The Importance of Mental Health Screenings for Student-Athletes with Dr. Lindsey Keenan Ph.D., LAT, ATC
Season 3, Episode 9 | Podcast #45
Lindsey Keenan is an Athletic Trainer and Associate Professor in the Department of Sports Medicine at West Chester University and is Co-Founder and CEO of PROmotion Health, a mental health screening solution for sports medicine and schools. She received her bachelor’s degree in athletic training from Lock Haven University, two master’s degrees from East Stroudsburg University in Athletic Training and Sport Management, and her doctorate in Kinesiology with a concentration in Sport & Exercise Psychology from Temple University. Lindsey works clinically with the WCU NCAA Women’s Rugby team and teaches courses in the undergraduate and graduate athletic training programs, including sports psychology, cadaver dissection, and clinical courses. Her research focuses on mental health and concussion injury in student-athletes. She is considered a national expert on student-athlete mental health and has presented nationally and internationally on student-athlete depression, concussion, and mental health screening. Her entrepreneur journey led to the development of PROmotion, which she is utilizing clinically and in research to assess the mental health of student-athletes and referral outcomes.
Resources:
If you, or someone you know, is struggling with a mental health concern or crisis, contact a mental health provider as soon as possible. In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911. You can also text the Crisis text line 741-741.
In this episode, we cover:
3:10 How Dr.Keenan got into Athletic Training.
4:40 How Dr.Keenan’s personal bouts of depression in college and postpartum anxiety have made her more able to recognize mental health concerns and learn how to advocate for her and others.
10:05 The importance of not waiting until you’re in crisis to seek counseling, but to instead be proactive about your mental health.
11:00 How her experiences translated over to helping athletes and researching mental health concerns in student-athletes.
11:25 Suicide is the second leading cause of death for college level student-athletes.
12:00 The long-term consequences of leaving mental health issues unaddressed in college student-athletes.
12:45 The research on athlete mental health has only just begun, though there’s been a recent boom.
13:30 The connection between athletic identity and the mental health impacts of losing that identity after retiring from the sport.
14:30 What the current mental health screening process looks like for athletes.
14:48 Dr. Keenan recommends reading the NCAA best practices document for creating a mental health management plan.
15:15 The very first step in developing a mental health management plan is to have a designated mental health service provider for a referral. You should not be asking a student about mental health concerns or crises if you do not have a next step lined up in case of possible issues or crises.
16:00 There’s currently a huge need for mental health providers in the United States because there are not enough to help everyone who needs it. 55% of counties in the United States do not have access to psychiatrists, according to the Substance Abuse and Mental Health Services Administration (SAMHSA)
18:00 Who is considered a licensed mental health provider
psychiatrists who are MD
Psychologists
Counselors
Niche specialists within that.
19:30 a niche specialty is sports psychologists, which are heavily in demand but can be tricky to find the right one because there is no actual certification for sports psychology.
20:00 What questions to ask to determine if a person is a trained and qualified sports psychologist.
“Does this person know the culture of sport?”
Are they affiliated with AASP D47 or APA?
How long have they been working with athletes?
Are they focused on clinical psychology or performance enhancement (CMPC)
23:40 What is the objective of having a sports psychologist on staff?
26:25 The importance of referring an athlete to a psychologist that has experience with sports culture can not be understated.
A student-athlete is more likely to continue seeing a person with sports experience
At least find a provider that is willing to learn and see the nuance of the world of athletes especially relating to mental health.
28:55 What the full mental health management protocol looks like.
31:00 Dr.Keenan explains the difference between someone being actively suicidal and someone who thinks about it from time to time.
32: A mental health emergency action plan is extremely important, despite mental health crises being rare. A mental health emergency action plan outlines what is considered a crisis and how you will respond. It includes suicide, dissociative episodes, and psychosis.
It is important to never leave someone in an active MH crisis alone
Take them to a trusted mental health provider or to the hospital.
Every county should have a crisis center which can be another place to take someone.
35:00 only after emergency situation protocol is in place should you then go on to preventative measures.
36:20 The importance of mental health screening in high school and college athletes and why most athletic trainers are currently not screening athletes for mental health concerns.
37:00 What a mental health screening for athletes looks like
Dr.Keenan emphasizes the importance of using a validated screening tool like the Patient Health Questionaire 9 (PHQ9)
These screenings are not just for depression, they also can check for anxiety, eating disorders, and more.
There needs to be more work on validating tests that are specific for athletes.
41:00 What west Chester is currently screening for and how Dr.Keenan first began screening 15 years ago.
44:00 How Dr.Keenan served on a committee with the Pennsylvania state athletic conference where they looked at how the conference could be leaders in the space of mental health and athletes. The conference decided to adopt NCAA mental health best practices guidelines in all 18 PSAC schools in 2015.
46:00 How Dr.Keenan led the initiative of scaling screening at West Chester University.
48:00 How the GoPROmotion app started to play a role and why it was necessary.
48:00 what the PROmotion app consists of and how it’s used.
PROmotion hosts a variety of mental health screening programs.
PROmotion calculates and filters athlete scores into green yellow and red categories.
50:00 Why it’s so important to validate these scores in athletes specifically.
52:40 Dr.Keenan’s research has found that mental health screening cut-off scores were not applicable to athletes, athletes’ cut-off was 6 compared while the general populations’ is 10.
the hypothesis is that because of a stigma there is a greater fear of reporting causing athletes to underreport or minimize the severity of symptoms.
PROmotion builds options for both the general population and athletes into their app.
56:30 What sports in particular need these screenings?
57:00 There is a misconception that the more you talk about mental health the more issues there are, but in reality, the rates are the same and the issues are now being noticed more often
“As you change the environment, you are going to notice more and more athletes who are struggling with their mental health, and the keyword is ‘notice’ because they’re going to be more likely to be more open and report their symptoms.”
“As you change the environment, the reporting is going to go up, which is a good thing.”
58:00 You can optimize your team environment by addressing mental health openly and regularly. Bring up these questions and topics in every conversation.
59:00 If a student starts to open up to a coach or athletic trainer the main focus is on listening to the student's concerns and then offering the option of referring out. It is not a coach or athletic trainer's job to offer counseling at that moment.
1:00:00 How protocols and approaches vary with high school athletes and needing to involve parents. Dr.Keenan encourages that parent involvement is included in the mental health protocol the school and athletic program put together.
1:03:40 Anyone can administer this mental health screening for free online as long as there is a plan for what to do after.
1:06:00 How to approach mental health concerns when parents aren’t receptive.
1:07:15 Look out for symptoms that are disrupting your normal activity and reach out for help.
1:09:00 How mental health impacts performance and how treatment could improve it.
1:09:30 Programs need to reassure athletes that they will not be pulled from sports due to reporting mental health concerns and that any results from screenings are confidential.
1:13:15 It is ultimately up to the athletes to decide to take care of their mental health because you can’t force someone to get help.
1:14:00 Presenting mental health care as a way to improve performance often increases buy-in from athletes.
1:15:42 The major impact of mental health challenges on sleep and sleep’s significant role in performance.
1:16:21 Mike’s experience during his first year in football camp and the impact of losing your support system from high school.
1:16:45 Mental health issues are most likely to come up between the ages of 16 and 24.
1:17:45 Risk factors are elevated in women primarily due to societal pressures and in athletes of color due to systemic issues of inequality.
1:19:28 Where Dr.Keenan sees mental health research going and her comparison to the concussion progress we’ve seen in the last 10-15 years ago.
1:21:00 Dr.Keenan predicts that states will eventually need to mandate mental health screening.
1:24:00 Sports are a model for society and how it can pave the way.
1:27 How PROmotion plans to expand and share the benefits of mental health screening.
1:29:30 Talking about suicide does not increase the likelihood of suicide however talking about it will make people feel more safe coming to you
Contact
PROmotion Health website: www.goPROmotionHealth.com
@PromotionHlth on Twitter and Instagram
Lindsey Keenan social media handles @lindseyckeenan on Insta; Lindsey Keenan on Facebook
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