What really happens to the ‘Picture Perfect’ reality behind closed doors for elite athletes? Here is an insight into how athletes really feel behind the scenes, and the battles they encounter with their own mental health. “There is never a finish line” (Michael Phelps, ESPN).

When you are doing something, you love, you often don’t think about the bigger pictures, what could happen if that thing you’re doing went terribly wrong or an unexpected obstacle was put in your path. Elite Athletes are often perceived by individuals across the world as ‘talented and perfective professionals’ when it comes to performance in their sporting careers, however this is not the case behind closed doors. Like any other human beings, these sport-driven individuals face several career impacting issues both acknowledged and not acknowledged by the general public including injuries, illness/disease and personal issues. These factors introduce concerning risks and exposure to athletes and their future.

Over the past few year’s surveys, statistics and articles have shown that one of the most common and disregarded health concerns found in elite players are mental health issues. This health issue leads to the bigger questions including why is mental health considered one of the biggest issues amongst elite sportspeople and what are the reasons for athletes to have such a significant increase in this psychological area? Whilst athletes are busy making the most of their career in sport, they often are having to maintain their ‘picture perfect reality’ which behind closed doors is an entirely different rollercoaster of emotions and experiences. Athletes such as Naomi Osaka, Serena Williams, Michael Phelps and Darius Boyd have all experienced some form of this and for them it included facing their own mental health issues. But why did they encounter these issues?

Reasons for athletes to experience mental health issues

Psychologically speaking, athletes are constantly put under immense pressure to not only perform, but to exceed high expectations set by not only themselves, but by their fans and the general public. Stress is the most common cause of mental health issues in elite performers. Stress can often come from the environment and situation they are placed in, having to always look happy and be the best they can be. In 2018, Sky Sports UK interviewed athlete, Michael Antonio, A Premiere League player for West Ham United Football about how stress played a huge role in his mental wellbeing. “Imagine you had a bad day and then you had thousands of fans telling you, that you are terrible… There is a massive stress in the game when you constantly have to be your best”. Imagine how exhausting it would be if you were an elite athlete feeling this way. Stress not only can come from the way people view you as an athlete but also from unpredictable factors such as injury and injury reoccurrence.

Injury and injury reoccurrence can lead to major or minor setbacks in athletes and often influence their decision to continue on in their career or pull the pin and move on from. Having to sit on the sideline, or even watch other people replace your position often results in the lowering of self-esteem and an increase in self-doubt. Although these factors can be avoided as athletes have easy access to mental health services and psychologists who assist in these times, there can still be barriers preventing them to get the assistance they require. For Emelie Forsberg, injury played a significant role in her mental health world. Forsberg, a Swedish trail runner and ski mountaineer was in the ‘best shape of her life’ when her career was put on hold after encountering a meniscus rupture in early 2016. “It really hit hard realising that it was a really big injury and knowing my whole season, maybe even summer season would be gone” she told Markko Junolainen from Telesis Coaching.

“My whole world just disappeared” Forsberg commented. Rehabilitation from injuries also tests athletes physically, but almost all mentally. “There were so many mornings where those dark thoughts flooded in, and I had difficulties turning them around” Forsberg told Junolainen. Returning from injury can also be included in this. Rehabilitation is a process in which athletes coming back from injury must undergo to strengthen their rate of injury prevention. As already stated, injury often leads to missing time in the sport, which can lead to excessive stress pressure to come back fresh and just as good as when the injury occurred. That would be the dream, but in reality, athletes know that it is just near impossible, especially if the injury has led to personal issues newly introduced to deal with.

Just like any ordinary person, athletes face similar and if not some of the exact same challenges that we face in our day-to-day routines. This can include having to deal with past traumatic events, changes in lifestyles, tight schedules or even self-worth. Issues surrounding self-worth and self-view are two major personal factors affecting the mental health of performers. “For sure thoughts like, imagine if I had 5 kilos less, this vertical would be so much easier” is something Emelie Forsberg mentioned in her blog, focusing on the relationship mind, body and soul, admitting that athletes with this mindset have a poor way of thinking. Athletes with Lower self-esteem and poor self-view are less likely to feel good about themselves, which can provoke even more self-doubt. This can lead to self-isolating, and disconnecting from other people which can severely affect the lifestyle of both general people and elite performers.

Lifestyle related issues are also classified as one of the leading causes of mental health issues in athletes. Lifestyle issues can include coaching expectations, unsupportive networks, peer pressured environments, external commitments or even financial status. It is crucial that elite performers develop a strong and supportive connection with both their coach and coaching staff for both their own wellbeing and their love for the sport. Imagine if you were an elite athlete with a poor support network. See how this would affect the way you view your sport and your performance? Support networks through family and friend are a necessity for the success of an athlete, however they can sometimes become very stressful and hard to manage with a busy training schedule or long travel trips. For teams like the Australian Cricket Team or Australian Olympians, the time away from family can be quite difficult. In some cases, statistics have shown some athletes collect significant anxiety and sometimes even depression with the thought of being disconnected and isolated from family and friends. Part of this being ‘behind the scenes’, when athletes go out to perform, they uphold high expectations from the general public, keeping in mind that the general public doesn’t even know or understand what half the athletes have going on in their private life.

“What we do isn’t easy or else everybody else would do it” Simone Biles told reporters after withdrawing from the Gymnastics 2021 Olympics. Trying to fit into the incredibly high expectations set by the general public is a major issue contributing to the increase in mental health issues throughout the athlete world. Athletes remain under constant pressure of having to perform at their best and even beat their best to make both their fans proud, but to make their support networks proud. Maintaining their reputation is one of the biggest priorities of an athlete whilst managing their private matters. Whilst out on display, athletes can face criticism from “hate” to “dislike” which in the sporting world are mentioned when individuals don’t like an athlete often because of whether their level of skill is low or if they were previously involved in any scandals or poor behaviour.

Sometimes for athletes it is hard to achieve such high expectations whilst also having time to settle and experience life like any other human being. Whilst performing, athletes have great pressure behind them to maintain a happy and influential perspective over their audience. This is the common reason as to why athletes tend to show their emotion ‘behind closed doors’. “We’re human too and we have emotions and feelings and things we are trying to work out behind the scenes that people don’t know about” Biles told glamour magazine, whilst under pressure from her withdrawal. Withdrawing from the Olympics put a spotlight on the American gymnast for a long time with questions from the public as to why she withdrew. “I’m hopeful that my experiences and choices can lead to more empathy for athletes, because many of them have things they are working through behind the scenes”. Biles isn’t the only one expressing her concerns either. The recent AIS SPORT Australia survey reiterated that “It’s stressful for athletes to deal with constant high expectations of success, frequent travelling or risk of injury on top of the general life stressors they face like the rest of us” (SPORT AUS, 2011). These types expectations are often built overtime or from past experiences and performances athletes have participated in.

There are many athletes around the world that don’t give the media the publicity about their personal matters and battles, however, in recent findings there has been an increasing number of elites coming around to opening up. Olympic swimmer Michael Phelps is one of these. When Wayne Drehs from ESPN Sport interviewed Phelps, he opened up about factors that largely influenced his mental health. “To be blunt, the media is part of it. They dragged me through the dirt for everything over the years”. Athletes are known for having a wide audience of many age groups, however, like anyone, not everyone is going to like you. This is something that is constantly faced in the elite sporting world, with periods of being very liked and very disliked. The media is something that athletes face, which can be a positive or negative influence on their performance. Often the media like to put a twist on stories about athletes, which can lead to an immense amount of hate.

In the AIS related Sport Australia government article about sports medicine, it has been shown through surveying elite athletes that “Athletes were significantly more likely to report ‘high to very high psychological distress compared to general community norms, which are also more likely to report symptoms of depression and anxiety at a level that would warrant professional health care” (SPORT AUS, 2011). This information creates an alarming environment for the sporting world, with questions flooding from sources all over the world about the treatment of athletes by other members of certain communities. 

Why are athletes talking about mental health more and how do they deal with it?

Over the past few years Mental health has become a frequent and popular topic, specifically from the perspective of elite male sportsmen in a variety of sporting events. Services including counselling and psychology precincts are two such ways in which mental health issues can be addressed. Talking about their emotions is something that athletes have started doing more of, under the influence of each other for example, Michael Phelps. Phelps eventually opened up about his mental health, telling interviewer Gary Dehrs “It wasn’t easy to admit I wasn’t perfect, but opening up took a huge weight off my shoulders, it made life so much easier”. This was very much the beginning of athletes opening up about the mental battles they have faced over the past few years. This included athletes such as tennis stars, Serena Williams and Naomi Osaka. In 2019, statistics showcased that “up to 35% of elite athletes suffered from a mental health crisis” (Athletes for Hope, 2019). Not only are athletes inspiring each other, they are also creating an environment that is accepting of athletes and general people with mental health concerns. For the future, this is allowing not only athletes but the general public to feel comfortable, and accept that it is okay not to be okay. 

Sport psychologists are available in most elite organisations, which is the first-place athletes can go when they are comfortable. Other than these services, some athletes have found ways to get around their health issues and have placed themselves in a position to distinguish these issues. Michael Phelps in his interview with Gary Dehrs mentioned “I go to the gym, and wake up between 5:15 and 7 am. Sometimes I don’t want to be at the gym but I force myself to do it. I know it’s better for my mental health as much as my physical health”. These things were often distractions and put away the issues for a short amount of time. ‘Escapes’, the term athletes referred to when they could forget about their mental health issues is something that is mentioned more frequently. Phelps's escape was the pool. “When I was swimming the pool was my escape. I would take all that anger and use it as motivation” (Michael Phelps, 2019).  For each athlete, dealing with any sort of issue is different through their different coping mechanisms as well as professional service help.

Learning to deal with mental health issues can be a challenge to some, and for others, it can be very simple. Athletes often find it harder to deal with these issues due to their intense schedules and availability of health services. In 2019, the AIS partnered with Dane Bird-Smith, an Olympic and Commonwealth games race-walker who represented Australia in launching a large call to action regarding the mental health service for athletes. “My message to athletes is to reach out if you need help. Asking for help doesn’t mean you’re broken; it can help break down barriers and stigmas” Bird-Smith told the AIS reporters. In 2021, Bird-Smith withdrew from the Tokyo Olympics due to family medical issues, deciding it was best to focus on his family’s needs.

What type of Mental Illnesses do they experience?

When professional athletes experience mental health issues or even relapse with such concerns, it is shown that it can severely affect their sporting abilities in a range of ways. Mental health issues such as depression and anxiety can cause many to feel like they must make a change, whether it is to continue in their sport or take a break for a short or long period of time. Gary Souter, sports medicine author from Springer Open suggests that “Male athletes are more likely to use substances, develop eating disorders and develop overtraining disorder” (Gary Souter, 2018). Athletes can be faced with health issues including, anxiety, depression, eating disorders, panic disorder, and even generalised issues. These can affect the performance of an athlete immensely. The demand physically and psychologically can be very intense for athletes, which can cause immense pressure, leading to these illnesses. Most athletes through social media often share their stories of tough times and challenges and receive a lot of support from fans, relatives, and friends.

The importance of athlete mental health now and for the future

Just like any other individual in the world, good and strong mental health is a significant aspect of their lives. This includes emotional, psychological, and physical wellbeing. Surveys have shown that good mental health defined by athletes is the, “important to any of their success academically, athletically, socially and spiritually”, according to the National Colligate Athletic Association. Having a strong mental system and support allows for these individuals to excel in their sporting abilities, and maintain a resilient attitude toward their profession. This can give athletes more self-satisfaction and self-esteem. Poor mental health would result in larger health issues developing in the future that could impact whether an athlete continues to compete or even whether they believe in themselves. Having this strong ability results in athletes feeling happy with their progression in their careers. Keeping this elite pathway open for athletes is significantly important moving forward to keep the sporting future alive. Having the availability of psychology services is a key in the sporting industry to keep the mental health of athletes in pristine condition.

In terms of the future of mental health issues found in athletes, large corporations and organisations are setting forth their framework and plans to improve access to services and general assistance in improving mental health standards. Rosemary Purcell along with her colleagues from Springer Opens Sports Medicine precinct put forward the ‘Ecological systems model for elite athlete mental health’ which includes prevention programs, mental health screening, individually focused programs, and foundational preventatives. Statistics have shown that there is still a lot of work to emphasise the building of awareness of mental health problems and increase health-seeking behaviours from our athletes. This includes significantly normalising the mentioning of mental health issues throughout the larger communities.  However, there seems to be a strong future for athletes with successful programs placed within the wider world.

So, what is next?

Next time you turn on a replay or even live television to watch a sporting event, find an athlete, whether that is your favourite or just the first one that comes to your attention, and think about how they perform and what they could be experiencing from this. Remember, you never know what someone is experiencing, even if they are always cheerful and are constantly doing something social all of the time. Whether you know someone who is on a pathway into the sport, elite or not, or even just a relative or friend, it is always necessary to reach out and ask how they are doing. Athletes are just like any other human beings and deserve the same support and assistance in the mental health industry.