A game plan for mental health

Student-athletes can feel the thrill of competition but also experience the weight of added stress that sometimes challenges their mental health. Ari Miller is here to help. In his newly created position fusing psychology and sports, he helps Johns Hopkins athletes lead healthier daily lives and perform better on the field, court, or track.

Johns Hopkins has nearly 700 student-athletes participating in 22 varsity sports. Athletics can enrich a student's collegiate experience, improving physical fitness while creating lasting friendships and a lifetime of memories. But the pressures of sports competition, on top of the rigorous demands of classrooms and labs, can lead to mental health issues, including anxiety, eating disorders, substance abuse, and depression.

Studies have shown that student-athletes experience psychological issues severe enough to warrant counseling at rates higher than non-athletes, with as many as 15% of athletes having such issues during their time on campus. On a recent NCAA well-being survey of nearly 10,000 student-athletes, more than a third of the women surveyed, and nearly a quarter of the men, reported feeling mentally exhausted constantly or most every day. Making matters worse, college athletes are as much as three times less likely to seek help when they experience mental health issues such as depression, according to a 2017 survey by the University of Michigan School of Public Health.

For more and more schools, a solution is to bridge the divide between the athletic department and the counseling center via staff with a foot in each realm. Hopkins made this move in July of last year, when Miller was named assistant director, student-athlete mental health and performance. Miller, a licensed professional counselor, began his career coaching basketball and now holds a master's degree in clinical psychology. He came to Hopkins from the University of Vermont, where he was assistant director of athletics for sports psychology and counseling.

The Hub sat down with Miller to talk about his work keeping student-athletes healthy in mind and body.

What are the mental health challenges you've been seeing here at Hopkins?

Just to get into a school like Johns Hopkins you must achieve at a very high level in all parts of life. When young student-athletes first arrive on campus and have an exam or a hard practice, it might be one of the first times they've experienced something that does not go well for them. So one of the biggest things I'm working on here is just the adjustment to college and getting acclimated to being in such a competitive space. I work with students around self-care and balancing. How do you take care of yourself when your schedule is so packed? How do we build healthy life skills that allow us to keep our mental health in a good place? Oftentimes, we only hear about mental health when it turns into mental illness. Sound mental health is based on a wide range of behaviors and support systems that you can utilize every day, not just when things are hard.

What does your role look like day to day?

I provide a few different services for student-athletes and coaches that can be broken down into three main buckets. The first is that I provide individual sessions. Student-athletes can book individual one-on-one sessions with me that can be for free therapy, mental performance coaching, or for just support around mental health issues—maybe questions about how to support a friend.

I do team sessions as well. I meet with full teams where we'll pick a mental health or mental performance topic, and then we'll discuss how it applies to them and how it may fit into their season right now.

The third is coach consultation. I meet with coaching staff and individual members of our staff and consult about mental health issues, talking about mental performance challenges and how they're handling different issues their student-athletes might be experiencing.

Why are positions such as yours becoming more common on campuses?

I think we're starting to realize that the student-athlete experience is full of stress and challenges related to the time commitments they take on being part of a competitive team. For too long, those challenges were not talked about. There were not a lot of places for athletes to go for help, and there was a stigma around being vulnerable. The narrative is now changing nationally around how we support people in competitive spaces.

We've also had a lot of high-profile athletes over the past few years be open and vulnerable about their challenges, whether it be Olympians Simone Biles and Michael Phelps, or pro basketball players Kevin Love and DeMar DeRozan. So, I think universities and athletic departments are starting to realize that this is something that we need to continue to grow, and have resources for student-athletes specific to their unique experiences.

How did you end up working in the athlete mental health space?

During the first part of my career, I was trying to be a college basketball coach. I worked with three different schools, starting as an assistant coach and finally as director of basketball operations. And I started taking graduate courses in psychology to try to become a better coach. I wanted to learn about relationships and people and thought that it would be a way for me to sort of cultivate that skill set.

As I got a little bit older and got deeper into the profession and got deeper into the graduate program, I started to see this unmet need that a lot of the athletes I was recruiting and coaching were having. There was a lot that was pulling them away from their athletic pursuits, whether it be stress in their personal lives or dealing with performance anxiety. But there were no resources for them, and nobody was talking about it. I decided 10 years ago to make a career pivot and go in this direction. I feel like I'm still coaching athletes in a lot of ways, just on different skills.

Why are student-athletes less likely to ask for help relating to mental health issues?

For a long time, competitive sports existed under the premise that you needed to be strong and mentally tough. You know, just show up, do your job, and play hard, and everything will work itself out. And sometimes that is what's needed—you go to practice, you play hard, and you exhibit toughness.

However, as we are learning more about the needs of the entire person that plays a sport, we're realizing that to be mentally tough and physically tough, you need to be able to articulate your feelings and talk through things in your life that are presenting challenges. I think we're making some headway in breaking down that stigma, but it has been present in competitive sports for a long time and will take time to break down.

What changes have you brought to Blue Jay athletics?

I think just my physical presence here, this new position, is a massive change. My skill set and what I bring are very different from almost everybody else in the department. And the idea behind having such a position is that I'm not off in a building that no one visits unless they're having a session. I'm at games and practices. I'm walking through the halls being as visible as I can be.

Because I also work with the Counseling Center, I can serve as a bridge of communication to alert student-athletes of services that the center is offering that maybe they weren't aware of. I also meet with Counseling Center personnel to give them some education on the student-athlete experience and help them better understand the student-athletes they're working with.