2. The birth of the IOC consensus statement on mental illness in athletes – pursuit of excellence
2.1. The pursuit of excellence – the background of mental health issues in elite sport
2.1.1. “Sports Psychiatry” – active in Frontiers of International Olympic Sport
Technology Name: Sport psychiatry, Clinical Sport Psychology (CSP), Ps. “sport medical psychology”, “sport psychotherapy” et.al, (J. Heil; L.J. Zhu; D. Baron, 2011, 2013).
Technical Background: In the Olympic movement, scholars have recognized the political pressure, the economic pressures of professionalism and commercialization, psychoactive substance abuse including doping, the worship of high-tech (special Paralympics), the over limitation of athletic physiologicaland psychological extremes, our Olympic movement has gone in the opposite direction in some fields (personal communication in Brazil Olympic with M., McName, Y., Vanlandewijck, 2016).
We pursue the limitation of the physics nature, technology maximization, but the ecological harmony of human physiological system, the ecological harmony of psychological system, sustainable development of Human Life, is completely out of the Olympic Sports on the way to pursuit excellence (J., Y., Shen, 2008).
Anyway, in front of the fact, to chase “faster, higher, stronger”, while the other is the athlete’s physical and mental destruction, and even sudden cardiac death and suicide caused by competitive sport (reference the author’s book titled as “Suicide Achieve- Olympic family members” (Zhu, L.J., Heil, J., et.al., 2015), “Suicide Achieve” (sing star, film star etc. (Zhu, L.J., lenz, G., Musalek, M., Kliisouras V., Pritz, A., Heil, J., 2016).
Technical characteristics: As well as we know, “Sports Psychiatry” (CSP) is a new academic discipline of the International Olympic Movement, which haschanged the situation that the sports psychologist haven’t received clinical training, and psychiatrists have no sports science background, “Sports Psychiatry” and “Clinical Sport psychology” have achieved the interdisciplinary Leap between sports psychology and psychiatry.
Technical Citation: Scholars Liu Li and Shi Yuan, reported on the scientific journal “psychological technology and application” in 2014, they have introduced the trend of international Clinical sport psychology development.Recognized the first worldwide publication “Clinical Sport Psychology” (Frank Gardner) is in 2006″; second publication series worldwide are “Clinical Sport Psychology Perspective West and East“ (Li Jing ZHU,2011a-2011e) “.
Technical results: After decades of basic research at the School of Neurology and Psychiatry, Sleep Laboratory of Medical University of Vienna, School of Medicine of University of Southern California, Department of Medical Psychology of Lewis Gale Hospital, Sports Psychology Laboratory of University of Vienna, and applied research at Psychotherapy Room of Freud University of Vienna, we have found that the problem of mental illness of athletes is universal in the world, regardless of continent or race (although there are some differences).
At the Glasgow Scientific Report Conference of the 2012 London Olympics, the 2013 International Sports Psychology Scientific Report Conference, and the Olympic Science Conference in Santos, Brazil in 2016, after Dr. Zhu spoke, she was surrounded by the participators. Scholars talked about their personal experiences. The coach said that his athletes committed suicide. The scholar said that he had paid attention to this topic, but was denied by the chairman of sports psychology. They sighed: “You are finally here, World Psychiatry Association (WPA) is finally here!” The International Olympics has been waiting for more than 20 years. We can finally save the mental health of Olympic-level athletes, coaches, and sports officials through appropriate scientific methodology and clinical research results, and respect the life science laws of ecological sustainable development.
Economic Effects: To save the life of Olympic-level athletes, coaches, sports officials, how to evaluate from the economic effect, I quote the Buddhist sage “save a life, is more than to build a seven Buddha.”
Social effects: The direct significance of Sports Psychiatry (CSP) is to save the role model of our society: Olympic champions, super coaches, high range of sport officials, the suicide itself has long been confirmed as contagious (Sigmund Freud, 1900; Émile Durkheim, 1897); The indirect meaning of Sports Psychiatry is to save our society, carry forward the humanitarian spirit in Olympic peace movement.
Effect of the IOC: The project was endorsed by Dr Thomas Bach, President of the International Olympic Committee (IOC). As a former Olympic fencer, he agrees not only the gold medal behind the various distress, but also he is the actionist in the Olympic practice; such as, 2014 Youth Olympic Games (YOG) in Nanjing, P.R. China, is under the strong demand of the International Olympic Committee, due to the organizing committee (COC) does not have clinical sports psychologists, COC arranges two psychiatrists in Olympic Village (Text Communication: R. Buddget, 2014; T. Bach, 2014, 2016).
Olympic Movement: At present, with the support of the World Psychiatric Association (WPA), the World Council for Psychotherapy (WCP), and the International Society of Clinical Sports Psychology (IACSP), we are striving to push sport psychiatry – mental health to the Olympic Village.
2.1.2. The technical background of mental illness issues in elite athletes
Elite athletes reach the peak of physical performance and often undergo rigorous training and high-risk competition. However, the pursuit of excellence is often accompanied by dual pressures that have a significant impact on their mental health. The intersection of peak physical performance and potential psychological challenges poses a complex problem in elite sport.
(below) Athletes often find themselves struggling with anxiety, depression and other mental health disorders, which are exacerbated by the huge expectations placed on them by coaches, sponsors and fans, more refer to “Sport psychiatry” (Zhu, L.J., Heil, J., et.al., 2017).
The impact of competitive sport on mental health cannot be underestimated. Reports show that athletes abuse drugs at an alarming rate, and many resort to this coping mechanism to deal with the pressure of competition and the pursuit of perfection. This is further complicated by the impulse of the so-called “cult of technology”. Athletes are overwhelmed by the expectations of advanced performance indicators and technological improvements, and they often feel pressure to continuously improve at all costs, which can inadvertently cause mental stress, more refer to “Clinical Sport Psychology-Beyond the Gold Medal I-III” (Zhu, L.J., Heil, J., et.al., 2018).
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Additionally, rising suicide rates among high-level athletes have also raised concerns within the sporting community and beyond, more refer to “ Suicide Achieve –Olympic Family members” (Zhu, L.J., Heil, J., et.al., 2018), highlighting the urgent need to discuss mental health issues openly. Scholars have stressed the importance of fostering a holistic approach that prioritizes the physical and mental health of athletes. This perspective advocates for developing support systems that go beyond traditional performance metrics to ensure that mental health is given equal weight as athletic ability.
By recognizing the complex relationship between competitive sport and mental health, it becomes clear that understanding and addressing these issues is critical not only for the athletes themselves, but also for the integrity of sport as a whole.
2.1.3. Social Impact of Mental Illness in Elite Athletes
Mental illness in elite athletes has significant social impacts that go beyond individual experiences. Elite athletes often occupy a prominent position as social role models, and their struggles with mental health can serve as an important reflection of broader societal challenges. The visibility of these athletes expands discussions about mental health, sparking necessary conversations that might not otherwise occur. When athletes share their experiences with mental health issues, they confront the stigma associated with these illnesses, encouraging individuals in the general population to seek help and support without fear of being judged.
The impact of mental health crises, including athlete suicides, resonates deeply in society. Research has shown that the tragic suicides of high-profile athletes are contagious, leading to increased suicidal ideation and suicide attempts in others. This phenomenon highlights the urgency of addressing mental health issues, not only in the sporting world, but in all social structures. When an elite athlete commits suicide, it is a poignant reminder of the prevalence of mental health issues, potentially triggering coping mechanisms or desperate reflections in fans and aspiring athletes.
As a result, the need for social awareness and proactive measures to combat mental illness is increasingly evident. Providing support to athletes in their darkest moments can foster a shared sense of responsibility within the community. Initiatives that promote mental health education and resources can create an environment where discussing mental health issues becomes normalized, effectively bridging the gap between elite sport and everyday life. By advocating for mental health support for athletes, the wider society can not only help these individuals, but also pave the way for a cultural shift that values the mental health of everyone, regardless of their social status.
2.1.4. IOC-WPA action – Pursuit of Excellence
The International Olympic Committee (IOC) has increasingly recognized the importance of mental health among elite athletes and has taken a number of actions aimed at addressing this critical issue. As founder and executive board member of “International Olympic Committee (IOC) consensus statement on mental illness in elite athletes”, IOC consensus meeting on mental illness in elite athletes is successfully held in IOC Temporary Headquarters, Coubertin room, Lausanne, Swiss, the development schedule between WPA and IOC is as follows.
2012 WPA Prague Declaration: Contribution of Sports Psychiatry to Olympic
Sport
2013 Co chair, Sport psychiatry, World psychiatric Association (WPA)
The following documentation has submitted by the researcher to International Olympic Committee (IOC) on behalf of world psychiatric Association (WPA) from 2014 to 2019:
2014.3. IOC-WPA: Proposal of “Mental Health in Olympic sport”, before Nan
Jing Youth Olympic Game (YOG)
2014.8. Establish the “official communication channel” between World Psychiatry Association (WPA) and International Olympic Committee (IOC)
2015.3. In collaboration with Dr. Thomas Bach (IOC President) and Dr. Richard
Budgett (Chair, Medical and Scientific Commission IOC). Development a new program “mental illness in elite athlete” between WPA and IOC.
2015.4. “IOC-WPA: The emergence of sports psychiatry and its role in the Olympic sport”.
2016.7. Further development of the program “mental illness in elite athlete” during The Pre-Olympic congress in Santos and Rio, Olympic Game, Brazil. Dr Zhu has frequent communication with Dr Richard. IOC-WPA: IOC’s understanding of mental illness in Elite athlete
2016.8. Dr Richard (IOC) sent Dr Zhu (WPA) Announcement “IOC World Conference on
Prevention of Injury & Illness in Sport” (Monaco, 2017)
2017.3. IOC-WPA: International Olympic Committee and World psychiatry
Association first meet officially in person in Monte Carlo Monaco, Dr Li Jing
zhu represent Dr. Bhugra, President WPA, IOC Richard Budgett represent Dr.
Thomas Bach, president IOC, had a historical official meeting in person for
the first time. IOC-WPA: IOC’s understanding of mental illness in Elite athlete
2017.3. At the IOC World Congress in Monaco, Dr zhu WPA had direct face-to-face communication with senior IOC officials.
– Dr. Zhu raised the issue of mental illness at Margo Mounjoy’s session (she said, we are all talking about sports injuries at the physical level, and finally someone brought up sports injuries at the psychological level).
-Dr zhu WPA had direct communication with Lars Engebretsen at the Congress, and he said after listening: “Now It’s time, to care the mental illness of athletes.”
2017.3. Workshop presentation in Monaco: Introduction to Sports Psychiatry –
Dialogue between East and West
2017. March to August: The following documentation has drafted and submitted by
Dr. L.J. Zhu, Dr. John Heil, Dr. D.Baron to International Olympic Committee (IOC) on behalf of world psychiatric Association (WPA), American Psychology Association (APA):
1) IOC-WPA-WHO: Sports injury may as one of the triggers of sport psychiatric disorders in Olympic sport – transcultural perspective (Zhu, L.J., Heil, J., 2017)
2) IOC-WPA-WHO: Introduction to World Psychiatric Association, suicide section, Transcultural research section, sports psychiatric scientific section, Report of WPA, WHO –Administration resource (Zhu, L.J., Heil, J., Baron, D., 2017)
3) IOC WPA: Suicide and Mental Disorders (From WPA Suicide scientific section)
4) IOC-WPA: Sports Psychiatry in Olympic Village (Chat) (Zhu, L.J., Heil, J., Baron, D., 2017)
5) IOC-WPA: Cold facts – Suicide Archive: Wrestling Zhu, L.J., Heil, J., Baron, D., 2017)
6) Suicide Archive: Football Athletes Zhu, L.J., Heil, J., Baron, D., 2017)
7) Suicide Archive: American football athletes (NFL) Zhu, L.J., Heil, J., Baron, D., 2017)
8) Suicide Archive: qualified for Olympic Game from 2000 Sydney to 2016 Rio OG (Zhu, L.J., Heil, J., Baron, D., 2017).
2018.3-5 President of International Sport Psychology Association (ISSP), Dr.
G.Y.，Si, make personal contact with Dr. Zhu, ISSP hopes to be able to
attend (non speak) IOC meeting. reflected the interest of ISSP
2018.11.International Olympic Committee (IOC) consensus meeting on mental illness in elite athletes” held in IOC Temporary Headquarters, Coubertin room, Lausanne, Swiss.
2018.11.Presentation on “2018 International Olympic Committee consensus meeting on mental illness in elite athletes”: IOC-WPA: Stressors and environmental factors that impact elite athlete mental health: How Injury, Performance, and Mental Health Intersect
2019. Publish “International Olympic Committee consensus statement on mental illness in elite athletes” on British Journal of Sport Medicine
2019 “IOC Athlete Forum”, Olympic athletes voting on mental health
2019 US Olympic Committee (USOC) establish a dept. “We are team USA,
Mental health awareness”
2020 UKOC build a special mental health team
2021 US superstar gymnast Simone Biles sparked a global conversation around
mental health in sports when she chose to withdraw from the women’s team
final at the Olympic Games Tokyo 2020 and four subsequent individual
finals to prioritise her mental health as she dealt with the now-infamous
‘twisties and turn”.
2023.11. Translation “International Olympic Committee (IOC) consensus meeting
on mental illness in elite athletes” into Chinese language by COC, China
2024.7 International Olympic Committee (IOC) consensus meeting on mental
illness in elite athletes” become popular/ “IN” in Fepsac Congress
(European federation of Sport psychology) and Paris Olympic Game
from 2024.10 “Sport Stammtisch” ORF Austria by Pf. Musalek, SFU
2.1.5. Under the leadership of IOC President Dr. Thomas Bach, advocate for initiatives aimed at recognizing and supporting mental illness in athletes
This shift is highlighted by actions taken under the leadership of IOC President Dr. Thomas Bach.
Dr. Bach is a world champion in fencing. Dr. Zhu is sincerely pleased that Dr. Thomas Bach, Dr. Richard Budgett IOC has eliminated the “stigma of mental illness among athletes”. During the four-year coordination process between the WPA and the IOC, he has obtained their approval and support.
Under the leadership of Dr. Thomas Bach, Dr. Richard Budgett, the IOC is committed to ensuring that mental health is treated with the same seriousness as physical health in sport.
In 2018, the International Olympic Committee held its first consensus meeting, convening various stakeholders including athletes, psychiatrists, mental health experts and sports professionals to discuss the challenges athletes face in terms of mental health issues.
The meeting set the stage for the development of the 2019 IOC Consensus Statement on Mental Illness in Elite Athletes. This key document is not only a guide to understanding the prevalence of mental health conditions in athletes, but also a framework for building high-quality support systems within sporting settings.
The 2019 Consensus Statement emphasizes that organizations and federations must prioritize mental health by implementing support measures. A key aspect is encouraging a culture where mental health discussions are normalized and stigma is reduced. By supporting initiatives like this, the IOC aims to create an environment where athletes feel safe to seek help without fear of career consequences.
The IOC’s efforts therefore represent an important step towards integrating mental health considerations into the overall package of athlete care, ensuring that mental health is prioritized alongside physical health. These proactive strategies are critical to a holistic approach to athlete development and performance.
2.1.6. International Olympic Committee reaches consensus on mental health of elite athletes
The International Olympic Committee (IOC) recognizes the pressing mental health issues affecting elite athletes through its consensus statement, which highlights the prevalence of mental health problems among this population. Research shows that athletes develop mental health disorders at rates equal to or higher than those of the general population, often exacerbated by the unique stressors of high-level competition. Psychological stressors inherent in elite sport can manifest as anxiety, depression and other mental health conditions, ultimately affecting an athlete’s performance and overall physical health.
A key aspect emphasized by the IOC is the need to distinguish between characteristics of elite athletes and maladaptive behaviors that may arise from stress or trauma. Athletes often display resilience and high levels of motivation; however, these characteristics may mask underlying pain. The risk of conflating the stress of competitive sport with mental health issues is that it may prevent athletes from seeking help because they fear the stigma associated with mental illness, or underestimate the severity of the problem.
Furthermore, the IOC consensus highlights the current lack of standardized guidelines for mental health management in the field of sport psychology. This gap in protocol raises concerns about the quality of mental health support available to athletes, making it difficult to ensure continued effective interventions. As a solution, the International Olympic Committee promotes a biopsychosocial approach to mental health management. This comprehensive model emphasizes the interplay of biological, psychological, and social factors that influence an athlete’s mental health. It emphasizes the importance of individualized treatment plans that meet the specific needs of each athlete while simultaneously creating an optimal training environment.
Ultimately, implementing the IOC’s recommendations could pave the way for better mental health resources and support systems, ensuring top athletes prioritize mental health alongside their physical training.
2.2. 2018 IOC Consensus Statement on Mental Illness in Athletes Meeting –BMJ published in 2019
2.2.1. Introduction to IOC Consensus Meeting
Dr. Zhu’s pioneering contributions to the field of athlete mental health highlighted the importance of mental health in high-level sport. On behalf of the “World Psychiatric Association” (WPA), she is the first initiator of the “International Olympic Committee (IOC) Consensus Statement on Mental Illness in Athletes Conference” and is an executive board member of the 2018 International Olympic Committee (IOC) Consensus Statement on Mental Illness in Athletes Conference. Member of the Executive Board (20 people) who has had a significant impact on the development of best practices aimed at supporting athletes’ mental health.
These conferences provide a platform for experts to discuss evolving mental health care strategies, making Dr. Zhu’s insights invaluable in developing policies that benefit athletes worldwide.
In November 2018, the World Psychiatric Association (WPA) organized a major consensus meeting jointly with the Medical and Scientific Commission of the International Olympic Committee (IOC). The conference aims to address an increasingly pressing issue: the mental health of elite athletes. Mental health issues have attracted global attention in recent years, and despite their physical prowess, elite athletes are not immune to such challenges. This consensus meeting aimed to examine the best current evidence on mental health issues in this specific population.
The main purpose of the meeting was to establish a comprehensive and widely supported consensus statement that would serve as guidelines for elite sport stakeholders. Various tests and surveys indicate that athletes face unique psychological pressures, including the burden of performance expectations, high levels of competition, and the potential for injury, all of which are factors that impact their mental health. Statistics show that elite athletes are at a higher risk of mental health problems such as anxiety and depression than the general population. Additionally, previous findings suggest that bias against mental health issues within sport often leads to underreporting and a lack of appropriate support.
This opening statement highlights the urgent need to address mental health issues in elite athletes and sets the stage for the publication of a consensus statement. The conference brought together a diverse group of professionals, including sports psychologists, coaches, medical staff and athletes themselves, all focused on exploring effective strategies to increase mental health awareness and interventions within elite sport. As we delved further into the outcomes of the consensus meeting, it became clear that a collaborative approach was critical to creating a supportive environment for athletes facing mental health challenges.
2.2.2. Research Methods and Evidence Review
The methodology for collecting and reviewing the literature related to mental health in elite athletes involved a comprehensive and systematic approach. Initially, a team of subject matter experts was formed, consisting of researchers, clinicians, and practitioners specializing in sports psychology, psychiatry, and sports training. This collaboration aimed to carefully review the large number of published articles related to mental health treatments in elite athletes (a total of 14,689 articles). The team utilized electronic databases such as PubMed, PsycINFO, and Scopus to ensure a comprehensive collection of relevant literature.
In order to conduct a targeted review, strict selection criteria were established. Studies were included based on their relevance to elite athletes and their exploration of non-pharmacological and pharmacological interventions. Non-pharmacological interventions included cognitive behavioral therapy, mindfulness training, and other psychological approaches that have gained traction in enhancing mental health in athletes. Pharmacological interventions were also considered, including medication options for managing anxiety, depression, and other mental health conditions that are prevalent in this population.
During the evidence review process, the research team employed an established framework to assess the quality and robustness of the selected studies. This involved reviewing study designs, sample sizes, effectiveness of interventions, and overall impact on mental health outcomes. Through critical appraisal, the review highlighted gaps in the research, areas for further exploration, and effective strategies specifically for the management of mental health in elite athletes.
This solid evidence base informed the discussions at the consensus conference, which resulted in recommendations and guidelines aimed at improving mental health support for athletes. By integrating different perspectives and scientifically validated approaches, the outcomes of this conference highlighted the importance of adopting a comprehensive mental health strategy within sport organizations.
2.2.3. Clinical Practice Guidelines for Mental Health in Athletes
The consensus conference on mental health in elite athletes resulted in the development of several clinical practice guidelines designed to address the unique mental health challenges faced by this group. The primary aim of these guidelines is to enhance the prevention, identification, and treatment of mental health disorders. The recommendations are designed to promote a comprehensive approach to mental health that recognizes the multifaceted nature of the athlete experience.
Firstly, tailored intervention strategies are essential. Mental health programs for elite athletes should be tailored to individual needs, taking into account the different stresses and demands that come with high-level sport. These strategies should incorporate mental health assessments as part of routine health screenings, ensuring that potential issues are identified early. This proactive approach allows for timely interventions, ultimately improving the overall health of athletes.
Another key aspect highlighted at the conference was the need for a collaborative approach to care between mental health professionals and sports organizations. Establishing clear lines of communication can foster better understanding and collaboration, allowing coaches, trainers and psychologists to work together to support athletes. By creating an integrated support network, athletes can feel more comfortable seeking help and discussing their mental health challenges.
In addition, training staff and coaches play an important role in promoting mental health among athletes. It is essential for these individuals to be educated on mental health to recognize signs of distress and foster an environment of open discussion of mental health. Regular workshops and training sessions can enable coaches and staff to take effective action to create a culture that prioritizes mental health and reduces stigma.
The practical implications of these guidelines extend to various stakeholders, including sports organizations, mental health professionals and athletes themselves. By adopting these recommendations, the sporting community can create a more supportive environment, ultimately improving the performance and quality of life of elite athletes struggling with mental health issues.
2.2.4. Future directions for mental health management in elite sport
As the discussion on mental health in elite sport continues to evolve, it is important to consider future directions to enhance the management of mental health among athletes. A key aspect is creating a supportive environment that prioritizes the emotional well-being of athletes as well as their physical performance. Coaches, sports organizations, and athletes themselves must recognize the integral role mental health plays in overall athletic success and take proactive steps to foster this connection.
One of the recommended strategies is to implement routine mental health screenings, similar to physical health assessments. Regular screenings can help identify athletes who may be struggling and intervene promptly, allowing them to seek help without fear of discrimination. Additionally, providing training to coaches and staff on mental health issues can empower them to recognize early signs of distress and respond appropriately.
In addition, promoting a culture where emotional expression is welcomed and normalized is critical. Athletes should feel safe to discuss their mental health issues without being disapproved or judged. Encouraging open dialogue about mental health can break down harmful stereotypes and create an environment where seeking help is not seen as a sign of weakness, but rather a sign of strength.
Ongoing research into mental health programs, including the effectiveness of new treatments and support systems, is critical. Sports organizations should stay abreast of the latest developments and strategies that can be incorporated into their programs. These efforts can lead to the evolution of policies that not only protect athlete mental health, but also foster resilience and promote overall well-being.
Future directions for both research and practice require ongoing collaboration between key stakeholders, including the International Olympic Committee (IOC), the World Psychiatric Association (WPA), mental health professionals, and various sports organizations. By working together, these entities can effectively implement the guidelines proposed in the conference, ensuring that they are not only adopted but also tailored to the diverse needs of elite athletes across different sports.
In summary, advancing mental health management in elite sport requires strategic initiatives aimed at creating a supportive culture, providing education and resources, and adhering to research-backed practices. Emphasizing the importance of mental health is a collective responsibility that will ultimately benefit athletes, coaches, and the wider sporting community.
The consensus conference on mental health in elite athletes yielded significant findings that illuminate the complexity surrounding this critical aspect of sporting performance. It was established that mental health is critical not only to the health of athletes, but also to their overall performance and success in competitive settings. These findings highlight the need for a nuanced, multifaceted approach to mental health care in the sporting community.
In addition, it is critical that qualitative monitoring of mental health issues become a priority within elite sport. Ongoing monitoring will help identify trends, risk factors, and emerging challenges facing athletes. This proactive approach will enable stakeholders to adapt their strategies based on new evidence, ensuring mental health resources are effective and relevant.
In conclusion, the collaborative efforts launched by this consensus meeting will create a more supportive environment for elite athletes’ mental health, promote their well-being and enhance their potential to succeed in their respective fields. As we move forward, establishing a robust mental health framework will be key to shaping the future sporting landscape.