The State of Mental Health Care in the NBA

Ringer illustration

“This depression get the best of me …” In the middle of the night, during All-Star Weekend in his home city, DeMar DeRozan tweeted the simple line. The Raptors shooting guard initially deflected the groundswell of support and concern from fans, saying that he was merely quoting a song. A week later he reversed course, putting aside his characteristic reticence to let the world in on the depression and anxiety he’s struggled with from a young age.

“I’m so quiet, if you don’t know me,” DeRozan told the Toronto Star in February. “I stay standoffish in a sense, in my own personal space, to be able to cope with whatever it is you’ve got to cope with.”

DeRozan’s disclosure was followed in short order by two more from prominent players — the Cavs’ Kevin Love recounted a November panic attack in The Players’ Tribune, and former first-round pick Kelly Oubre Jr. chimed in to say he can relate to Love’s and DeRozan’s stories.

That several professional basketball players — including LeBron James’s right-hand man and an All-Star Game starter — have spoken openly about their mental health this season, let alone in the same two-week span, is notable. DeRozan, Love, and Oubre didn’t start the conversation, but their name recognition propelled forward dialogue that Metta World Peace, Royce White, and WNBA standout Chamique Holdsclaw had boldly broached years ago.

“Some of these guys in this league, it’s almost like they have to put a cape on when they play,” says Celtics head coach Brad Stevens, a staunch supporter of mental health discussion in the league. “And oh, by the way, they have to do that against the best players in the world.”

Retired guard Keyon Dooling has shared his story of post-traumatic stress disorder for years since abruptly leaving the Celtics in 2012. As the National Basketball Players Association’s first wellness counselor, he hasn’t stopped since, even penning a Players’ Tribune piece last week tackling the mental health stigma that he argues still pervades the NBA and the African American community.

“For so long, we weren’t ready to speak about some of the challenges in our lives,” Dooling told The Ringer. “For [players in 2018] to speak about it in plain and normal terms, it just really makes it very relatable for what everyone in society is going through at different times in their lives.”

What distinguishes this wave of discussion is that it’s backed by tangible action from the NBA and the players association: an initiative in the 2017 collective bargaining agreement to further mental health and wellness, complete with a dedicated new position to helm those efforts. Dooling will soon report to a director of mental health and wellness, who will operate an independent wellness program funded by the NBA and the players association. The NBA, which declined to talk to The Ringer on the record, has not specified whether the new hire will have authority in determining when a given player presenting mental health issues is fit to play. Dooling will serve as a liaison between players and the new program’s resources.

The new director position shows that the NBA is indeed making progress, but also that there’s still much work to be done to take care of players’ — and coaches’ — mental health.

Head coaches Tyronn Lue (chest pains, lack of sleep) and Steve Clifford (severe headaches) made headlines this season for taking medical leave to address physical ailments. The willingness of those coaches to set aside time to treat their stress-related (though not mental-illness-specific) health concerns emphasizes the importance of seeking treatment and recognizing the toll that pressure-filled NBA seasons can take on the body and mind.

“As [my headaches] got more severe, we just used stronger medication,” Clifford, then still the head coach of the Charlotte Hornets, told ESPN’s Zach Lowe in March. “And what you find out is, it doesn’t take care of the headaches, and then you get to a point where you have to change, as Dr. [Joe] Garcia, our team doctor, and our neurologist, Dr. [Ki] Jung said, you have to find out what the cause is and you have to change it. A lot of times in coaching it’s similar to what [Lue’s] doing. It’s lack of sleep. Some of it is stress-related, some of it is too much work, and a lot of it, frankly, is the schedule, the travel, and not getting into regular sleep patterns.”

Other coaches took note. “I’m sure all the coaches stopped in their tracks when they saw [Lue step away],” Miami Heat coach Erik Spoelstra told The Palm Beach Post in March. But it also started a long-overdue dialogue. Spoelstra said that he talked to other coaches in the wake of Clifford’s leave, and that he expects mental health discussions to be a main focus of coaches this offseason.

Access to mental health professionals is a big part of the NBA’s changing attitude toward mental health, for players and coaches alike. Teams aren’t required to employ them, but more seem to be offering that support.

“I am aware of several NBA teams that historically have not had psychologists involved that are now in the process of looking for psychologists,” says a sport psychologist who practiced part time for an NBA team from 2013 to 2016. (They requested anonymity from The Ringer to protect the privacy of players they treated.)

Many teams choose to hire clinical psychologists or sport psychologists. The former serve as therapists who counsel players who present symptoms of mental illnesses like anxiety and depression as well as issues with family relationships or grief, while the latter work with players to improve aspects of on-court performance like mindfulness and communication. Sport psychologists can offer referrals for clinical specialists to players who may need them, but are not typically licensed to provide regular talk therapy or prescription medicine.

As a February Sports Illustrated investigation into sexual harassment and violence shows, the Dallas Mavericks’ office culture has not been progressive in every respect. But the Mavs were the first team to bring a full-time sport psychologist on board, hiring Don Kalkstein around the turn of the century. “We don’t want the thought process to be ‘I have to make this shot,’” Kalkstein told the Los Angeles Times in 2015. “We want the thought process to be, ‘I’m going to catch and shoot, I’m going to get myself in a good position.’ So they concentrate and focus more on the process, which eliminates what we consider pressure and anxiety.”

Other teams, like the Bucks, Pacers, and Kings, are also known to have positions dedicated to supporting mental health and performance. The Celtics have a part-time clinical and sport psychologist available for players and coaches. Stevens says he’s started the past couple of training camps by going over statistics about mental illness with players, the importance of vulnerability in strong leadership, and the resources available should a player choose to seek confidential help from the psychologist.

“We don’t want to try to look like we’ve got this all figured out or that we’re some trailblazer, trendsetter,” Stevens says. “We just wanna make it so that people know that our guys are talking about it.” Stevens came to coaching after a job as a marketing associate in the pharmaceutical industry, which he says opened his eyes to how life-changing psychiatric care can be. The support of a renowned coach like Stevens can make all the difference in players’ mental health care, the anonymous sport psychologist stresses.

“I did not have the full buy-in from the coaches and therefore the players to use me as a resource,” they say. “Not one of [the head coaches] would allow me to stand up for five minutes in front of the team.” The psychologist, who works in private practice, would consider rejoining the NBA, but only if the GM’s hiring decision is backed by enthusiasm from the coaching staff, which then normalizes the process of players asking for help.

It can be easy for jaded fans to write off NBA players’ mental illnesses as ridiculous or privileged, given their fame and apparent wealth. In the shootaround before the Malice at the Palace, Pistons fans taunted Metta World Peace (then Ron Artest) for his on-court anger issues with signs reading “Ron Artest Is Crazy” and “Ron Artest Needs Zoloft.”

“They just look at them as superhumans, the men and the women,” says Holdsclaw, who has spent much of her time after retirement working with young basketball players and encouraging them to express their feelings. “I’m quick to tell [critics], man, ‘Let me tell you something, this does not discriminate. It don’t matter what race you are, how much money you got, your socioeconomic status. It doesn’t matter your gender, it doesn’t matter if you’re from the city, from rural America. This hits everyone.’”

Athletes themselves can be critical of peers who are upfront about their mental health. The grit and independence required to play professionally and emotionality seem mutually exclusive. For example: “A lot of people are afraid to take medication,” says Holdsclaw, who was initially wary of the psychiatric pills she was prescribed and how it’d affect her game. “Especially athletes, because we think we can work through everything.”

Stigma will live as long as athletes themselves equate mental illness with weakness. “[Love’s essay is] great for awareness and mental health — and that’s absolutely fantastic and you need that — but then there’s a side at the same time where it’s like, ‘Oh OK, your enemy is going to read that,’” Chris Bosh said on The Bill Simmons Podcast. “That’s great that we’re all friends, but at the end of the day there’s one trophy.”

Although resistance to mental health advocacy remains, it’s less pervasive than before, thanks in part to icons like Holdsclaw and her NBA counterparts. In 2004 the Washington Mystics star, Pat Summitt protégé, and former no. 1 draft pick let people in on a new, less perfect dimension of her life: She lived with depression.

“I couldn’t move, couldn’t talk,” Holdsclaw told The Washington Post, describing how she felt after her the death of her grandmother, who raised her in New York. “I was like, what is going on?” Holdsclaw was more recently diagnosed with bipolar disorder, which she still gets treatment for.

More recently, Holdsclaw’s NBA peers have spoken up about their own mental health — including her former teammate on a Queens Boys & Girls Club basketball team. World Peace, after winning the 2010 championship, gave a shout-out that helped change the league’s perception of what athletes could and should be.

“I definitely want to thank my doctor, Dr. Santhi — my psychiatrist,” he told ESPN’s Doris Burke. “She really helped me relax.”

Reflecting on the memorable moment, World Peace told The Ringer: “I didn’t know how much publicity it would get.” His forthcoming autobiography, No Malice, addresses his mental health throughout his childhood and playing career. “I didn’t think about it. I think I was one of the first ones to actually come out like that.”

In 2015, new Laker Roy Hibbert, who had worked with counselors during his time with the Pacers, credited World Peace with paving a path for honesty about mental health in the NBA. “I felt that when he did that, it kind of opened the doors to make it somewhat OK,” he told ESPN.

The NBA’s growing acceptance of and advocacy for mental health awareness dovetails with a larger movement throughout sports and beyond. The former NBA sport psychologist credits increased mental health talk among pro sports leagues to activism and slow but steady reform at the college level. Many schools now offer student-athletes access to the care they need within their athletic departments, alongside other essential resources, like athletic training and academic tutoring.

Chatter is also growing louder outside the classroom. The world’s most decorated Olympian has shared that he has wanted to kill himself. NFL wide receiver Brandon Marshall has long been outspoken about his borderline personality disorder. MLB players are slowly coming forward: All-Star closer Roberto Osuna attributed a missed relief appearance to anxiety, and journeyman catcher Mike Marjama opened up about his anorexia. In addition to speaking about their own personal experiences, DeRozan and Love filmed a PSA for the NBA encouraging mental wellness. (DeRozan, Love, and Oubre declined comment for this story.)

Meanwhile, mental illness also pervades pop culture. “I had a 9-year-old say to me, well, you know, Selena Gomez checked herself into a clinic because ‘I’m suffering from depression,’” Holdsclaw says. “For me, being with [kids], I see how they attach to people with similar struggles, how it’s great to have people who are open and honest. Now, because of that young lady, I can give other people this example of Selena Gomez, who they may identify with more than Kevin Love or DeMar DeRozan.”

Most people who talked to The Ringercelebrated society’s progress with mental health awareness and the NBA’s place within it, especially given the renewed discussion among players and the new joint NBA-NBPA initiative. But Royce White, who left the NBA in 2014 and later joined its Canadian counterpart, isn’t sold, even as he admits the current discourse in the league represents some positive momentum.

“We are first-and-40, and we’re acting like a 10-yard pass is anything other than us still being 30 yards behind where we need to be,” White says. “It needs to be acknowledged that we are re-having a conversation that we already had.”

White, who rejects the characterization that he left the NBA solely because he couldn’t manage his anxiety while on airplanes, also says that the “mental health conversation” in the league is shallow, with administrators and fellow players alike unwilling to engage with his deeper criticisms and policy ideas, including the NBA’s lack of protocol surrounding mental illness and time off for players, as well as its partnership with Anheuser-Busch, which he believes fosters an unhealthy culture at games. He also believes mental illness has been an issue in the league for far longer than many would like to admit, pointing specifically to substance use (often closely linked with mental illness), particularly cocaine in the ’70s and ’80s. “What you need to come out and say, [NBA commissioner] Adam Silver, is that we should’ve done something about mental health a long time ago.”

Even among those cheerleading the NBA’s latest steps to support players’ mental health, there’s disagreement about the right approach. While some would like to see all teams required to have a full-time mental health counselor or sport psychologist on staff, that’s not a setup that would necessarily be comfortable for all players. Those professionals are bound to confidentiality agreements, but the optics of being seen receiving mental health treatment in a team facility can still discourage players from using them.

“What happens to a player who is having some mental struggles?” the former NBA sport psychologist said. “Does he want the coaches to know that, who might not give him as much playing time? Does he want the front office to know that?” Teams would also do well to ensure that players who wish to seek help outside the team, like World Peace and Holdsclaw did years ago, know how to do so and can get reliable referrals from team officials.

The NBA’s work won’t end with the installment of a mental health and wellness director. The league will continue to work with Dr. Victor Schwartz, the chief medical officer for the Jed Foundation, a nonprofit that focuses on sustaining emotional health and preventing suicide in young adults (and for which Holdsclaw serves as an ambassador). In addition to focusing on the NBA, Schwartz will take a look at what, if any, changes should be implemented in the WNBA (which has a different collective bargaining agreement) and the G League to best help a broader range of professional basketball players.

As the NBA — along with the WNBA and G League — further prioritizes mental health care and advocacy, that effort will ideally trickle down to younger generations of players and fans.

“Anxiety, depression, maybe bipolar, whatever the case may be, those are things that people don’t always know what they’re going through,” Stevens says. “They know that they don’t feel right. They feel sad. They know that they would like to get better and maybe what DeMar and what Kevin and what others are doing is telling you, ‘Hey, not only can you get better, it’s good to talk about it so that you can find the answers right around the corner.’”

[“Source-theringer”]