“It's Okay to Not Be Okay”: Mental Health Concerns and New Directions as a Result of the COVID-19 Pandemic

It is no secret that being an athlete is both physically and mentally demanding. Repeated exposure to stressors as a result of the competitive environment can lead to the prevalence of mental health symptoms and disorders among athletes (Reardon et al., 2019). When compared to non-athletes, mental health symptoms and disorders occur at equal or higher rates among elite athletes (i.e., Professional, Olympic/Paralympic, and collegiate) (Breslin et al., 2017; Reardon et al., 2019; Rice et al., 2016). Further, elite female athletes (Gorczynski et al., 2017; Kuettel & Larsen, 2020) and athletes of marginalized racial or ethnic groups (Eylem et al., 2020) may be at an increased risk of mental health disorders. The COVID-19 pandemic has presented new stressors and mental health concerns not only for the general public (Czeisler et al., 2020), but also for elite athletes (Edwards & Singh, 2020; Edwards & Thornton, 2020; Mehrsafar et al., 2020; National Collegiate Athletic Association, 2020). For many athletes, the initial responses to the lockdown phase of the COVID-19 pandemic resulted in increased symptoms of anxiety and depression (di Fronso et al., 2020; National Collegiate Athletic Association, 2020). Despite the increasing prevalence of athletes facing mental health challenges, the stigma of sport culture surrounding perceptions of mental health may exacerbate or perpetuate existing or new mental health concerns (Bauman, 2016; Breslin et al., 2017; Reardon et al., 2021; Wahto et al., 2016). As a result of this, it is evident that in order to support the overall health and well-being of athletes, the nuances of sport culture that perpetuate the stigmas surrounding mental health must shift.

Although hints of increasing mental health concerns among athletes have surfaced in the last five years (Gorczynski, et al., 2017; Moesch, et al., 2018; National Collegiate Athletic Association, 2020), the COVID-19 pandemic launched mental health concerns for athletes to the forefront. Athletes were asked to live in “bubbles”, play in empty arenas, and were subjected to strict testing protocols to ensure player safety. Despite these drastic changes to their playing environment, they were still expected to act and perform as if this was all “normal”. What the world witnessed was far from normal. While fans rejoiced at the haphazard return of sports, athletes felt themselves feeling new pressures surrounding their performance, resulting in further feelings of stress, anxiety, and fear (Brooks, et al., 2020; Graupensperger, et al., 2020). In addition to the pandemic and talk of a "new normal", athletes, particularly those in the United States, found themselves in the midst of the Black Lives Matter Movement. This movement was pivotal in creating discussions surrounding racial injustice in the United States, and many athletes and athletic organizations used their voices and platforms to raise awareness regarding these social justice issues (Cooky & Antunovic, 2020; Coombs & Cassilo, 2017; Evans et al., 2020). As if the pandemic lifestyle was not draining enough, athletes now felt prompted to act as advocates, engaging in athlete activism in full force. For many athletes, life became physically, mentally, and emotionally exhausting. In the past year and a half, numerous testimonies surrounding the significance of mental health have emerged, igniting a new conversation about the importance, and the necessity, of mental health for performance.

Mental Health at the 2020 Olympic Games

As the COVID-19 pandemic surged in early 2020, the difficult decision was made to postpone the 2020 Summer Olympic Games until the following year. While this move was done as a preventive public health measure, this decision shook the international sports world. Elite athletes train their entire lives for their chance to compete in the Olympic Games. For some athletes, deferring the Olympic Games to the following year meant an additional year of rigorous, exhausting, disciplined training. Olympic contenders were asked to physically, mentally, and emotionally push their bodies to stay at an elite level, should they want to continue to vie for a coveted spot on the Olympic roster. For some athletes, this grace period was welcome. Jade Carey, for example, a member of the United States’ gymnastics team, used the extra year to fine-tune her skills on floor and beam so that she could better her odds of making the Olympic team (Lewis, 2021). Her discipline during this “gap year” not only garnered her a spot on the Olympic team, but brought her silver medal in the team event and an individual gold medal on the floor event (Apstein, 2021). For other athletes, this extra year of training brought to light the immense pressure athletes are under to perform at a peak level, the toll that pressure takes on an athlete's mind and body, and the clear lack of mental health support available for our athletes when that pressure becomes overwhelming. While Jade Carey found success in Tokyo, her teammate, Simone Biles, found herself in an unimaginable situation.

Biles, arguably one of the greatest international gymnasts in history, removed herself from the team competition after completing one event (Svokos, 2021). While the world assumed she had pulled herself from the competition due to a physical injury, Biles later, and bravely, reported that she removed herself from the competition for mental health reasons (Parco, 2021). Knowing that she was not in the mental space to compete and would risk injuring herself physically should she continue, she decided to discontinue the competition (Silva, 2021). To do this on the biggest stage in the world took courage, selflessness, and true leadership (Harris, 2021). While she stepped down with the support of her coaches and teammates, what the world saw was someone who was a quitter, not mentally tough, and unable to handle the pressure. What they did not see was an athlete who was human; an athlete who had spent years in a physically, mentally, and emotionally abusive athletic environment and continued to carry on, despite carrying a heavy burden; and an athlete who, despite having proved herself time and time again, was tired. Simone Biles gave us stark insight into the pressure female athletes at the elite level face, and used the biggest stage in the world to make a statement about the importance of mental health. She emphasized the importance of humanizing elite athletes saying, "We also have to focus on ourselves, because at the end of the day, we're human, too...We have to protect our mind and our body, rather than just go out there and do what the world wants us to do." (Silva, 2021). She was not ashamed to admit her struggles and her voice was heard loud and clear by millions, completely altering the landscape surrounding the importance of mental health in the elite athlete world.

The Bubble

As all sports seasons halted in March 2020, the world was quick to wonder, “when, and how, will we return to sports?” Four months after the NBA (National Basketball Association) and WNBA (Women's National Basketball Association) initially shut down their respective seasons, organizers created the infamous “bubble”, which is where basketball players were expected to finish their regular season and postseason play (ESPN, 2020). Bubble requirements were strict. Players entering the bubble could not leave and were isolated from their families for months. WNBA and Australian National team player, Liz Cambage, had such a mentally draining experience in the bubble that it exacerbated her anxiety leading into the 2020 Olympic Games in Tokyo (Fryer, 2021). She ultimately forfeited her Olympic dream and chose not to go to Tokyo to compete as she knew being in an isolated state again would create too much anxiety for her and adversely affect her on court performance (Fryer, 2021). The format while playing in the bubble was also a shock to the system for many players used to playing in front of sold out crowds in electric arenas. The players found themselves playing in empty arenas. The only fans present were those that appeared via video broadcast, or as cardboard cutouts placed in the stands. The crowd noise was computer-generated. Players felt like they were in a constant state of practice, instead of an intense, competitive game situation (Wharton, 2020). At the professional level, many athletes play from a place of intrinsic motivation (Sullivan, 2019), but when placed in an empty arena, with no friends, family, or fans to play for, they felt lost and depleted (Uggetti, 2020). Anthony Tolliver commented on the difficulties of handling parenting in the bubble, “It's tough to be a FaceTime parent. It's not nearly as fulfilling, but it's better than nothing” (Schuster, 2020). The game had lost some of its sparkle, and playing a sport they love became a chore.

As COVID-19 continued to wreak havoc on the world, the United States found itself facing another sociocultural struggle. Although issues of racial injustice had not been silent for some time, the murders of George Floyd, Jacob Blake, Ahmad Avery, and Breonna Taylor created an international movement in support of Black lives (Williams, 2021). Basketball players in the bubble were drawn to this movement, decidedly engaging in activism on the court by painting “Black Lives Matter” on the court floor, boycotting games out of respect for those who perished, and using their platforms to speak on behalf of those whose voices had been silenced for so long (Williams, 2021). Prior to the start of the 2020 season, the WNBA had dedicated their season to social justice, specifically focusing on women's rights and the rights of those in marginalized groups (Williams, 2021). This movement exacerbated those efforts and resulted in subsequent changes within the league regarding how players would be treated for their activism efforts within the league moving forward (Williams, 2021). Although the Black Lives Matter Movement had little to do with basketball, it became a central focus for those in the bubble. As many NBA and WNBA players are BIPOC (Black, Indigenous, People of Color) themselves, this cause was much more than just words painted on the court or t-shirts displaying the names of lives lost to racial violence. They, too, had spent their lives feeling the pain and suffering associated with living in a marginalized group, and while they found themselves on a powerful platform where their voices were heard, they were not exempt from the mental and emotional toll living as a BIPOC had on them. Dr. Kensa Gunter, the clinical sport psychologist for the Atlanta Hawks stated, “I think a lot of people don't want to feel like they have to choose between playing basketball and continuing to engage in the activism and advocacy that they're passionate about...Athletes are navigating and negotiating change all the time, but this level of change, and this many areas of life all at one time is what makes this particular moment a bit more intense” (Uggetti, 2020). Although the bubble lifestyle was temporary and the Black Lives Matter Movement has quieted for the moment, the mental health struggles these professional basketball players endure is ongoing.

Mental Health on the Tennis Court

Naomi Osaka took the tennis world by storm after winning her first Grand Slam title by defeating Serena Williams in the 2018 U.S. Open. Her victory was enormous. Not only was this her first major title, she was also the first Japanese player to win a Grand Slam title (McDonald, 2018). Her victory, while monumental, was overshadowed by the events leading up to the final points of the game. Serena Williams had received several violations in the second set, resulting in an intense exchange between her and the chair umpire. Osaka went on to beat Williams, but fans could not help but notice that the joy of victory had been stolen from this young champion due to the events of the match (McDonald, 2018). The crowd, disappointed in how the match-end played out, booed Osaka during the post-match interview. Osaka found herself apologizing for the result of the match and was visibly upset delivering her words (McDonald, 2018). While Osaka would go on to become the number one player in the world and win the Australian Open in 2019, the events of the U.S. Open triggered the start of Osaka's mental health struggles as an elite athlete. While on the outside, Osaka seemed like a shy, quirky young adult, on the inside, she was experiencing depression and anxiety that she was afraid to discuss with the world. This all came to a head at the French Open in 2021, when Osaka withdrew from the tournament after refusing to participate in post-match interviews, citing mental health concerns (Wamsley, 2021). Instead of supporting her wishes, the tournament fined her for each appearance she skipped. Not wanting to take away from the spirit of the tournament, she discontinued her participation. In the aftermath, she stated that she needed to take some time away from the court: “The truth is that I have suffered long bouts of depression since the U.S. Open in 2018 and I have had a really hard time coping with that” (Wamsley, 2018). She went on to mention that public speaking, especially on an international level, was anxiety-producing and her refusal to participate in post-match press conferences was done in an act of self-care (Wamsley, 2021). Many athletes came to her defense and rallied around her, as many had experienced their own struggles with mental health issues, even before the COVID-19 pandemic. In response to Osaka's withdrawal, Dina Asher Smith, a sprinter for the United Kingdom, stated: “...If someone is taking steps to protect their mental health people should listen and work together - not double-down and put her in this position. Athletes' mental health needs to be taken seriously and prioritised. We are people too” (Wamsley, 2021).

Osaka's departure from the French Open left the tennis community shocked, as Osaka was well-known for her activism on and off the court, being very vocal about her support for BIPOC and ending racial injustice especially during the Black Lives Matter movement. Her activism efforts shed light on the paradox many athletes face when trying to navigate multiple identities and the mental health concerns that come along with it. This became particularly salient in 2020-2021, as athletes worked to be advocates for multiple causes. The same girl we once saw wearing face masks donning the names of those individuals who had died at the hands of racial injustice pre- and post-match during the 2020 U.S. Open, was now being asked to take on a new role as an advocate for athlete mental health as well. Osaka herself, found this tricky ground to navigate: “I feel uncomfortable being the spokesperson or face of athlete mental health as it's still so new to me and I don't have all the answers. I do hope that people can relate and understand it's O.K. to not be O.K., and it's O.K. to talk about it” (Osaka, 2021). Despite her work as an activist, she had experienced internal struggles as an athlete that had impacted her mentally and emotionally. While tennis players and other elite athletes came to her defense, the way her mental health concerns were handled at the tournament provided insight into the lack of mental health support available to tennis players and the stigma surrounding discussing mental health issues at the elite level. Osaka took a leave of absence from tennis, returning to play for Japan in the 2020 Olympic Games and thereafter as a participant in the 2021 U.S. Open. In the first round of the U.S. Open, Osaka was upset by an unseeded player. During the post-match interview, she broke down in tears, stating that she needed to step away from the tennis court for a while (Sullivan, 2021). Osaka's mental health journey is not unique, but the stigma surrounding discussing mental health made her feel like she was alone in her fight. Despite the challenges of speaking out about mental health and the additional layer of isolation and anxiety as a result of the COVID-19 pandemic, Osaka received an outpouring of social media support from other elite athletes: “Michael Phelps told me that by speaking up I may have saved a life. If that's true, then it was all worth it” (Osaka, 2021). While the pandemic has physically distanced athletes for more than a year, social media has provided a web of electronic support and encouragement (Leng & Phua, 2020).

Resilience and a Call to Action

In a difficult time when it seems as though the world is falling apart, athletes are coming together in support of one another and society as a whole. The sense of resilience these athletes display despite the seemingly insurmountable challenges they have faced throughout the pandemic is impressive. Being thrust into the spotlight as elite athletes, all aspects of their lives are on display for the world to see. We, as a society, expect athletes to portray strength and perfection, and the general assumption is that expressing mental health concerns displays a sign of weakness. The authors would argue, however, that this is actually a sign of great strength and resilience. The ability to step away from the game to focus on overall health and well-being is one of the most difficult decisions an athlete can make. We need to remember that athletes are human, too. It is in our best interest to applaud athletes’ decisions to step back and take a breath, to rest, to recover physically and mentally, and to welcome them back to the game when they are ready with open arms. Allowing athletes the time they need to heal away from the game means that one day they will be okay, whether they return to competition or not. It is our role to provide support to those who need it without judgment or negativity and to advocate for those needing a voice. Compassion is at the root of change, and reveals the path where the stigma ends.