What It’s Like Providing Care for Mental Health at the Olympics

In this exclusive video interview, Jeremy Faust, MD, editor-in-chief of MedPage Today, sits down with Jessica Bartley, PsyD, senior director of psychological services for the U.S. Olympic & Paralympic Committee, to discuss providing mental health support to athletes at the 2024 Paris Olympics.

The following is a transcript of their remarks:

Bartley: I’m Dr. Jessica Bartley, I’m the senior director of psychological services at the United States Olympic and Paralympic Committee, and this is my third Olympic Games.

Faust: The typical question I lead with is: What common injuries do you prepare for? But you’re thinking about something a little different.

Bartley: Yeah. So, we do a lot of preventative work as well as more of that crisis and in the moment — somebody may need a bit of a booster shot before we’re headed into competition. So a little of everything on the preventative side in the moment.

And then we’ve also got a lot of resources that we are targeting what is often referred to as the “post-Olympic blues.”

Faust: OK. Tell us about that.

Bartley: You know, I think it’s so much bigger than the post-Olympic blues. We serve Olympic and Paralympic athletes, so thinking about the games as a whole, and honestly I find that there’s a lot of depression, there’s anxiety, there’s all these different mixed emotions.

What I find really happens is: What were the expectations and how did things not line up? Thinking of just simply processing the emotions that come up and processing the experiences, really being able to make sense of what just happened in this competition is really kind of what we’re doing.

Faust: That sounds like a process that’s not an overnight one.

Bartley: We’ve actually really started trying to tackle this on onboarding. So when someone makes Team USA, we’re starting to talk about, what is it like to go to the games? What is it like to be a part of Team USA? What are your expectations, your goals, your dreams?

And I think we try to just make sure athletes know that there are resources available. We provide mental health and mental performance resources. We’re here at the games, and then we are also really tackling things (after the games).

The two big topics that we’re going to tackle post games are going to be navigating decisions — so how do you make a decision, whether it’s around retirement, the next steps, what you want to achieve next — and then again, processing the emotions of this distinct experience.

Faust: We always think about making the team, but no one ever really thinks about leaving the team. Especially when these individuals have been thinking about this for probably their whole lives.

Bartley: Yes. And so there are a lot of thoughts, feelings, and emotions that come up around that. And do you want to talk with your family? Your coaches? How do you think about it yourself? Did you meet the goals that you were hoping to meet? Did you achieve everything you wanted to achieve? Was this the experience you wanted? How does that influence decisions of what to come next? So, it can be a pretty complicated decision.

Faust: Are you also on the performance side? Are you pretty involved in that aspect as well?

Bartley: Yes. Our psychological services is overseeing mental health and mental performance.

The way we like to think of it is really on a bit of a spectrum or two sides of the coin. When we’re thinking about it, we’re often looking at the mental health piece where something has come up. And a lot of times I think it’s, maybe you’ve fallen below baseline, you’ve gone below baseline, and we’re just going to try to get you back to baseline.

And then a lot of times when I think about sports psychology or mental performance, it’s kind of like pushing the boundaries of good to great. Refining some of the skills or even accessing the best of your physical abilities and not letting the mental get in the way.

So there are a lot of different ways of thinking about the differences between mental health and mental performance.

Faust: You probably get to know the athletes pretty well over time. Are there situations where you are worried, but they’re not? Like, “Uh oh, they’re not doing so great,” but they’re in denial or they think, “Oh, I’ve been to whatever. I’ve been to PanPac (Pan Pacific), I’ve been to Worlds (World Athletics Championships), so I’m going to be fine at the Olympics.” And you’re looking at them thinking that something bad is going to happen here.

Bartley: Yeah. And I think that’s where we try to have really open conversations.

I think about, “Hey, I’m going to do this interview 3 hours before I compete.” Well, have you ever done that before? Have you done that media that close to a competition? So a lot of times we can come in with just some experience and expertise. I’ll be honest, sometimes we even bring in a more veteran athlete if we’re worried about something in particular.

If we’re worried about somebody and what they’re maybe doing at the games and trying to take advantage of all of the activities and opportunities. Are you getting in enough practice? Are you getting in enough sleep? How are you doing with the food? (And they say), “No, no, no, I’m fine. Everything’s fine.”

And so again, there’s often opportunities where we can have those conversations and just maybe try to illuminate, “Well, this is what I’m seeing. This is what I’m thinking.” And again, I think they’ve gotten themselves to this point, so it’s always a bit of a balance.

Faust: Yeah, and I would think that the sleep, as you said — I have not spent any time in the Olympic village, but I just walked around it just now and you see these like gods walking around, everyone looks fit. And they wait their whole lives to come here. They want to meet the athletes. It’s a social experience, it’s meant to be. How difficult is it for them to just go to bed at night?

Bartley: Yeah, I think there are a lot of nerves and a lot of things that come up. There are a lot of really cool opportunities. There are really incredible activities in the village. You want to go see a game, “Hey, I really want to go see women’s soccer play today in the quarterfinals.” And you have to often make those decisions around what you want to be involved in and what’s in the best interest of your performance and your well-being.

So I think that’s what’s been really interesting is just sometimes problem-solving with athletes and saying, “OK, if you did this, what does that do? How much does that put you on your feet? How much transportation is that? When is that going to put you going to bed? Are you going to be able to get a meal while you’re out?”

Faust: Maybe for some people going to that quarterfinal soccer match is the perfect thing because it gets them out of their head.

Bartley: Yes.

Faust: But for somebody else, it could cause total panic.

Bartley: Yes. We had an athlete who came in and asked to paint some of the other medical team’s nails. It was just a good distraction. It was a good place for her to not be so focused on what’s going on before competition or some of those pieces.

It’s just incredible that they’re all human beings and just trying to take it all in with this experience, but (she) didn’t want to be out and about and on her feet. So she just joined us in sports medicine.

Faust: And when there’s someone who — again you said so well — what’s gotten them here has worked. And yet this is different, right? So there is that recognition.

Do you feel like you or other sports docs are a little averse to doing anything that’s at all different than anything they’ve ever done? Someone’s having trouble sleeping, changing how they do their sleep hygiene, or is it more like just reaffirm what they know?

Bartley: My strategy is often reaffirming what they know. And again, I think it’s a bit of a balance. A lot of times we’ve had long-standing relationships, so I think we can point out like, “Hey, this actually looks different. Maybe we do shift some things,” or, “I see you at your best when …” Just being able to, again, highlight that for them or talk through it a bit.

But otherwise, the number of times I’ve been pulled in before a big event, “Hey, talk to this athlete. Fix this athlete.” Going in and just saying, “What got you here? What got you here? What do we do? How do we think about that?” Because a lot of times they can’t even focus on that.

So just a reminder, a question, a conversation around what got them here and really being able to talk through what got them here is what I try to stick to.

Faust: Other than you, what other mental health resources does the team have? Who can they go to? What’s the sort of infrastructure there?

Bartley: The United States Olympic and Paralympic Committee Psychological Services providers, so those are the ones that often work with these athletes day-to-day. There are nine of us here. We have eight in the Paris area and one in Tahiti, so she gets to support surfing. We’ll have more for the Paralympic games that will come out.

Our entire team consists of 15. We have a coordinator of services and 14 providers. And then we have over 300 providers on our registry, so we often are using contractors. There are a number of contractors here, we have about 12 at the Paris Games with different sports. They could be working with a particular team and they’re traveling with that team or they’re working with a couple of athletes. So, we have a number of those that are here.

And then we know a lot of our providers are on call back home. We have our psychiatrist back home. So again, a lot of those are just phone calls. We have really learned to do a lot remotely. And then we’re also 24/7 on-call, so if anybody needs anything, we have an on-call rotation. We’ve got it really dialed in so we can help in the moment if needed as well.

Faust: Do you think that people like Simone Biles — having prioritized mental health first in Tokyo, famously, and of course having such a heroic games this time — like Michael Phelps, have really changed the conversation for athletes up and down in every sport?

Bartley: I do. I feel like our really notable athletes speaking out, whether that’s with the Olympic movement, with professional sports, collegiate sports — I hate to say this, but I even think anybody who has a platform that is talking about mental health, whatever their celebrity status may be, has really normalized the conversation around mental health.

The way I look at it is, anybody who has those platforms and uses it to share a bit about their mental health is really helping us de-stigmatize.

Faust: When I ask other physicians, what’s changed in sports medicine in the past 10, 20 years, this is an area where there’s been a huge change. Can you talk a little bit more about some of those changes?

Bartley: Yeah. So when I was an athlete —

Faust: And what did you do, by the way?

Bartley: Soccer. I was a soccer player. There weren’t resources. And actually, that’s what I feel that I was led to do. I didn’t have these resources. I felt really lost when I was in college. I didn’t have my identity as a soccer player anymore after an injury.

And so thinking that I just didn’t have these resources, that was always one of my goals. Well, what are these resources? How can they be created? How could I have potentially stayed in sport or thought about things differently?

And again, I don’t think I would’ve changed anything with my path because the injuries and frustration led to where I am now. But I just want to make sure the athletes competing now have these resources and it can be much more of a normal part of the sporting experience and the sporting environment to talk about mental health and mental performance, because again, that’s not something I had.

Faust: Alright. And if people want to get involved, how can they do it?

Bartley: Particularly on the mental health and mental performance side, we actually have a registry that I mentioned. We take applications, we’re actually accepting applications now and accept them on a rolling basis. So providers can actually apply to be on our registry. We do ask that they have at least 5 years working with athletes and mental health, athletes and mental performance.

But we love having a lot of resources outside of the U.S. Olympic and Paralympic Committee just to be able to give the athletes a lot of options and find them a very good fit for their services.