Protecting Athlete Rights To Mental Health Treatment
I would like to talk to you about the athlete that you saw today.” Navigating this conversation can be incredibly difficult in clinical practice, especially if the athlete requests that details not be shared. Often, the request is made without understanding the conflicts this can cause or the potential damage the care partnership or at worst, with an unspoken disregard for the confidentiality of mental health services. Athletes deserve the right to confidential and accessible mental health services.
As the field of sports and performance mental healthcare expands and evolves, maintaining high standards of ethics and professionalism must remain at the forefront of clinical practice. While athletes are often surrounded by a number of shareholders including coaches, athletic trainers, agents, educators/employers, medical personnel, family/friends, and media, careful consideration of information sharing and communication with these groups is imperative.
Establishing clear protocols for collaboration including identifying protected information versus shared information can help with role clarity between providers and the various stakeholders. Additionally, emergency action plans for mental health emergencies can provide clarity and expectation management similar to medical emergency action plans. Failure to establish such protocols or allowing oneself to lose sight of professional standards can result in incidental disclosures that could contribute to inadvertent boundary crossings and potential ethical violations.
HIPAA does allow for permitted disclosure in cases of abuse and to prevent serious harm to health or safety1. Additionally, the U.S. Center for SafeSport offers trainings to identify best practices for creating a safe and supportive environment2. Both the American Psychiatric and Psychological Associations also have guidelines for clinical practice to help further guide these conversations.
“I think it would be really good if we communicated the struggles you are having with your trainer and coach, because I want to make sure you have the support you need right now and as you travel. How can I help you have those conversations?” Oftentimes, discussions with the athlete and including them in the process can help balance safety as well as the athlete’s autonomy and privacy. There are times when that inclusion is difficult or the athlete refuses. Depending on the severity of the situation, it is important to have the difficult conversation that if a plan cannot be made for their safety, the conversation might include not traveling with the team and looking at intensive outpatient versus inpatient programs if necessary.
If a provider is serving a dual role with a team or organization including performance evaluations and/or therapeutic use evaluations, it is important to disclose such information from the beginning of the clinical encounter. Failure to discuss these dual roles leads to mistrust and can irreparably damage rapport. When appropriate, athletes need to be included in discussions related to removal from play and plans to return to play. There are multiple examples in recent years of athletes prioritizing their mental health and taking leave from sport to focus on this need alone.
For medical prescribers, it is important to discuss benefits versus risks of medication use including potential impacts to the athlete’s health and safety in play. In some cases, this includes assisting the athlete in disclosing the information while balancing their privacy. Furthermore, it is also important to have conversations with athletes about the prohibited/banned substance lists as these lists can vary from one sport to another.
In closing, there are special ethical and professional implications to consider when working with athletes that providers must take into consideration that is unique to this population.
Written in collaboration with Amanda Klass, D.O. Dr. Klass is a board-certified psychiatrist, specializing in sports psychiatry. Since joining the faculty at the University of Kansas Health System in 2016, she has actively partnered with the sports medicine department at the health system to develop her involvement as the organization’s first sports psychiatrist. She is on the MLB therapeutic use exception registry as well as the USOPC clinician registry.