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      Athletes Connected: Inside the University of Michigan's New Approach to Mental Health for Athletes
      Athletes Connected
      May 18, 2016

      Athletes Connected: Inside the University of Michigan's New Approach to Mental Health for Athletes

      Adam Kern couldn't sleep.

      He was having a difficult freshman year at the University of Michigan, in his hometown of Ann Arbor. There had been the death of a family member, plus the usual oscillation between thrilling freedom and total unmoored terror that's intrinsic to the college experience. And then there were the academic pressures, and the additional onus of being a student-athlete on the Wolverines track and cross country teams. While his twin brother, Nick, seemed to excel, by spring track season Adam was an athlete on the bubble. His struggles were starkly clear to him, and his failings measured empirically on stopwatches and result sheets. The generalized anxiety that he had since childhood—an anxiety that might manifest in music being stuck in his head or a complete freeze after the first page of a test; an anxiety that had led Adam to ask his parents for a therapist in fourth grade—just seemed to make everything worse. There was no let-up.

      Every race took on the proportions of life and death; for Adam, being an athlete and being himself seemed one and the same, and as he confronted the possible end of his athletic career, a host of other frightening questions opened in turn. In April 2011, he ran the 5,000-meter race at Michigan State's Spartan Invitational unattached—that is, for himself, not the university.

      "To me, it was another chance to prove myself, that I was worthy to have a roster spot," Adam says in the lobby of Michigan's Institute for Social Research.

      But the burden weighed him down, pressing on a body still battling knee inflammation that had first flared up a month and change prior. What he dreaded, that his lack of strength and fitness would be too much for him to overcome, came screaming at him now with cold certainty. Adam came through his first mile behind schedule and his race deteriorated from there; he fell further and further off the pace he desperately wanted, until he crossed the finish line and practically collapsed. As he cooled down with his brother, tears streamed down his face. He knew he was going to be cut.

      And he was.

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      Officially jettisoned from the team, Kern felt like his very identity had been taken away from him. His insomnia got worse. He took to taking extreme methods to sleep—what, doesn't everyone move their mattress to the floor, use their desk and chair and sheet to build a sensory deprivation tent to block out the noise and the static, just to get some fucking sleep?—but nothing seemed to help. Finally, Kern sought out the therapist he had first gone to as a child.

      It took a combination of therapy, SSRIs, and time, but Kern got better. He surmounted the depression, graduated with a bachelor's in psychology, and even started running again; these days, he is training for a triathlon, each step he takes now for himself.

      And he began to help others.

      Will Heininger one of the former Wolverines athletes working with Athletes Connected.

      Today, Kern is part of a new team: Athletes Connected, the University of Michigan's athlete-focused mental health program. A joint effort of the University's Depression Center, the School of Public Health (SPH), and the Wolverines athletic department, it aims to combat the stigma around mental illness and encourage athletes suffering from mental health disorders to seek help; it aims to do this by helping them understand more about mental health issues, and by making help more readily available.

      Athletes Connected began as a pilot program two years ago, with a multi-departmental team that included Daniel Eisenberg, an associate professor at SPH, Trish Meyer, who was then the manager for outreach and education for the Depression Center, and Barb Hansen, the athletics counselor for the Wolverines.

      Research into college students and mental health painted a bleak picture. According to the SPH's in-house magazine, Findings, a third of college students suffered from anxiety, depression, and other mental health conditions. Of these, only 30 percent sought treatment; when just looking at student-athletes, though, that number fell to 10 percent.

      Before Athletes Connected, Wolverines had two in-house counselors they could see, in addition to the campus counseling resources and various wellness groups available to the entire student body. The problem, it seemed, was not necessarily the lack of resources but the obstacles discouraging athletes in particular from seeking help. Athletes Connected was formed to correct those dire numbers, funded by a grant secured from the NCAA in the spring of 2014.

      The team moved quickly.

      "We really began doing the work in earnest, the videos and things, in May and June of 2014," Hansen says. They also held focus groups of athletes to help guide the program.

      The videos were instrumental to the pilot. Featuring recent graduates Kally Fayhee, a swimmer, and Will Heininger, a football player, they are exceedingly well produced; Fayhee and Heininger detail their struggles with mental health during their Wolverine careers and their respective roads to recovery over loving shots of the natatorium and Michigan Stadium.

      These videos were shown to the coaching staffs at the University in September of 2014, and later that fall to the athletes. Surveys were given out to athletes before and after the screenings on whether the videos were engaging or useful, if the athletes would use the coping techniques and the support groups described in them, and if they would avail themselves of an athletic counselor if they felt they were facing a personal problem.

      The immediate results looked promising: Over 90 percent of the athletes found the videos relevant; more than half admitted to mental-health-related performance issues in the previous four weeks. A number indicated that they would seek counseling.

      "We saw a huge increase in student-athletes utilizing resources after that first year, with all of those educational presentations that we did," says Emily Brunemann, a graduate research assistant in the School of Social Work, former Michigan swimmer, and current member of Team USA. As the year went on, however, participation dropped back down. Student-athletes, it seemed to Brunemann, had to be continuously reminded about the importance of their mental health. "Sometimes it falls to the wayside when they pick their priorities," she says.

      Athletes often put in 30 to 35 hours a week for their sport, on top of all the academic and social commitments they share with their non-sport-playing peers, and students who depend on scholarships to stay in school face a very real pressure to maintain a certain level of performance. Faced with limited time, athletes are more likely to put mental health low on their priority list.

      Perhaps most damaging of all, though, is the misunderstanding surrounding mental health issues, which results in a stigma that's acutely felt by athletes—and male athletes especially. "It's that tough-it-out mentality," Brunemann says. "We've heard that constantly from student-athletes. They feel like they have to tough it out, they should be able to fight it, they're strong enough for this and can handle it on their own."

      They are not getting this from nowhere. Sports reward toughness, both physical and mental, and the language in which sports gets talked about, from locker rooms on out, hinges on the idea of toughness. Athletes must be able to deal and overcome, to perform, when pressure is high. Their ability to do so, they are told, is what separates them from the general public; the ability to do this seamlessly and perfectly is what separates the transcendent athletes from the merely mediocre or even great. There's truth in these clichés, but also something that is all too easily weaponized. It's an outlook that encourages athletes to put up a facade in order to avoid admitting to weakness.

      "There's a worry that they—a big fear, actually—show to a coach that maybe they can't, or a particular day or a particular week they are really struggling, that they could lose their place on the team, their playing time, the coach's perception of them may change," Hansen says. "So it is a big fear. Probably one of the biggest barriers, if not the biggest."

      Encouragingly, these fears may be more unfounded than first thought.

      "The really interesting thing is ... probably every student-athlete that I've worked with who has eventually decided to make their coaches aware that they're having a particular struggle, they have gotten just the opposite reaction," Hansen says. "Support and care and concern and flexibility—that keeps happening. But that fear is still pretty big out there."

      For all their extra pressures, athletes have extra benefits, as well. Teammates and coaching staffs offer built-in support networks; the rhetoric of mental resilience and tough-love "life-lessons" rolled out by coaches may come across as cliché, but sports—competition and teamwork and focus and all the other old verities—really can foster that sort of mental strength. Athletes Connected has set up "wellness groups," which are facilitated by licensed social workers, that play to these strengths, and they provide a welcoming, team-like environment for Wolverines players to talk about mental health.

      Athletes Connected is, in the end, about more than just helping Michigan's athletes. Take Will Heininger, the football player featured in one of the videos talking about his depression. Now the program coordinator, he gives talks at local high schools, where the word of a former Wolverines football player carries more weight with some students than any counselor or teacher ever could.

      But the biggest impact that Athletes Connected may have beyond the Ann Arbor campus lies in the program's research component, led by Eisenberg and his team at the School of Public Health, which includes research assistant Adam Kern.

      "For the first year, that meant thinking about what kind of measures we wanted to use to evaluate the success of the team presentations," the tall, soft-spoken Eisenberg says in his office overlooking Forest Hill cemetery. Next came a study on the effectiveness of videos or articles as a medium for reaching athletes. "We did a randomized trial with the videos, where we invited all the student-athletes to take a brief online survey. And then, of those who participated, we randomized them to watch one of the coping skills videos featuring Will or Kally, or to go to a website with an article on that same topic, the same coping skills."

      Eisenberg's team found that the videos—about deep breathing and reframing self-defeating thoughts—seemed more effective than the articles, with respondents saying they were more likely to remember and use the coping methods they watched rather than read about, especially for the simple concept of deep breathing. Results like these, if they hold true in larger, more diverse populations, could be used to craft ever more helpful materials in the ongoing fight against stigma, misinformation, and lack of access to care.

      The School of Public Health's newest Athletes Connected research initiative ties in to mental health and performance, a subject with wide-ranging implications. Eisenberg is currently working with a group of 40 to 45 student-athletes to track things like their mood, sleep levels, and other data points related to mental health, as well as their academic and athletic performance. Athletes are particularly well suited to this kind of study, namely because their performance can be, and constantly has been, quantified; race results, batting averages, and personal bests are some of the metrics that Eisenberg will look at.

      "We have a unique opportunity to see how mental health relates to performance and functioning in a very measurable, salient way," Eisenberg, whose background is in economics, says. "Which might yield some lessons that are more general, beyond student-athletes."

      A scene from Kally Fayhee's video about mental health awareness.

      Much like many of the athletes it helps, Athletes Connected finds its strength in teamwork.

      That starts in the athletic departments, where the trainers, who see athletes when they're injured and at their lowest, are often the ones to steer students Hansen's way. That personal, in-house connection is coupled with the University's powerful medical resources and the Depression Center. The Depression Center's advocacy mission is bolstered by the School of Public Health's findings, and the SPH research can be utilized to help improve attitudes toward, and treatments of, mental health.

      While the early and anecdotal results of Athletes Connected are positive so far, Eisenberg believes there is still a long way to go. Still, the conversation surrounding the program is a marked improvement over the suffocating silence that has typically surrounded mental health.

      "The main evidence of success is ... the amount of enthusiasm we've seen from the student-athletes, the administrators, in the athletic department, really in the rest of the campus community," Eisenberg says. "People all over the country getting in touch with us, saying they are excited about it. There's definitely a high level of interest. At this point, [that's] all we can ask for."

      Athletes Connected has something that a runner like Adam Kern can appreciate: a strong start.

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