By Drs. Carla Edwards, MD @Edwards10Carla and Jane Thornton @JaneSThornton

Few events in history have altered the staging of the Olympic Games. Thus far only the World Wars have kept our athletes away from the grand stage, and several politically based boycotts prevented some nations from participating in other Olympic Games. In fact, few events have altered day-to-day function across the globe as has COVID-19. In what seems like an instant we have gone from training and congregating wherever and whenever we want- to travel restrictions, closed borders, closed training centers, and millions of people living in self-isolation.

Pandemics in one sense are isolating, while in another they are unifying. Neighbourhoods and communities band together to ensure the least advantaged are taken care of. Teams find themselves in similar circumstances of training and competition interruption, while wondering if they are being disadvantaged if other nations are not abiding by the same restrictions.

Timing and the Olympic/Paralympic Games

Let’s think about a typical Olympic/Paralympic Quadrennial:

Starting with the amazing experience of the Games- some surprises, some expected performances, and some disappointments- followed by retirements, “breaks”, school, and gearing up for the next Games. Some take a prolonged break while others insist on never missing a beat in training, already focused on the next Games. In between there are World Cups, World Championships, Pan American Games, ParaPan Am Games, Pan Pacific Championships, NORCECAs, and many other qualifying competitions for various sports.

Athletes put their lives on hold for this. Innumerable sacrifices occur along the way: relationships, jobs, school, friendships, and housing- to name but a few.

Since COVID-19 started to eke its way across the globe (in the final half of the final year of this Quadrennial), it has affected athletes and sport organizations in variable ways. There are understandable uncertainties and anxieties about when qualifiers will be held, how to maintain fitness and training, and whether the Olympic/Paralympic Games will occur this year. There are numerous camps who believe the Games should go ahead as planned; while others support them being postponed or cancelled. There are huge ramifications for all of those options, but the tangible concerns among athletes will include feeling:

• fear that they will be less physically prepared for upcoming events
• as if they are at a competitive disadvantage
• ill
• socially isolated
• disconnected from typical healthy outlets and support networks
• emotional if someone they know–friends, family or teammates–becomes ill
• lost and begin to overthink their life’s direction: what to do if the Games are delayed or cancelled; whether to continue; about next steps in general.

Transitions in an athlete’s career are inevitable. Graduation and retirement after major games are natural transition points and are more under the athlete’s control, while significant injuries, deselection, and the threat of Games cancellations force an athlete in a direction that is not on their terms.

Effects on an athlete’s mental health

Athletes who have pre-existing Obsessive Compulsive Disorder (OCD) that have compulsive handwashing may scrub their hands until they bleed and lose much of their epidermis. Athletes who fled countries abroad as the curtains of COVID-19 travel bans were falling may experience symptoms of Post Traumatic Stress Disorder (PTSD). They find themselves feeling alone and isolated as those around them do not understand their experiences and cannot provide the comfort they need. There are feelings of helplessness and fear as either they, their teammates, or Interdisciplinary Support Team (IST) members are tested for COVID-19 and await the results. Their support structures are physically disbanded, and they have a lot of time on their hands. Some athletes are still trapped in foreign countries, unable to return home. In the average person this would elicit feelings of fear and helplessness. With the threat of severe illness across the globe, it can also create fear of never making it home. National Sport Organizations have worked hard to get their athletes home, but those who are away on professional contracts have other hurdles to jump.

Our Canadian athletes are across the globe- they need support wherever they are. Let’s start by validating their concerns and letting them know they are not alone! A global pandemic such as Covid-19 can have a significant impact on an athlete’s life, including:

• Exacerbation, triggering, or worsening of pre-existing mental illness (anxiety, OCD, depression,
  insomnia) * IF YOU HAVE A HISTORY OF MENTAL ILLNESS SUCH AS ANXIETY DISORDERS,
  MOOD DISORDERS, OCD, PTSD- these have a potential to be triggered and amplified by these
  circumstances. It is important to monitor your symptoms and seek support from a sports
  psychiatrist if you feel your symptoms are unstable or if you are having thoughts of suicide or
  self-harm.
• Illness (COVID-19)- yourself, teammate, family member or friend
• Isolation

Know where to go. The type of struggles you are having may dictate what level of support you need:

1. If you are worried about how these interruptions will affect your maintenance of fitness and mental strategies for performance and anxiety, then Mental Performance Consultants can support that.
2. Psychologists and counsellors can assist in the delivery of psychotherapy to discuss mood changes, anxiety and sleep strategies (as well as other things).
3. For more severe symptoms such as severe anxiety, or low (or high) mood that lasts for a week or more and interferes with function and self-care, a Sports Psychiatrist would be the best service to access. If anxiety, disordered eating, mood or OCD symptoms (obsessions and compulsions) are more difficult to manage, or if insomnia or panic attacks are become more regular, a Sports Psychiatrist should be involved in your care. If hopelessness, self-harm and suicidal thoughts are occurring, referral to a sports psychiatrist is a must.
4. One of the biggest differences between the types of providers include the fact that Psychiatrists are medical doctors who can make diagnoses, order medical tests (if necessary), provide prescriptions (if necessary), and their fees are covered by provincial health insurance.
5. All of these providers can work together to provide comprehensive and complementary care for the athlete. Many National Sport organizations have access to Sports Psychiatry services that can be delivered across the country. For those who do not have a formal relationship with a Sports Psychiatrist, support can be easily accessed.

Available resources:
Specialized mental health support is available. Contact your regional Game Plan advisor (https://www.mygameplan.ca/), Director, Health and Performance Services at your COPSIN centre or institute, Sport Psychiatry Services (www.synergysportmentalhealth.ca) or CCHMS (https://www.ccmhs-ccsms.ca/) for assistance with a mental health referral.

1. Game Plan- @gameplandematch- Morneau-Shepell Support line 1-844-240-2990; https://mygameplan.ca/resources/health
2. Director, Health and Performance Services at your COPSIN Center or Institute
3. Sport Psychiatry- Central contact for services across the country, direct athlete care: Dr. Carla Edwards- cedwards@synergysportmentalhealth.ca www.synergysportmentalhealth.ca
4. Assistance for general service referral – CCMHS- (https://www.ccmhs-ccsms.ca/)
   Canadians are STRONG and RESILIENT.

#37millionstrong
Postpone today, conquer tomorrow
Drs. Carla Edwards and Jane Thornton