The Intersection of High Performance and Mental Health
Although peak performance and mental health are certainly related, the relationship between the two is more complex than it may seem. Improved mental health can lead to better performance outcomes for elite performers (and vice-versa), yet individuals can still perform at very high levels even when dealing with diminished mental health (Lebrun et al., 2018). Thus, while performance and mental health are connected, they are two separate components of wellness and perhaps need to be addressed with differing interventions (McHenry et al., 2021). McHenry and colleagues (2021) define performance enhancement as care to “those who are generally mentally healthy in optimizing their regulation of psychological skills and strategies to meet performance demands” (p. 3). The World Health Organization (WHO; 2022) defines mental health as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community” (para. 2). Recognizing that diminished mental health may lead to “significant distress, impairment in functioning, or risk of self-harm,” many times leading the individual to seek clinical mental healthcare (para. 4).
A helpful way to conceptualize the difference between performance enhancement and clinical mental health interventions is through the wellness continuum. As shown in Figure One, on one end of the continuum an individual is thriving, and on the other end of the continuum an individual is facing severe functional impairment–or inability to participate in normal life activities, such as going to work and socializing, due to a major life transition (e.g., death of a loved one), mental health crisis, or a diagnosis.
Figure One. The Mental Continuum (adapted from Locke et al., 2001)
An individual will move along this continuum throughout their lifetime and, therefore will need differing levels of support at different points in their life. Considering an athlete, or another individual who performs at a high level, a focus on performance enhancement will be most successful in periods of thriving and resilience. Focus on performance enhancement may also be successful during short-term periods of periodic distress when someone is not experiencing functional impairment. In these times, a professional who focuses on performance enhancement interventions, such as a Certified Mental Performance Consultant (CMPC), could meet the individual’s needs. However, if an individual is experiencing functional impairment or severe functional impairment, performance enhancement should not be the focus, rather professional care from a licensed professional is needed instead. Common professionals who can provide this level of care can include a psychiatrist (MD or DO), a licensed psychologist (LP), a licensed counselor (LPC), and a licensed social worker (LMSW or LCSW; see Beasley et al., 2022 for a thorough review of the differences between licenses).
This is not to say that an individual cannot work with a clinical mental health provider in periods of thriving (it is advised), or that a professional who specializes in performance enhancement cannot continue to work with an individual if they are in periods of diminished mental health (they can, in conjunction with clinical care!). Even so, it is important to consider the difference between the care needed for performance enhancement and the care needed for clinical mental health, as an elite performer will need access to both types of care. In fact, it is considered best practice for organizations to employ a holistic, interdisciplinary care team where all professionals can work together to meet the needs of the individual (McHenry et al., 2021). Overall, although performance and mental health are certainly connected, and many times a professional cannot address one without addressing the other, there will inevitably be moments in an elite performer’s career where one will need to be prioritized, pending where they are on the wellness continuum.
Organizationally, this means elite organizations should be offering both types of care through an interdisciplinary model of care. While this may look different pending on the organizational setting, the WHO (2010) suggests any type of interprofessional care model includes “multiple health workers from different professional backgrounds work(ing) together with patients, families, carers, and communities to deliver the highest quality of care” (p. 7). McHenry and colleagues (2021) provide one example of how this care team may look in a sport organization:
A potential protocol would have the (certified mental performance consultants) deliver (performance enhancement) programs for teams and individual athletes and serve as a first line of defense for recognizing and referring athletes for mental health diagnosis and treatment. The (licensed social workers), using case management skills, could complete mental health intakes, assess psychological and social service needs, and coordinate appropriate care for the athlete. The (licensed psychologists) and (licensed professional counselors) could then focus on mental health diagnosis and treatment for athletes in need, and all members could benefit from case consultations to learn from each other’s unique perspectives on case conceptualizations and treatment plans (p. 6).
In other words, certified and licensed professionals are hired in the organization to work together to address the dual goals of optimal athletic performance and clinical mental health, and ultimately overall wellness.
References
Beasley, L., Hardin, R., Magliocca, J., & Smith, Z. T. (2022). An exploration of the licensure differences of mental health professionals in NCAA Division I athletic departments. Journal of Higher Education Athletics and Innovation, 1(9), 1-16. https://journals.shareok.org/jheai/article/view/1057
Lebrun, F. Collins, D. MacNamara, A. Rodgers, S. (2018). Learning from elite athletes’ experience of depression. Frontiers in Psychology, 26, online. https://doi.org/10.3389/fpsyg.2018.02062.
Locke, D. C., Myers, J. E., & Herr, E. L. (2001). The handbook of counseling. Sage.
McHenry, L., Beasley, L., Zakrajesek, R. A., & Hardin, R. (2021). Mental performance and mental health services in sport: A call for interprofessional competence and collaboration. Journal of Interprofessional Care, 36(4), 520-528. https://doi.org/10.1080/13561820.2021.1963218
World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. https://apps.who. int/iris/handle/10665/70185
World Health Organization. (2022). Mental health. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
