Do We Need More Discussion Around Mental Health in the NFL?

It’s no secret that professional football players face both physical and mental trauma on the field. While every sport comes with certain risks, the contact-oriented nature of football puts players at higher risk of certain mental illnesses.

One risk factor comes from chronic traumatic encephalopathy (CTE), a neurodegenerative disease brought on by repeated head injuries. A 2017 study of 111 deceased NFL players found that 110 of them, or over 99%, had CTE.

Two high-profile NFL players, who died by suicide, Junior Seau and Dave Duerson, were both found to have CTE in their respective autopsies. The reported symptoms of CTE include depression, impulsive behavior, emotional instability, substance misuse, and suicidal thoughts of behavior. The link between professional football and mental illness is clear, but the conversation around mental health is often swept under the rug among NFL players, coaches, and staff.

If CTE is a risk among former NFL players — the symptoms of which are often debilitating and deadly — why isn’t more being done to treat mental health in the NFL? UNLV professor Brad Donohue reports that “football players are less likely to pursue mental health programs than athletes in other sports and one of the greatest reasons for this is perceived stigma.”

Unfortunately there is still the internalized perception that football is a “manly” sport and that “real men” don’t talk about their feelings — that to ask for help amounts to admitting weakness — and thus mental health issues are often brushed aside.

“An important aspect of sport culture that can impact athletes’ willingness to acknowledge mental health issues is not wanting to be seen as ‘weak,’” says Christine Selby, Ph.D., a Professor of Psychology at Husson University’s College of Science and Humanities. “Regretfully, the larger culture in the United States continues to view mental health issues as something suspect. Those with mental health concerns can be viewed as not ‘strong’ enough to ‘pull themselves up by their bootstraps’ and essentially ‘get over it.’ This mentality can be more pronounced in sports, including contact sports such as American professional football.”

On top of that, comes the idea that players need to always be on — performing at the highest caliber. Afterall, the NFL is first and foremost a business and performance is what matters. “When talking about elite level athletes such as those in the NFL, the pressures to perform week after week are high — especially for those who have made it to the playoffs,” continues Selby. “There are significant internal and external pressures for these athletes to do whatever it takes to ensure their team wins. This can mean ignoring all forms of pain, including psychological pain. Most athletes want to compete no matter what and are willing to sacrifice all aspects of their well-being.”

Couple that with players’ knowledge that their career are limited to only a few years — the pressure means that mental health struggles abound. “In a vicious cycle, the increased fear of physical injury and loss of career creates more stress and more susceptibility to cause or exacerbate mental health issues and/or the athlete turning to counter-productive/self-defeating ways to control anxiety, such as illicit drugs,” says David M. Reiss, M.D., a psychiatrist practicing primarily in CA, NY, and MA.

What The NFL And Players Are Doing To Change The Conversation

Last May, the NFL took action by announcing a mental health and wellness committee. This led to every team being required to have a mental health professional working onsite for at least eight to 12 hours a week.

In the intial release, it was said that these programs are designed to help the mental health of players, teams, and their family members by collaborating with “local and national mental health and suicide prevention organizations to reduce stigma related to mental health and promote suicide prevention and awareness.” While this is a wonderful and encouraging step — and should be applauded — the move comes after many players have been forced to take mental health awareness into their own hands.

One such advocate is Brandon Marshall, a wide receiver who previously played for the New York Jets and Chicago Bears, among others. “If you would have asked me eight years ago what does mental health mean to me, I would have said mental toughness,” Marshall told USA Today. “As football players, we are taught to never show weakness, to never give an opponent an edge. To open up when something hurts, in our culture, is deviant. But when you really sit down and think about it, connecting with those emotions is the real strength.”

With that in mind, he and his wife started Project375, an organization designed to bring awareness and broaden the conversation around mental health. He shared with Talkspace that he “realized that football was only my platform, not my purpose. My purpose is to help kids and those who suffer.”

Rob Gronkowski, a former tight end for the New England Patriots, is another player who’s been very vocal about the mental health ramifications he experienced playing in the NFL. At the age of 29 he chose to walk away from football to preserve his well-being. “Before I was just kind of foggy a little bit,” Gronkowski told CBS News. “That’s when I knew that, you know, football was, you know, doing all that, all the damage. I just knew I had to get away from the game of football and start working on my mental well-being, for sure.” This admission, and continued vocalization about his struggles after his playing days, presents an opening for other players to do the same.

What Other Sports Organizations Are Doing

Not all sports face the same issues when it comes to mental health discussion. “Stigma is experienced differently across athletes, and not all athletes experience stigma,” says Donohue.

Leading the way for mental health awareness is the NBA. Beginning in the 2019-2020 season, the NBA now requires there to be at least one mental health professional on each team’s full-time staff. This change came after players such as Kevin Love on the Cleveland Cavaliers and retired Boston Celtics point guard Keyon Dooling came forward with their mental health struggles.

In the world of aquatics, change is also being made. This month USA Swimming announced a partnership with Talkspace to provide unlimited access to mental health therapists at no cost to their athletes. This private and accessible method will allow swimmers to seek help at their convenience and find a therapist who works best for them.

Steps being taken to provide better mental health care in the NFL

When organizations prioritize the mental well-being of their players, change can indeed be made. One challenge sports organizations face is helping players deal with, not just the pressures of the spotlight, but also their short career spans. “Programs to help athletes accept the reality of limited careers and the low odds for high-level success — and early on, develop a realistic ‘plan B’ without diminishing motivation or ambition but keeping hopes reasonably realistic,” says Reiss. He recommends helping players to develop a post-football career soon after entering the NFL, as a reminder that other opportunities following football can also be fulfilling.

Another important aspect is making sure players are being properly diagnosed. With the potential for players to downplay their injuries in order to remain on the field, Reiss stresses the importance of having independent neurologists available to assess concussions and other potential brain injuries. On top of this, he recommends regular mental health screenings for all players to proactively catch problems, and work to treat them, before they become more serious.

Of course, the overarching step needed is to reduce the stigma players face about being open with their mental health struggles. This will undoubtedly take time — and is as much about shifting the broader culture — but the education of NFL staff will help prioritize player’s mental health, Reiss explains, while also encouraging the “education of athletes that their long-term well-being, and well-being of their family, is more important than immediate success.” It’s an important sentiment that isn’t often voiced in professional sports.

Starting Mental Health Discussion With Young Athletes

While increased discussion of mental health is clearly needed at the professional level, having these conversations with younger athletes can be tremendously impactful. Reiss recommends providing realistic information to young athletes about career prospects while also reinforcing “the long-term benefit of acknowledging and addressing problems rather than denying them by ‘manning up and playing through’ injuries of any type.”

When young athletes begin to face mental health challenges as they age, they’ll already be prepared for those tests. The normalization of mental illness won’t happen overnight, but major platforms — like the NFL —can help push progress forward.

The sooner the stigma around mental illness is broken down the better — for professional athletes and all of us.