Buzzword alert: Mental health.

If you’ve paid attention to the news or checked your social media feeds, rarely do a few days go by without this topic appearing. While some scoff at the discussion, many others are embracing the concept that taking care of the mind is just as important as taking care of the physical body.

In sports, the conversation around and initiatives to address mental health continue to evolve. The openness by high-profile advocates like Kevin Love and DeMar DeRozan prompted the National Basketball Association (NBA) to expand its mental health program, mandating all teams to have at least one mental health professional on retainer.

Closer to home, the Ohio State Department of Athletics is taking steps to open a dialogue about the mental health of its student athletes, coaches and staff. In June 2019, head football coach Ryan Day shared his personal loss of a family member to suicide and how that was the catalyst to the creation of the Ryan and Christina Day Fund for Pediatric and Adolescent Mental Wellness at Nationwide Children’s Hospital.

Also this summer, the department doubled its sport psychology staff to include four full-time staff members to provide increased access to mental health and performance enhancement services to student athletes. The idea to expand this part of the staff was already in the works, but was slightly expedited due to the back-to-back tragedies in El Paso, Texas, and Dayton, Ohio.

“It was very important to make sure that we did an assessment of our student athletes and determine if any of them had family or friends impacted in those particular areas,” athletic director Gene Smith said in a recent episode of his podcast. “[These events] also caused us to pause and really think through what we should do for our student athletes and our staff, and try to make sure that we’re prepared to help them deal with such tragedies. And then, help our staff be able to deal with something that may occur in our environment that they have to deal with.”

Assisting with building the staff is the athletic department’s lead psychologist, James Houle, Ph.D. He’s hopeful about the increased discussion about mental health and the resources provided.

“These conversations are normalizing mental health. I think people have words to describe how they’re feeling now. These leaders that come out like Kevin Love or Demar DeRozan or Michael Phelps. It’s like ‘OMG, him? Really?’ Especially for the athletes, they are able to look at them and go, ‘Wow, me too,’” Houle says. “It’s still bothersome to come in because the idea of therapy is [nerve wracking], but there is more willingness to go. And because more people are talking about it, they’re able to get treatment earlier.”

Dr. Houle himself was a hesitant adopter of therapy. Prior to his days as a Buckeye gymnast, he earned two U.S. Junior Olympic national championships and placed second in the junior division at the John Hancock U.S. Gymnastics Championships in 1999. In the midst of earning those accolades, he struggled—bumping heads with his coaches and teammates, and talking of figuratively choking at the Pan American Games. His coach at the time, current NBC commentator Tim Dagget, encouraged him to change something before his attitude ruined his gymnastics career. His mom decided to take him to see a sport psychologist at a nearby college.

“The story I say is I was dragged to that office, kicking and screaming. I thought it was ridiculous,” Dr. Houle recalls. “The two biggest things he helped me with was, one was my attitude going into the gym. He made me smile every time I went into the gym for a month. […] It wasn’t magic, but because I was smiling, I was more approachable. My coach thought I was in a better mood so he was nicer to me, which in turn made me nicer to him. Then after a month, I felt better going into the gym.

“The other thing he did was he gave me permission to have a bad day. Just be done. That really was a game changer.”

Following his own treatment, Dr. Houle bounced back and won his second Junior Olympic national championship and his sport psychologist was the first person he called. “I said, ‘we did it!’ Ten years after that, I bumped into him at a conference and he had saved that voicemail.”

His athletic experience, coupled with his curiosity about psychology in the first place, helped shape Dr. Houle’s career path that led him back to Ohio State, this time as a staff member. He shares his personal stories with clients to help break down some of the continued misconceptions about psychology and therapy.

“I think a lot of people see it in the media and in the movies and think that’s what it is: laying on the couch and having people analyze your dreams. There’s also a misconception about confidentiality—that’s a big one. I spend time on that in the beginning. If you ever see me talking to your coach, you can know that 100 percent for certain that I’m not talking about you because that’s against the law. I could lose my license if I did that.”

Societal and familial pressures are also barriers to treatment for some. Men may feel like they need to shoulder the burden by themselves, while some have been raised to talk to family members instead of medical professionals. “Or, sometimes people think they’re weak if they choose to go to therapy. This is a big one for athletes. They think if they are weak if they come in here and cry or are vulnerable.”

However, once someone can break through their reservations about therapy, the breakthrough could spell out more success personally and athletically. Dr. Houle notices more coaches and student-athletes look at a holistic approach to treatment (mental and physical) as a competitive edge.

“Say somebody has performance anxiety and they’re ‘choking’ because they’re so nervous and they’re losing their technique and flailing. Physiologically, you need to slow everything down. We need to get your heartrate down and your breathing slower.

“Mentally, we work on things like how you talk to yourself. In those super clutch moments, having a small phrase that’s very directive that tells you what to do, as opposed to a pressure situation and their mind goes blank. It’s about having a mind game plan—that’s what we strategize. A lot of that is encapsulated in what we call mindfulness, as in paying attention to the present moment on purpose without judgement.”

Dr. Houle says that the top two issues he sees in student-athletes are anxiety and depression. According to the Anxiety and Depression Association of America, anxiety disorders affect 40 million adults (18 years old and older) in the United States, while 17.3 million adults in the U.S. suffer from some form of depression. In some cases, both anxiety and depression go hand-in-hand. To assist in treatment, Dr. Houle says that teammates, coaches, friends, family or the student-athlete him or herself may notice some warning signs.

“What we’re looking for is a marked change in behavior. An outgoing person all of a sudden ‘ghosts’ you and they’re hanging out in their room all the time by themselves. Say they’re 21 and they like to have a couple beers, but it goes from a couple beers to three weekends in a row they’re blacking out,” Dr. Houle explains. “Another example is a pretty happy-go-lucky person is quieter or more irritable. When you have that ‘whoa’ moment, that’s a sign.”

Dr. Houle also notes that with mental health issues, sleep and appetite go out the window, with noticeable swings to way too much food or sleep or not enough of either. In regards to sleep, “for athletes, it’s already hard for them to get a 12-14 hours of sleep. But if they’re getting two hours of sleep then they have to swim at 5 a.m., therein lies the problem.”

Depression symptoms are feelings of deep sadness or apathy. For men, it could look like anger. What a lot of people hear about are the suicidal thoughts or self-injury behavior. Anxiety symptoms look like nervousness, worry, some panic, irritability or fatigue.

“When I talk to people about fatigue, [athletes] wonder how anxiety associated with that. Well, your heart is basically running a marathon when you’re just sitting in class, so if you’re feeling more tired than you should be.”

There’s still a long way to go in normalizing mental health conversations, but the topic isn’t as taboo as it was just a few years ago. Dr. Houle notes that more students and student-athletes are coming into college with some type of experience in therapy or mental health treatments.

More are realizing that maybe you have to go inside your head to get out of it.