experience with impostor syndrome and anxiety, even after winning Olympic gold in Tokyo. The landscape of mental health in sports is changing, and women are often at the forefront.

There's a reason this transformation is taking place now: the stakes have never felt higher. This spring, several NCAA women athletes died by suicide — star players and standout students who often appeared fine to their friends and family. Katie Meyer was a goalkeeper for Stanford's soccer team; Sarah Shulze was a runner at the University of Wisconsin-Madison; Lauren Bernett was a catcher for James Madison University's softball team. The International Olympic Committee has reported that 35 percent of elite athletes experience a mental health issue like disordered eating, burnout, depression, or anxiety at some stage in their careers, while a 2021 study of 186 elite Canadian athletes put the number at nearly 42 percent.

At this moment, many of us are asking: What will it take to create actual change in the way sports handle mental health issues? And, when you consider the amount of personal and societal pressure that weighs on the shoulders of elite athletes, what does "good" mental health in sports even look like?

Around the time of the Tokyo Olympics, Jasmine Blocker was struggling. A sprinter who ran at Princeton and earned a relay gold medal from the 2019 world championships, the 29-year-old says she's lived with anxiety and depression since her preteen years. She'd been able to manage her symptoms, she says, right up until the pandemic.

The isolation brought on by COVID was "life-altering," Blocker tells POPSUGAR, and as the Olympics kicked off in Tokyo in July 2021, her depression and anxiety were coming to a tipping point. She wasn't competing herself, but as the Games drew the usual intense attention, she recalls feeling "lazy" and berating herself for having panic attacks. "This is ridiculous," she remembers thinking. "I need to get it together."

But when Biles withdrew from Olympic events to protect her mental health, Blocker's mindset began to shift. "This is a real thing," she says she realized. "It's justified to [say], 'It's not safe for me to do it because my head's not right.' It's justified to [say], 'I have to take care of myself first so that I can be there for others.'"

Blocker says the feeling of validation stemming from Biles's actions was a major factor in her decision to enroll in a partial hospitalization program (PHP) on the recommendation of her therapist. PHP is a structured mental health treatment program that patients participate in several hours a day, three to five days a week, for anywhere from a few weeks to several months. Distinct from full-time hospitalization or an in-patient program, patients return home every night after a day that might include therapy (individual and group), practice building coping skills, and mental health evaluations.

"My mom always said, 'You can't heal where you got sick,'" Blocker says. "I needed to remove myself fully and focus on my mental health." PHP, she says, put her "in a position where there were no excuses, and it was time to focus and to get better." The program drew Blocker away from her track career, but she knew it was the right decision. "I was not happy about [the break]," she says. "But at the same time, I couldn't get out of bed." Her depression was severe, she says, and she knew she couldn't be competitive on the track if she didn't put her mental health first.

Mental health is every bit as important as physical fitness when it comes to performance in sports, but that concept often goes overlooked or gets misunderstood. "In the world of sports, there's this thing about mental toughness," Blocker says. It's assumed that athletes will grind through any obstacle, no matter the cost (think: Michael Phelps pushing his body to exhaustion to secure eight Olympic gold medals in 2008 or Kerri Strug landing a vault with a broken ankle to win team gymnastics gold in 1996).

But this mindset simply can't be applied to all mental health hurdles. "Pushing through" depression, anxiety, and other mental health issues is not an available choice for some athletes — and even when someone is technically able to do so, it's not always the right choice. "A lot of the things that hold you back in competition don't really have anything to do with competition at all. It's about other things that are going on in your life," Blocker explains. "If you have to step away to address those so that you can come back stronger, then that might be the move. That was the move for me."

Still, making that kind of move can be difficult. The relationship between sports and mental health is interesting and complex. Sports attract perfectionists, says psychologist Lisa Post, PhD, director of a clinical program for athletes at Stanford, and with perfectionism can come anxiety and self-blame. When you work your way up to elite sports, the mounting pressure to perform can trigger new mental health issues or magnify existing ones. "Relentless" social media only adds more pressure, Post says, as does the ongoing COVID pandemic, which has scrambled athletes' fitness programs and the entire world's sense of security. "Their training routines are disrupted, their social lives are disrupted," Post explains. Returning to sports after the pandemic was "yet another huge transition" for athletes to face. And even in years that don't present unprecedented challenges like the pandemic, Post says she often sees athletes deal with anxiety, burnout, and mood disorders like depression.

There's also financial or career pressure. Sports are a bigger business than ever, Post adds, and not just at the professional level. Excelling in sports can earn you a college scholarship and the possibility of avoiding student debt, which puts pressure on student athletes to maintain their athletic performance, physical health, and academic success to keep their place on the team. Now, student athletes also have the possibility of scoring lucrative sponsorship deals, which translates into even more pressure to succeed in their sport. "There's money involved [in sports]," Post says simply. "Pressure's going to be there."

Then, there's the systemic abuse that pervades women's sports — emotional, verbal, physical, and sexual — which undeniably has an effect on athletes' mental states while they're in sports and long after.

But at the same time, for many athletes, including Blocker, sports can also be a "safe haven." Being on the track and competing is "empowering," Blocker says. The joy of moving her body and the endorphin rush that comes with it "helps me get through the day," she adds. No matter the outcome of a race or a training session, she says she never feels better than after she's given her all in a workout.

At their core, sports are "very healthy," Post agrees. "As long as it's not a toxic emotional environment and you're doing it willingly, [sports] can be really fantastic." For the college students she sees, sports provide community and positive, sometimes lifelong relationships. Athletes are encouraged to build good routines and take care of their bodies, and of course, any type of exercise has a beneficial effect on mental health.

The truth is that sports and mental health have always been intertwined in a complicated way. Sports can provide community, boost physical and mental health, foster self-confidence, and serve as an escape. Sports can also be the opposite of all those things: isolating, physically and mentally debilitating, or something that athletes can come to dread. The dividing line between the two, Post says, lies in the tools and preventative care that athletes have at their disposal. That includes positive, supportive coaching as well as access to mental health professionals who can help athletes form "process-oriented" goals (instead of outcome oriented), practice positive self-talk, and navigate challenges like injuries or life transitions.

This is an area where the sports industry has some work to do. Despite the urgent need for mental health awareness and support, all too often athletes still face negative consequences when they ask for help. When Biles withdrew at the Olympics, she received support, yes, but also plenty of criticism. Controversial broadcaster Piers Morgan tweeted, "Are 'mental health issues' now the go-to excuse for any poor performance in elite sport? What a joke." In "The Weight of Gold," a documentary about Olympians' mental health, figure skater Gracie Gold recalled getting "shrugs" when she spoke up about seeking therapy. Osaka faced a fine after skipping a press conference at the 2021 French Open, a setting that she says is harmful to her mental health.

Ultimately, then, the path forward is threefold: First, mental health resources need to be available. Then, athletes need to be made aware of them by their teams and organizations (like the US Olympic and Paralympic Committee). Lastly, the powers that be in the sports world must work to foster an open and supportive environment that encourages athletes to reach out for help when they need it.

Each one of these steps comes with its own set of roadblocks at the moment. And that's another reason it's so impressive to watch what these athletes are doing. One after another, they're refusing to stay silent and speaking up about their mental health, poking holes in the established narrative — that mental health issues are a sign of weakness or something you can just push through. The more voices that join in, the louder the conversation becomes, until the powers that be can no longer ignore it. Team USA, for example, now offers athletes a registry of mental health professionals, a free teletherapy service, and a 24/7 support line, among other resources. Pre-participation psychological examinations are taking place at the college and Olympic level to screen for mental health issues, Post adds.

Perhaps athletes shouldn't have had to demand those types of resources in the first place, but it's undeniable that the more athletes speak up about their mental health, the more change they create — and the more they inspire others to follow in their footsteps. "By talking about [mental health], you really open the doors for a lot of people to improve their quality of life, save lives, and be their best selves," Blocker says.

When it comes to mental health in sports, we're making progress, but the journey is ongoing. It's going to take continued conversation and openness, continued pressure for more available resources, and a continued dedication to make mental health a priority. Blocker's advice to athletes is to check in, candidly and often, with themselves and others. "It's being honest with yourself about where you're at, first and foremost," she says. "[Asking yourself,] 'Am I OK right now?' And it's OK to not be OK."