Transcript

0:10

My side as well. So, Mister Neil, how are you doing this morning?

0:13

Doing very well. Thank you for the opportunity to speak with him.

0:16

Yes. We're excited to have you here in for the audience. Mister Neil, we leaned on him as the curator for this for this session and have as several and the topics, and also the the faculty we have for this morning is is as good as it gets. So With that, as a quick introduction to Mister Neil, Mister Neil, if you hadn't heard of him, you you definitely know of his work. And He has been a he's an NADA Hall of Fame member.

0:49

He's currently the program director and assistant professor Concordia University's athletic training program. He also spent prior to that in nearly 35 years as adjunct professor and athletic trainer at Syracuse University. More importantly, related to this topic, he has chaired 2 NADA sponsored inner association and consensus statements on psychological concerns of the app student athletes. The first one was in 2013 followed by another statement in 2015. So has many of number accolades.

1:23

He's in this in the emergency medicine related to mental health emergencies. He is in this space. He's also doing work and social work and also working on his degree in there, and then also he's had number of committees and other accolades. So will give it over to you, Mister Nealy. I know you can give some of your background, and then we'll go ahead and get started today.

1:45

Thank you for being here.

1:46

Thank you very much. Again, for the opportunity to speak with this group, this very important topic that's growing in concern, not only in society, but also in athletics. Just additionally, I've been trying to finish up my master's degree in social work. Just decided a few years ago, even though I had a great awareness of mental health issues with people, I was not credentialed to do mental health counseling. But now I will be.

2:16

And presently, I've been doing mental health counseling with a local agency. And University of Michigan here for the last a year and a half, 2 years. So, hopefully, I can bring in some of those those concepts as well to this topic. I really have no conflict of interest relative to this to this talk. Again, these views are expressed or in this presentation or or those are mine.

2:43

And the next thing I would like to do is to cover our growing objectives. Is discussed in physical and the psychological triggers for behavioral emergencies, explore common psychiatric emergencies, encountered in athletic environments of which I've seen several and then identify potential bottles related psychiatric emergencies and athletes. You don't see a lot of bottles related psychiatric things in athletes on the scene of athletics. Very seldom you ever see that. However, they do act out in society or at the facility from time to time.

3:20

I want to provide you a trigger warning This presentation does disc discuss psychiatric emergencies, and some people may find this disturbing to hear or discuss If you are uncomfortable with any of these items in this presentation, please, if you decide to drop out that's understandable, And if you stir if you have some any types of disturbing thoughts or feelings, please seek mental health professionals. Psychotic disorders. It's usually on the psychiatric spectrum and other psychotic disorders in the DSM 5, something I'm very familiar with in my new my new role as a counselor. The key features of psychotic disorders is delusions, hallucinations, disorganized thinking and speech, grossly disorganized or abnormal motor behavior, and negative symptoms. The severity of these symptoms are predictive of important aspects of this disorder.

4:22

So it depends on the spectrum of how severe these criteria are presented and for how long. Usually see these for a minimum of 1 month with worsening criteria acutely. So when you're with an athlete, and they started displaying some of these behaviors over a period of time. In the DSM 5, it says it has to believe for a month. However, oftentimes, we've all been around athletes.

4:50

I've been around tens of 1000 of them. And oftentimes, people get into labeling people. You know, they're a jerk or other words you would use or they're a strange person or things of that nature. So instead of stepping back, from doing these labels, we should instead be looking at their behaviors and how severe some of their behaviors might be how they impact themselves, how they impact other people. Brief psychotic disorder typically experience emotional turmoil or overwhelming infusion.

5:24

They are they have an inability to to function. They have an inability to think clearly. And they do present ahead of these symptoms with other things that we will be discussing. And again, those who are at risk for these psychotic disorders or fall along this schizophrenia spectrum. The psychological crisis, it's like it feels like you have signs of them, you've heard about them, or you have observed them.

5:58

So feels like for the person who's having the psychological crisis is they can't stop their pain. They can't they can't think clearly They can't make decisions, and it's very hard for them to function. They are acting out and in some ways, they're very incapacitated. Secondly, Ball, they have different kinds of signs as they have abrupt changes in their behavior. You see people who don't take good care of their hygiene.

6:26

They have weight loss or weight gain. They do decline in performance in school or on the team. You see their their performance declining on the field or in the wake room or you hear about them not attending class. These are all precursors to the psychological crisis. Excuse me.

6:46

They report dramatic changes in sleeping and eating problems. They would draw from activities in relationships and isolate and isolate themselves from their teammates, from their classmates, They may also go into alcohol or substance abuse. Some may do self injuries, such in the forms of cutting, and they may develop suicide ideation. What have you heard as the athletic trainer or the person trying to help this athlete is that you hear them saying it's all or nothing thinking. They catastrophize every little thing, and they feel hopeless.

7:24

So they may have done some good things that day. Either class or the field, but they make one little mistake, and it's a catastrophe. Or they think that something bad is gonna happen, and that's what they dwell on. You have a tendency to ruminate. Would you observe as the athletic trainer or the EMT?

7:44

Would be a loss of important relationships or the emotional of the team. They become impulsive. They may just do things impulsively they say things or do things without thinking things through, like fighting on the field or saying racial comments. Giving away prized possessions, loss of interest in previously pleasurable activities playing the sport, seeing their friends, for example, And again, abusing alcohol or substances, these are all precursors to the event. Who are people that are at risk for a psychiatric emergency?

8:20

We know from a lot of data out there in the mental health field that people as children may have adverse childhood experiences. So on the average of 28% or whatever before, adolescent psychiatric disorders were associated with world war childhood adversities experienced between the ages of 13 17. So before I go down these, it's very, very important that you understand that a lot of mental health issues and problems and disorders of people experience as an adolescent or an adult start in childhood. They may seem strange. They may seem withdrawn.

9:00

They may seem angry. They may seem anxious. That's the time to start looking into and addressing them. As a youth and as an adolescent. Because I can tell you as a as a counselor of numerous people, The people I talk with on a broad spectrum of of clients is that most of their almost all of them report their problems started as a youth.

9:24

And from adverse childhood experiences, they had not adapted parental styles. They were applied to them growing up. Some come from, you know, great neglect or or abuse. These are the things that people experience and getting to know your athletes and their backgrounds is really critical because knowing these things helps you identify a potential problem. So when someone starts to act out early, you could intervene.

9:51

So in these childhood anniversary experiences are they experience parental loss. Maybe there's only one parent in the home. Maybe one parent is in jail. Maybe one parent is dead. You have parental mistreatment.

10:05

They abused their child. Either physically, emotionally, or sexually. You have parental maladjustment. The parents themselves may have mental health disorders, or they themselves have a substance w's disorder. And again, people come from economic hardships.

10:22

Other contributing factors we are now discovering in the area of mental health is the use of cannabis. With the legalization of marijuana, more and more people are trying it, more and more people are using it It is a psychologically addictive drug. Some may argue physiologically as well. We also know that A lot of adults in their ages, forties, fifties have a very difficult time. Stop smoking marijuana.

10:51

So it is a habit forming lifelong condition at times for some people. And what we found is that studies of those using cannabis for port at increased risk of developing psychosis. There were several long term studies that have demonstrated this. And then lastly, Ball, we know that athletes have very unique stressors of being an athlete, and these stressors can end up triggering or exacerbating a present mental health condition. The mental health status examination of MSE is something that is utilized by social workers, counselors, people in emergency rooms.

11:36

And this is a component of the medical and psychological examination. What you wanna do is you wanna evaluate quantitatively and qualitatively a range of mental functions and behaviors at a specific point in time. So this information is gathered about the the patient or the athlete's behaviors, their thinking and their mood. So I would I'm gonna go through this, and I would strongly encourage the audience to be very familiar with this. This is a this is a an algorithm that you can use whenever you are talking with, approaching someone who appears to be in psychological distress.

12:14

This is an effort for you to identify it early and to intervene early before it goes humbling downward and reaches critical mass where the person, you know, is in the self harm or harm of other people or starts breaking up property. These are the various areas I just wanna touch all a little bit, which as you can see here. These are things that touch a upon their behaviors or thinking and their mood at the given time you're interacting with them. You wanna take a look at a person's appearance. I've listed all of them there, but what I've done is I put an asterisk by the ones that are really critical.

12:51

You want to look at someone's posture. How are they presenting themselves? Are they slouched over? Are they upright? Do they not engage with you?

13:02

You wanna see if they're looking at you when they're speaking with you? Are they looking away? Were they not engaged? You would look at their grooming. Do they appear like they obeyed?

13:14

Do they appear like they're taking care of themselves? You wanna look at their manner. Are they agitated? Are they withdrawn? Are they not responding to your questions?

13:27

These are all things that I think that you should be be taken into account. You wanna see if they're paying attention to you. I will tell you this as I as I instruct future athletic trainers as students is we have to have patients where we're talking to people. We're such an effort to try to get to what the nature and the severity of an injury is instead of just letting us have a dialogue with the person and being quiet and let it then express themselves. You can learn a great deal by just staying staying quiet.

14:00

So when I do counseling sessions, I ask questions, and I asked them to tell me things was going on, and I just stay silent. And then I do follow-up questions from there. But people with psychiatric Disorders, they may be all over the place, or they may not be talking at all. You also want to look at emotional, facial expressions. Are they do they have a flat effect?

14:24

Or do they express themselves with their body language and their facial expressions? Those are all things in this appearance part that you should be paying attention to. Motor, I think the most ones you wanna look at here are agitation, or do they appear agitated. Who appears agitated to you are right on the cusp of becoming violent towards themselves or towards others. So I think it's really important there when someone is agitated and you're standing, if you can either start walking with them or try to get them into a seated position.

15:03

In that way, you kinda like lower the temperature. So you kinda minimize that agitation that you're seeing in order to engage them in a good dialogue. You wanna see if they have abnormal movements? Are they twitching? Are they fidgeting?

15:16

Are they picking? There's there's things as a picking disorder. Are they always picking it themselves? You're gonna look at their gate as they're walking. They could be have a taxi up.

15:27

They could have all kinds of things that are going on that could be an indicator of a substance abuse issue, or do they have catatonia? Whereby they just stare off into the distance. I've been involved in 2 or 3 of these with athletes where they just lay down. And they are not engaging in any way shape or form. They just totally zoned out.

15:51

Those are not great signs. Next, I think you wanna look at speech. I think you wanna look at all of these. What is their rate? What is their rhythm?

16:01

Are they really loud? Or they're very muted? They speak a lot. Do they answer your questions? Are they slurring their words?

16:11

Are we having a hard time articulating what's going on? They cannot express themselves? Do they are they do they have spontaneity? Do they just all of a sudden, just start talking out loud while you're trying to talk. So these are areas in terms of the speech, which is really important for you to monitor.

16:33

Next, you will look at their effects. Do they appear stable to you? One of the things I try to instruct Aflac training students are is to engage yourself with as many people as possible. In this day and age of electronics and the phone and computer always things, we become less and less in tune with working with people, being around people. It's not uncommon to see people at the work setting or after a class.

17:01

As soon as it's done, they walk out and they get their own their phones. They're talking to somebody, and they're checking their text, they're checking their emails. And what they're doing is they're not engaging people in the hallway as they're walking. Looking at them, smiling at them, saying hello, those kind of things. You have to become more in tune with watching behaviors of people in order to have an appreciation when somebody is not that stable in their effects.

17:29

Do they talk inappropriately? Do they act inappropriately? How intense is their effect? Are they way over the top or they are only withdrawn? You're gonna look at their move.

17:41

Now people's moves fluctuate throughout the day depending on what's going on. A key element or the critical element in counseling and social work is a biocycle social element. You're the biophysical, you're the psychological, and then you have the support. So if someone is from not in a good place biophysically, either because they're hurt, they're they're sick, or their sleep deprived or hypoglycemic or they're dehydrated, they're already at risk of having their mood affected. If psychologically they don't have very good coping skills for stress, that's another area that can affect them.

18:23

And last level of which we'll see in our presentation and again in suicide ideology is when one does not have good social support from people, they are a great risk. Having bad outcomes. So when you're looking at someone's effect is how well do they present themselves in terms of their mood? They can be in a bad mood, but can they walk through a bad mood. What you see with people with psychiatric disorders and people don't do well psychologically, is that their mood becomes their norm.

18:58

Their bad mood is who they are. And one more bad thing or a sense of hopelessness comes along, and then they start tumbling. So in the area of counseling, what we try to do is we try to help them identify what affects their mood. What they can control, what they cannot control, and have discussions on how to develop good coping skills to address both of those. What is their thought content?

19:28

You wanna get talking with them and ask them what their thoughts are. Do they have suicide ideation, which we'll talk about a little bit later this morning. Deathwishes. Do they have a homicidal ideation So the things that I'm going through here today, and I'll go through in the suicide ideation, is things that we are looking for as we're going in as we're doing counseling work with our clients. And we pick up on things they say or we ask them directly if we think that something's going on.

19:59

Do they have depressive cognitions? Are they depressed? Are they feel hopeless? And do they feel sad most of the day? Are they obsessed about something or somebody?

20:12

Do they ruminate? I found that a lot of people who who struggle psychologically, they have a tendency to ruminate. They think all the time about their stressors. They think all the time about things that they that make them sad or make them anxious or make them hopeless. Ask them what they're thinking about, and how often do they think about those things?

20:35

They have phobias. They have ideas of references. They have paranoid ideation. That's what happens oftentimes. And then they have magical ideation.

20:44

Things are just gonna happen magically for me, and then they have delusions and or hallucinations. In their thought process, how do they make associations from what they're doing now presently and are they are they in the present. Many people when they reach a certain point, they will disassociate. I think a lot of people have been in these circumstances when a great stressor hits you or someone is really getting on you Psychologically, they're they're, you know, credit criticizing you or whatever it might be. People have a tendency to disassociate.

21:25

You feel like you're outside of your body. So are you coherent? Are you associating where you are at the present and my thought process? Are you logical in what you're talking about? Are you blocking your thoughts?

21:42

Are you blocking the thoughts of other people? It's hard to reach them. Once you get to the point where it's hard to reach those people, now you start having a lot more issues. And again, they are not attentive. Their perceptions could be off.

22:00

Delusions are misinterpreting things that you're seeing. You're delusional. You're seeing a certain thing, and you're just totally misinterpreting it. Hallucination is where you're seeing things that are not really there. And those are the 2 distinctions right there.

22:17

People have hallucinations. They have illusions. They depersonalize themselves from the circumstance. And more alarmingly, they're depersonalizing themselves from actions they may be taking on other people. Dave Javu is the sense of I've been here before, Jamayas vu is where you're in a circumstance that you should be familiar with and you're not a person.

22:44

I don't know who this person is. Or a circumstance among the practice field, I normally recognize among the practice field. So these are things that you should be thinking about and looking for. Again, in their intellect, you're making a determination there What is your global impression of this person? Are they average?

23:08

Are they above average? Are they below average in their intellect? And I work with people who've had psychiatric breaks. Some have been very smart. Some have not been kinda like the middle will grow their intellect.

23:21

So it affects both ends. I think the biggest thing is is the insight. Oftentimes people in psychiatric crisis don't have an awareness they're having the problem. They just don't. They're so disconnected through all these mental status examinations that you can do that they have no awareness where they are.

23:49

They don't know how ill they are. They don't know how they're behaving. And now becomes a problem because now you have to make them a little bit of a wear and then you have to have some plants in place to address these. Your initial engagement with athletes, and I can think of two or three times where I've had to do this is you you have to be aware of the fact that you wanna try to have a dialogue with them. And oftentimes, People don't know what to say or do.

24:22

For example, if someone was to die and you hear about the death of somebody, most people don't know what to say to people. When someone's having a psychological problem, they feel depressed or really anxious, People don't really know what to say in terms of support. The same goes for psychiatric breaks. It's scary. Is concerning, and you're a little confused yourself as an athletic trainer at EMT.

24:51

What's going on when you're being asked to walk into the scene or you come upon the scene, what you're supposed to do. I would recommend that your 1st day the most the most important thing is to stay calm. You wanna lower your voice. You wanna engage them. You may not wanna get too close to them, but you wanna be in their space.

25:11

And you wanna position yourself usually around their 45 degree angle. Because looking straight up into somebody who's having a psychotic break can be very intimidating for them. When I did a lot of voluntary work at the Syracuse VA, I had a therapy dog, and I would go in and I would visit wounded soldiers, people or hospice, but the most the most oppressive Part of that experience was going up in the psychiatric unit was a triple locked area. And they would teach you to try to stay at the at some of the veterans 45 degrees, never look them directly in the eye. You look right above their so you're looking at their face, but not directly in their eyes.

25:53

And you made no sudden moves or you didn't move with your hands too fast because that could be a triggering thing for them. So I saw a lot of psychotic breaks and psychiatric emergencies in that locked up area of the VA hospital. So I witnessed how they took care of those things, and I was involved in 2 or 3 of them myself or my therapy dog. And a lot of those techniques do do work. So you wanna lower your voice, you stay in your ground, You try to be calm, and you try to stay at their 45 degrees, you're not looking directly into their eyes.

26:31

You wanna suddenly seek help of others to alert your EMS services and or the police because you have a sense that you're gonna have to go someplace for their own safety. And again, safety first, you wanna keep your distance from them. If they start to walk around and they're not, you know, and they're not gonna run into traffic, you're not gonna chase them into traffic because you put yourself on harm's But if they're walking around, you wanna stay in your proximity of them just so people know where you are as help arrives. And I think also when you're talking with them, you wanna you wanna seek to understand in which what their main complaint is. They may not themselves fully understand what it is.

27:16

But if you can get them to articulate something to you, that's something to work on in your dialogue. Say, I'm really upset about this. Say, okay. Well, you sound and you look like you're very upset about this. Can you tell me more?

27:30

So by trying to engage them in a little bit of a conversation helps keep them with you while you're waiting for help to arrive. So in the case of in the case of a couple athletes I work with, we activated our play, which I'll talk about here in a second. And when help arrived, I've I've always found that the police and the EMT people who are better trained at this They they actually do a pretty good job in trying to keep the situation calm, and then they explain to them for their own safety. They need to go someplace for someone to evaluate them on one or two occasions, I actually went with the athlete to this area because I was someone they were familiar with. And we were able to go and help them get them into a situation where they weren't a threat to themselves or other people.

28:21

And they were around immediate mental health care. I think the athletic trainer should know your protocol for psychiatric emergencies. We know our protocols for emergency action plans, concussion protocols, and things of that nature. I think you you need to have one for what is your psychiatric emergency. If it's at university level, they should have one in place.

28:43

At the high school level, they should have one in place for a place of employment. You should have one in place or not, then the discussion should be made to start having that. So you should know your your this mental health emergency action plan, I think you need to review it, at least annually, if not more often. I think you need to have the plan nearby for reference. I always kept all my emergency plans on in my desk and in my briefcase.

29:13

Because you're gonna have an emergency psychiatric emergency on the road. And what do we do when we're on the road? Normally, you just go to the hospital. You have to ask for local EMS or police to come to assist you. But what is your protocol?

29:29

How do you handle that after the fact? I think you gotta find out which hospital or facility that the person goes to, How would they be transported there sometimes by ambulance, sometimes by police? And where is the mental health inpatient facility located? To inform family members as you start to contact them. Where do they wanna go to go visit their their level of them.

30:01

I think in summary, you need to know your potential actors may contribute to a psychiatric emergency, people with a mental health disorder, people with adverse childhood experiences, or a greater risk those who use substances, especially marijuana. And it'll also be a recognized that athletes who have a mental health disorder and experience in unique stressors of being an athlete are at risk. So you take an athlete who come from an adverse childhood experience. They themselves may be struggling with anxiety or depression. And then they have unique stressors as an athlete in their time, lack of support, being demoted from the team, being injured and having their athletic identity at risk, those are the ones you need to have on your radar.

30:50

You need to engage them, talk with them, And if you get the sense that something's not going well, go down your mental status examination with them and try to get them into early care. There are my references. And again, thank you for attending this presentation. And with that, I'd be happy to take any questions.

31:15

Great. Thank you, Mister Neal. If you would, I will have you unshare your screen. I think there's some issues with the submitting and the type in the chat area. And hang on one second.

31:28

Any Well, let me making sure that you should be able to use the chat function. I think there was a issue earlier. If not, you put in the q and a any questions you may have. I know I have involved give us everybody a chance to submit some questions in. The question I I guess I've always had it's always difficult.

31:54

I think you mentioned earlier about just that communication, you know, in in the mental so I get to the emergency is always an awkward situation. You mentioned, like, there's some normal a normal occurrence. Somebody just somebody passing away in the family, somebody close to them. I'm not really sure what to say. How do you hand what are some tips that you would give to as far as talking with a you you're gonna have to call somebody, but how do you best how does the athlete try to other providers work in, how to how to pass that information, what to say, and more importantly, what not to say over our over a phone call because it could get interpreted in any number of way depending on how they are, how they're listening.

32:41

So what you're asking is how how would I would articulate to a parent or guardian about their child who just had a psychiatric emergency?

32:48

Right. Because I've had this I do a lot of large scale events and having to call. I've had several cases where I've had to call the the family member, you know, have an athlete who's seriously injured and having to pass that news. They may be several states away. They may be in town.

33:05

And trying to be give them concern with that without being without passing too much information along because you you don't know where all the the status is point in time.

33:14

Yeah. What I would say in in this case, what I've had to do is, you know, I'm I'm calling you about John or Jane, identify yourself, describe the circumstance that happened that they were struggling with some of their thoughts, some of their behaviors, that raise enough of a concern for us to take them to a facility where they can not only be safe but also be evaluated for potential mental health concerns. Okay. Great. Very, very, very simple, and then you you can answer and then you can answer any follow-up questions from them.

33:48

And I guess the the thing would be is just to be be honest and say, if you don't know, you don't know, that's probably a success. I've had to deal with the you know, an athlete that wasn't related to psychiatric, but I know the mental health specialist simply said, look, just face the truth. Face the question with the truth and nothing but the truth. But you had to know how to gauge that as well from the response standpoint.

34:12

Yes.

34:12

Okay. Have one question that's already come in from Mir from Mir and is asking, can you name a psychiatric EAP as a reference? Or, I guess, would be where to it's a good starting point for if you're developing a psychiatric emergency EAP.

34:32

There's some there's some things in the in the area of social work. It has a few, but it's not a lot in-depth. I think a lot of them is your local organization, your local EMS, people may have those. It's interesting that that's being asked because I'm being asked maybe to update the consensus statement that I chaired back in 2013, and we will be putting in a little element of the psychiatric emergency in that new consensus statement. So hopefully, we'll give some people some guidelines there.

35:03

Very good question there. Along those lines with this is not something you can you you don't get a lot of practice in. It's not like having an ankle sprain or, you know, the the normal you know, how to how to treat that. Any suggestions on how the the audience can reach out to their local resources and participate in, like, simulation activities. Or or are there virtual, like, online platforms that have or do do you know of that that you know, you could log in and say, I wanna interact, you know, like a simulation room or how to how to manage what to say, what not to say, how to interact, what would maybe a threatening situation, whether it be through virtual reality or in person with other resources.

35:55

Yeah. Great question. I would say if you can do simulations in person or better as opposed to virtual because, you know, you if when you do virtual, it's kinda like, okay. We're kinda like, you know, play acting here. But if you're more in person, if the person knows how to act out, it's better.

36:11

Here at Art University, We actually work at University of Michigan. They bring over all their athletic trainers and their doctors, and we do actual simulations of various scenarios. And they videotape them and then they study them how they can better prepare for all these various scenarios, emergency care, psychological crisis as well. And Dale Coleman does a tremendous job in preparing his and his staff on that. The other thing I would tell people is what I did.

36:38

When you get the time and I know we're stressed for time, for athletic training, go volunteer at a VA hospital. Or nursing home where I did a lot of work as well as a volunteer to work there. I saw a lot of psychiatric issues happen there with older people. Once you see them, and you can watch how people interact with them and got it deescalated, you can adopt those and adapt those those methods. Okay.

37:05

That's very good. No. I guess the obviously, they're doing the in person's best or even probably even riding with your local EMS

37:13

Yes.

37:13

Would be 1. You have to go through some approval probably, but

37:17

Yes.

37:17

They deal with that. Worked for a while doing some work with EMS unit, having those psychiatric transports. Those when you were hitting right on target, with, you know, the first time you walk into a psychiatric wing of a of a hospital, it's, you know, you think you're looking at, you're trying to remain calm at the same time. You feel like that based on who's in there, they're they're they're they're throwing eye daggers at you, so to speak, and you're not again, they don't know who you are and vice versa and happen to be, you know, keeping your keeping yourself between the door And that exit point is a incoming Yeah.

37:55

I've had people knock on doors and tell me don't come back with the dogs because they didn't like dogs. Triple locked area area, you had green. They were normal. They're all scrubs. No belts.

38:05

No shoes. Then you had yellow. We had concerns, and they had several red. They were pile up or suicidal. So you're just trying to engage in, you know, what I'm doing is just I use the dog to start dialogues.

38:14

You know, let's say, my dog, and then some say no, get out of here and say, well, I love the dog or crying or holding the dog, and it gives you an opportunity to speak with them.

38:23

So somewhat over, I guess, related to the you mentioned your experience working with with animals and going into the facilities. What has been if and and that may be one opportunity for someone like local using dog using canine training or animal training to is a psychological support. Are there are there any triggers that you've seen that really that the patient who is in a psych psychological emergency they they gravitate towards with an animal. Something like the gravitate would change or that.

38:57

Yeah. That someone gravitated to the dog because that's a sense of stability. However, some people may be frightened of dogs. Or in one case, a guy was working with a Vietnam veteran. He used to shoot a lot of dogs.

39:07

He was in Vietnam, and he had bad flashbacks to that. I still kept coming in. There's a little Boston terrier. I mean, he was a pause certified person internationally certified dog for therapy. And having that and I used to bring him into the Aflac training room, but I watch who he would go to.

39:25

And then the next day, I would engage a athlete and say, hey. Do you like pet and buster? Yeah. How things are going? Not so well.

39:31

And then they would open up to me about potential problems, and then I would get them referred for mental health care.

39:37

Okay. Reagan. Thank you. I do have one other question here. Is from Mandy, she's asking, you talk about You talked about how to have a conversation with a parent, but could you give an example how to speak with a coach?

39:53

Summarize informed or aware of the possible issue in their athletes. So trying to bridge that gap with the right conversation.

39:60

Great question. So what I would tell the coach is, you know, that Jane had a little issue this afternoon. You may have already heard about it. For privacy sake, I'm not gonna go into great detail what's going on. I can't tell you that they were taken to a facility for their own safety.

40:19

For further evaluation. And then you can decide from there based on the conversation how much is is to be found out because the coach may very well have been right there when everything happened, and then they're upset. And then what I've always found is you're always trying to take care of it as someone who's trained in critical interest management as well. You're trying to deescalate the people who viewed these things for them because that can be a triggering thing for them as well. In their own past or family members past.

40:46

So with the coach, I would just basically explain they were taken for their own safety, and that should be their buzzword for further evaluation.

40:53

Okay. And then give them information as as

40:57

As as well.

40:57

Just give them timely information when you have it. I think the one probably the one thing would be is not don't pin yourself into a corner saying, I'm gonna give you a a a answer at 5 o'clock today.

41:09

Yeah. Never do that.

41:10

And if it's and if it's not if they're not getting called by 450, they're they're they're already asking the question, and you don't have an answer, then it it it creates more stress, not just for you as a provider, but for the other other individuals involved. Yeah.

41:25

And I would tell you the last thing because I know a short time is the fact that you One of the things we also want to prioritize in the next consensus statement is how to integrate people back onto teams after psychiatric emergency or suicide ideology. Because there's a a stepwise thing there that that very confusing for many people.

41:46

Yep. And I had I know after myself, we were closing up, I had that new years ago for an athlete and had to go through a have psychological emergency, and they're sure enough, they were like, oh, they can go back on the road. And we're like, hold on a second. This is not you know, this is a very different what what was occurring. So and that's just not understanding at the time being a young athletic trainer, but now understanding, you know, look at what the process was for that.

42:12

So, any case, we are now at 9:46, and we run time, Mister I guess, one quick question. See, we can get this. We should we're we're starting later. So we do need to be Lindsey mentioned, we do need to be aware that some athletes do not look coach to have many, if any details. And Right.

42:31

That's a great question about maintaining prophecy and dignity and That's

42:38

why what I tell me, have a and had a situation or an incident, they went to take care of their safety. I'm gonna tell them that they have a second illogical break or anything of nature. It's no different than someone going to the hospital for an emergency for their physical thing. So she's absolutely right. You can't you don't break comfort to jelly.

42:54

How ever, I will tell you this, and I'll talk about this into my next presentation, is there's a difference between privacy and confidentiality. So when the threat, then confidentiality goes out the window.

43:05

Yep. Does. Well, great. We're out of time.