Transcript

0:11

So apologize for my video not being up, but I'm going to introduce my friend, Mickey Collins, who serves as LSU Director of Sports Medicine, Associate Athletic Director. Now congratulations. Position promoted here this past summer. LSU's associate, athletic director in director sports. Melison oversees the health care for LSU's 450 athletes.

0:36

Which includes 25 athletic trainers, 10 physicians, besides therapist, chiropractors, and physical therapist. So her role is to expand the school's new champion healthcare partnership with our Lady Lake Medical Center. She played a critical role in the integration and the continuity of medical care for athletes during this transition. Over the last 18 years, Mickey has been the head athletic trainer for LSU Women's Basketball, Go Tigers. Before joining that, I've got a training staff with football 2019.

1:11

She was part of Final Fours with LSU Women's Basketball, play Key role in LSU's football national championship. Her first role as LSU was as the athletic trainer of volleyball was inducted into the LAT hall of fame in 2022. She has also taught LSU's athletic training curriculum and is in an outstanding clinical preceptor and has read reviews from all of her students that have ever been with Mickey. Master's degree in sport pedagogy, LSU, or their bachelor's from University of Nebraska did not know that. While Nebraska Mickey worked as a student trainer, for the Cohen Husker football team win this basketball and gymnastics team, Mickey.

1:57

It is an honor to have you to bring up our final presentation. I'm really anxious to learn more about this. Thank you.

2:06

Thank you very much, Roni. I appreciate that. Okay. Are you seeing the screen? How I'm seeing the screen?

2:13

Yes. I'm seeing it.

2:14

Follow-up considerations. Yeah. I

2:16

see it. It's ready.

2:18

Okay. Awesome. Well, thank you so much for having me. I wanna Today, I'm gonna talk about follow-up considerations in the aftermath of an athlete, a psychiatric emergency, and implementing a return to play and some other considerations that I think that we need to think about. I have some closures.

2:39

You know, those are our normal disclosures. I do wanna say I'm not an expert in this field by any means. I am no him Neil by any means. But I everything that I've gathered and everything that I've read and it's to better force me in what I can do for my student athletes and for my program. And everything that I've went through, I kinda was over going through it by myself and having to figure things out by myself.

3:07

So we've we've really put together a program here at LSU that we're proud of. I one more disclaimer. I realized that I am at a very a division 1 program that allows is a for the Forbes of many great opportunities and resources. So there will be some times that we'll have to kinda think outside the box and think what resource do you have in your community and what what you are afforded to have. So that is my disclaimer.

3:37

My learning objectives today are understanding the mental health challenges and the potential impact on sport and the need for removal from play. Comprehend the considerations needed for safe and effective RTP following a mental health emergency, and understand the factor, it should say factors that are beneficial to create a management plan following a mental health emergency. So here we go. The first things I kinda wanna talk about is just a little review over. I'm sure what Tim talked about, which is some of the mental health.

4:11

I'm calling them challenges that you will see any psychiatric event that we have, you know, there's such a wide array of them. But a lot of what we'll see, we have to before we can talk about return to play, we have to talk about removal from play and why we would remove them from play. At what point we would remove them from play? Who are making those decisions and so on and so forth? So, obviously, the first one we have here is mental health challenges, is depression.

4:42

We're talking about you know, when a student athlete or an athlete has low mood, hopelessness, poor concentration, you know, anything anywhere from guilt, worthlessness, suicidal thoughts, negative thoughts. And what is the potential impact that they have on sport? And obviously, on life. But in sport, lack of engagement, a motivation, low energy, negative thinking, negative body language, so on and so forth, which could lead to poor performance. Now, obviously, sport isn't the end all be all.

5:16

Right? That's not why we want it's not that it's not really important when it comes to a student athlete's mental health. However, sometimes when you take away sport, that makes, you know, their depression worse, things like that. So those are things to think about we had a student athlete that every time he walked into the building, he felt these symptoms, he had a lack of engagement, he would socially isolate. He had negative body language.

5:48

When he when we referred him to therapy, which oftentimes is a athletic trainer that is the 1st line of defense and noticing these things. When when we are able to refer him Our our next job was, okay. Can he be in sport? Is he well enough to be in sport? And we actually end up removing him from sport because this depression got so bad.

6:12

He was fine to be able to be in academic and social life and things like that, but it was the sport that was bringing him down. So, you know, sometimes things like that happen. The next one, we have mental health challenges as anxiety. You know, we have excessive worry, muscle tension, or concentration. All of those things alone leave to lead to muscle tendon stress and things like that, that that leads to injury.

6:40

So those are things that we really have to be careful with. Also, do when somebody has anxiety, are we gonna be worrying about a panic Is somebody gonna have a panic attack during that time? Which when we we've had soon athletes that they've had so many panic attacks when it came to competition that they really couldn't be a part of competition because they struggled so much with their panic attacks. You know, at first, maybe maybe it's a one time thing. Let's get them to a physician, see what a physician says.

7:13

But then when it's when it's becoming disrupting their life, their quality of life and things like that we have to really look at is sport important for them. Is that is that something that they really need to do? In in our level, when you look at the pressures that you have, you know, social media, fans, NIL, all that kind of stuff, let alone, young kids with the parents of pressure, the peer pressure with even parents alone, those are things that can really set a student athlete over. Then we have obviously challenges, mental health challenges in anorexia, neuropathy, and bulimia, and knees. These are kind of a different category.

7:54

Right? Because there's a lot of times that they might not be able to participate due to not enough chloric intake, just their bodies not, you know, with bulimia, you know, anorexia, you can get heart issues, things like that. So those are some different mental health challenges. But before you even get to that, oftentimes, like, Neil says, we really want to leave them in the for environment, but there's some challenges there. Then we move on to things like mania, psychosis, with mania, we've you know, a lot of times you'll see a decreasing for sleep.

8:36

Maybe a student athlete hasn't slept for, and you know that a student athlete hasn't slept for 24 hours what's going on? Why? You know, we we need to be referring these things or looking for these things or this risky behavior that they do. A lot of times in in our we see a lot of risky behavior. Why are they doing this risky behavior?

8:55

Is it in conjunction with some other things? Do we need to refer them to be looking at different things like that. But potential impact on sport, aggression, distractibility, intrusive, and disruptive behavior, All these type of things we we look at, and then we have psychosis, which as abnormalities in thought content such as delusions and hallucinations or disorders in thought formations such as disorder thinking. How can that disrupt sport? Obviously, delusions may appear as confrontations or accusations.

9:32

They get teammates and stuff. And, you know, we say all the time, man, that person joking around, but in in actuality, you know, there there are children, student athletes, all that with psychosis that if if it really becomes an issue, we need to be make sure we're referring and seeing, you know, getting them checked out. The next one I wanna talk about is substance abuse. And substance abuse is interesting. Right?

10:00

Because you know, in in my world, substance abuse becomes a thing where it's illegal for, obviously, sometimes it's not illegal. So, you know, you have marijuana, which is illegal in our state of Louisiana, but alcohol after after 21, you know, obviously, you can drink. So there's NCAA rules, there's SEC rule, or all that kind of stuff, institutional rules, not SEC rules. But when does that when does their excess of drinking or use become an impact on sport? And when When how what does that factor?

10:39

When do we need to take away the sport? And those are things that we need to look at. So if you look at the mental health continuum, that you'll see you see kind of all over, you know, you student athletes or people, we kinda go through this We were healthy. And then, you know, every a lot of people have mental health stressors like today. You know, silly stressors, I I might not be able to get over if I wasn't healthy, you know, stress of, you know, maybe a coach yelling at me or something like that, if if you can get over it.

11:15

If not, you kinda move into this significant functional and permanent. And and from that, you can become severe. And it's really a lot moderate and severe at your looking at do we need to remove a soon athlete from sport? Do we need to remove maybe it's the stressor or maybe they they are it's becoming unsafe for them to participate in the sport, and those are things that we need to look at. Because when you kinda get into that moderate area, That's when you are really getting restlessness, disrupted sleep, rumination, which leads to even more disrupted sleep, you know, all that, that is that is a recipe for injury as well.

11:59

You know, you're not getting you're not getting recovery and things like that. So moving on, the things that we kinda look at when we're talking about removal from score is a collaborative team should be making these decisions. And it's it's easy for me to say that. Right? I have the support of mental health team, our dietitians, our team physician.

12:25

But, you know, at your institution or at your school or wherever you are, You need to be thinking of who is your team, who is who in the community can help you, who is on your team to really kind of look at these these issues and and and come together as a team. Oftentimes, the athletic trainers looks looking at the majority of it or sees the emotional So if if somebody is seeing a therapist outside of your outside of your institution and you you're just kinda getting tibbits, they might not know half of what you see every day. You know, the the athlete might just be telling the therapist, oh, well, this is this is this and this is happening. But in all actuality, you're seeing something completely different. So I think it's important to be able to create that open dialogue to be able to maybe maybe if the parents are involved, you're telling the parents what you're seeing.

13:18

Or if you can get that open dialogue with the therapist to some degree, to be able to share what you're seeing, how you're acting. But these factors should be addressed, and it's and an athlete stability and suitability to participate. So those are, you know, when it becomes not safe, when it becomes really constantly not stable or the function, their their ability to function properly, and safely is becomes compromised. We kinda have an issue. Right?

13:57

And we we might need to roll from sport. And I'll I'll say this. I'm not even talking about I'm talking simply sports, so I'm I'm not I understand that we oftentimes are removing them from all activities and from school and things like that. But in this for this scenario we're talking sport. So consideration so after some type of traumatic event.

14:24

Maybe student athlete the athlete was removed from competition, removed from sport at some point. They've probably had some type of psychiatric trauma, some type of issue that challenge that has taking them away from sport. But then at there at some point, we have to decide, are we gonna remove or bring sport back? And what does that look like? And that's what I wanna focus on now.

14:52

So that there again, there there starts with our team. Right? So it's all fine and dandy if they are seeing somebody in the community, that's a mental health professional, and they're like, oh, you can get back to the team. Not a problem. Go on back.

15:06

Well, they have no idea. All the different areas that, you know, that the that the team represents and all the commitments that come from a team and things like that. That's why it's really important, I say, to have some type of team, you know, maybe a school nurse, maybe it's your athletic director. People like that that everyone can kinda be on the same page and discuss because everyone knows the different challenges of a student athlete. So we are gonna talk a little bit about the die considerations.

15:39

And the considerations that we've come up with are diagnostic assessment. Risk appraisal. And is it is it possible oops. Sorry. Is it possible to create a management plan?

15:50

It's not always possible to create a management plan. And so if you can't create a management plan, you probably can't return to sport, and we'll kinda talk about this further. So we have different type of diagnostics assessments, and these are things that you should you could ask your team fits or your physician not this that the student athlete is going to or the mental health, are we doing these type of screenings? You know, you have your PHQ 9, your GAD 7, a mood disorder screening, whatever the suicidal screening tool hit, this shouldn't be placed upon the burden of the for the trainer to have to do these. These should be for the student or for the physician and for the mental health professional, However, if you wanna know, okay, I'm gonna bring this kid back into the team and and really you're gonna be the one laying eyes on this person every day.

16:40

If you wanna know that it's safe to continue, these are the questions that you need to be asking. What are these scoring on these? What what are these screenings look like? Are we doing these screenings biweekly? Are we doing them?

16:52

Have you done one, and then we are we're done with it? You know, That's really important because like I said, how would you like to go on the road with a student athlete knowing that his Phq9, his depression scale, was through the roof and you had no idea. And this child or this child or student athlete was suicidal, And for all you know, he was clear to get back into sport. And here you're in Tallahassee, Louisiana, you know, eight hundred miles from home and you you have no support. And really then the athletic trainer gets gets looked to bond to do all this stuff.

17:32

And it's like, woah. What do you what do you wanna do after the trainer? Woah. So you need to be as armed as you can possibly be. So that's number 1, the diagnostic assessments.

17:42

There are special cases with eating disorders. If you haven't ever looked at the eating disorder examination tool, the RED's clinical assessment tool, the 2014 female athlete try accumulative risk assessment tool any of these type of screenings, you know, eating disorders are a whole different task and for a whole different topic for another day. But Those are those are really you need to know where you are with that student athlete. Where that student if that student athlete's really safe to return to competition or to participation, things like that. There there's a lot of documentation out there saying that Horton's having a contract signed by all members of the athlete care team when a student athlete with an immune disorder returns to play.

18:32

Or returns to competition. During their case management, actually, they are dealing with a contract. There's if you wanna look at the female athlete trial consensus consensus statement, there's a contract in there. I hope you can kinda see it well enough. But you can go and I have it down there.

18:52

You can go and look that up and see and take a look and that's something that You know? And and I'm not saying that an athletic trainer should be, but this gives you the tool to say, hey. Are we doing something like this? We need to be doing something like this. Because you as the athletic trainer are the ones seeing it most of the time, or you're the one having to deal with this.

19:12

So that's that's important. So then we look into a risk appraisal. How would the athlete react to the following? And these are things that So if if our assessments are good and you're the mental health professional and the team physician are like, man, the the student athlete score is scoring well. He's doing well.

19:32

So then we need to find a look at the risk appraisal. What's gonna happen if the student athlete has a poor performance? If there's peer conflict, you know, let's say the pseudo athlete has been gone and they came back and the teammates were were kind of disengaging with him and and we're we're kinda angry not understanding what the student athlete had been through. Pressure situations, feedback from coaches, including criticism. Hostility on social media.

20:00

I had a student athlete that we had rolled back into play. When I played in Tire Stadium. The student athlete then went back to his apartment, got on Twitter, and was reading all about how, you know, the fans hated him and things. And I did it. I'm in a different extreme, but that send him back into a tailspin.

20:24

And those are things that we have to think about. Think about the Huxley or even a friend of a friend, you know, somebody Instagraming and saying that a high school kid was a horrible or missed a catch or something like that. How does that affect high school kids? How does that affect college kids? I mean, it it affects people.

20:46

And how would that affect somebody with a mental health disorder? So we go on to busy schedule, including sams, things like that. We have to think about the timing too. So if we're gonna bring somebody back in, would it be really wise to bring them back in during midterms or during during some really busy time, you know, it's easy maybe to just be a normal person on campus walking around and not having any issues or maybe just going to school every day and not having but then you add the stressors of a sport and makes it a little bit hard. What about what about traveling with the team?

21:28

What what is the playing there, will they be able to handle being traveling with a team, being away from maybe the comfort of their own bed, their own home, their therapist right away, things like that. And then you need to consider this as very important. We're gonna talk about this later. Consider the ecosystem of the sport. What is that sport system really like?

21:48

What is that team? Maybe at a high school. Yeah. They're we're gonna go into Volley and that volleyball ecosystem is tremendous. But then we roll into basketball, and we're about to roll into basketball, and that ecosystem for basketball is horrible.

22:03

Is that really a safe time for them to move into the sport if the ecosystem there is not good. It's not healthy. We also need when thinking about the risk appraisal, we need to think about the different follow ups from hospitalizations. After the 1st 3 months following hospitalizations, hospitalizations are the most critical. It's the period of the highest risk for suicide.

22:27

So if you have a student athlete that maybe he's in the hospital for a suicide attendant, something. This week's 3 months are so important, and that's what the research is showing that you're seeing the the vast majority of people reattempting suicide in those 3 months. So assessment of safety and stability should be a priority. Also, frequent follow ups and assessment should be a priority. So, We we need to just be looking looking at this all the time.

22:59

Other some other considerations, does a student athlete have post treatment residual symptoms? And what I mean by that, are they taking a medication that is conducive to sport? Are they taking a medication maybe they have to take something in the morning that kinda makes them a little groggy, but they practice in the morning. Or or whatever the case may be, those are things that we need to think about. Also, do they have a history of reoccurrence?

23:26

You know? Is is this a one one time thing, or or have we had a history where They really, really roller coaster, and every time we bring them back into sport, things get worse, things like that. Those are things that we really need to address and think about. So then we're gonna attempt. So we went from our assessments, the physicians, and the mental health therapist say yes.

23:50

This is great. And then we roll into we look through our risk appraisal and everyone, the team's kind of on board. And then we're gonna try to develop an individualized sports specific plan for this student athlete. But when we think about that, it's an intent. Right?

24:10

And no no nothing will ever go like we want it to go. Never really does. Right? And and even though we're going to attempt this, this management plan might not work. But the first thing, again, I will say, do you have an effective care team?

24:28

This should not be the athletic trainer's job alone. The athletic trainer let's say you're at a high school and you're the athletic trainer, then you have a a a a a physician that they use, and then you have a mental health professional that they use that really aren't a part of the school. So they're gonna come back into sport, but the the athletic trainer is gonna be the one dealing with all of that. We've seen a lot or maybe So this shouldn't be your job alone to be assessing this. So that begs the question, who has the athlete given consent to?

25:01

Who is consent it. So things to think about when when and how are the parents involved. Sometimes we get parents involved here on the collegiate level. Sometimes we don't. Coach involvement.

25:13

What can the coach know? What shouldn't the coach know? All these kind of things academics. Maybe maybe there's a teacher that really really bonds well with a teacher. Maybe maybe academics academics are really suffering.

25:29

So we need to kinda bring them into the fold as well. But, really, what resources are available to you. What can you do? What in your community? Who can you reach out to to help you with this?

25:42

Are your providers a part of your institution? And And I say that not all obviously. I know that not everyone has providers at your institution. And when I say providers I mean, your mental health providers, Some are at your student health center or, you know, or in the community. But why why it matters sometimes is it it's so easy for me to go and collaborate with somebody down the hall.

26:07

Right? And they understand truly understands the stressors of collegiate athletics. Where somebody in the community might not as well or somebody at the student health center, they really don't understand the stressors of a student athlete. So that is my that is my SIP box on that one. Okay.

26:27

So then kinda we have our plan. We're moving for the athletic trainer is not the sole provider. We are still gonna attempt to develop this plan. That's when we really wanna consider the sport ecosystem. System and the return to play.

26:43

And what I'm talking about, it's critically important to understand the specific elements surrounding the athletes were return to play, including teammates? How do they get along with their teammates? Have they I mean, have and has it been drama? Has it been all this one over well. Do the teammates even know what's going on?

27:04

How how do the teammates know? What about the coaches and other staff? Those those are things that we need to talk about. Sometimes, you know, coaches for a particular student athlete, it can be a more toxic relationship. And maybe it's just it doesn't work out with the the coach and the athlete because it's somewhat toxic or something.

27:28

Leading into that is the environment. Is it environment when you walk into the building is is it all well? Usually, that's not really the case, but is it toxic? Is it safe? We want it to be as safe.

27:40

And clearly, if it's toxic and it's not safe, for all student athletes, that's that's something that we need to be talking about and thinking about and discussing with somebody But we wanna make sure that this environment, why bring a student athlete in an in an environment that already isn't conducive to who they are and what what their needs are if it's not gonna work out because it's it's not a good environment for them. Risk associated with training, competing. You need to think about this on the road and at home. So if if there's an issue on the road, what what are those issues? Those issues could be something like maybe they hadn't seen their family in a really long time, and they're you're on the road, and then they're gonna get to see their family.

28:31

That could be a trigger. That could be an issue. Sometimes home isn't the safe place. Right? So seeing parent is not good.

28:42

Let's see. So moving on. So this management plan, like I said, an effective management plan can lead to return to play. So the other things that we wanna think about is assessment for return. So we're we're we're looking at an assessment.

29:04

We need to do we need to have a behavioral contract? And when I say behavioral contract, I'm talking kind of like our eating disorder contract. Sometimes if a student athlete has been in a really, really bad circumstance, and they're coming back into something. Sometimes contracts are important. Just so they are being honest with their we're they're saying we are asking them to be honest with how they're feeling.

29:31

We are asking them to work on all these other aspects before we engage them into sport. So your academics have to be in line. You have to be be able to be social. You have to do all these other things before we add you into sport. We need to look at regular monitoring So when we're looking at reassessment, we're reassessing medication monitoring.

29:59

How do we know that this this student is taking medication if that been prescribed. That shouldn't be the athletic trainer's responsibility. Sleep monitoring. If we know that they're not sleeping well, who should we let them know? Who should we tell that they're not sleeping well?

30:14

We know that they're not they're sleeping all the time in the athletic training room. They're complaining all the time about their sleep. Who should we be discussing this with? Or maybe we are noticing in the athletic training room that they have social elements that are not conducive, you know. They're not getting along with teammates or maybe they are separating themselves from other people.

30:32

Those are things that we need to be looking at. But if all is well with this, then we are going to bring them back into sport. But it's going to be a gradual increased exposure. So maybe we are gonna start with weights, and we might go into the weight room with a one on one with a strength coach or one on one with the athletic trainer and a coach and not really be around the team yet. And then we're gonna gradually, then we're gonna get them with the team.

30:59

And then maybe we might We're all doing well. We're assessing this, and then we're going into practice. And then we talk about games, things like that. Those are the things that we need to gradually bring somebody in, assess, and then bring back add some more. It's no different than you are returning somebody from an ankle spring.

31:19

Right? We are we are bringing them into the white room. We are assessing, and then we're adding some more. And then we are assessing, and then we are adding some more. And those are really the key.

31:30

However, I'll I'll say it again. It has to be a part of the team. A collaborative team that is looking and reassessing. This is an example of a behavioral health contract that we have here at LSU. This was a certain person, but I'm happy to share with anyone that would like to take a look at it.

31:51

And we have tons of different people that sign this student athlete, coach, our sports psychology department. Academics because this particular person had issues with academics, the athletic trainer, that's around them every day, and then myself as associate athletic director, Director of Sports Medicine. So these are things that are options. More follow-up considerations in the aftermath of psychiatry psychiatric emergencies. So we need to talk a little bit about transitional care.

32:21

Not everyone wants to return to play or not everyone should return to play. Not everyone can return to play. So we need to kind of think, what is your role in the transitional care? So if you have a student athlete that you know is an mental health emergency, and they will no longer place for What what is your what is your role? Where where do you lie in this?

32:47

Is there a clearly delineated delineated transition of care plan for the student athlete? Who are leaving college or then sport environment. Who is responsible for initiating transition of care? So maybe they maybe they're maybe in their moving schools, maybe they are transferring somewhere else. Maybe they're just they're not gonna play basketball, but they are just gonna be a regular student athlete or student.

33:13

What is next for them though? Are are you responsible for making sure that they have mental health resources for when they leave? Until they can get to their new institution or until until they can get them find their own. Are you providing them with some local resources? Things like that?

33:35

Those are some things to think about. Who could you refer them to? Some other things that I wanna talk about that I think are important to consider an incident report. After every emergency here at LSU. We do an incident report.

33:52

In that incident report, then we can sit and talk and find out where our lapses were. Sometimes we find that, you know, maybe somebody didn't know where the the what hospital we're going to or whatever the case may be. It's really, really important that even with mental health emergencies that we do in incident report. Do you have a critical incident plan? A critical incident plan, if you've never seen one of these that's like a it's it's different from mental health EAP.

34:23

A critical incident plan is talking about an issue that maybe happened on campus or at your school that was really traumatic. So maybe a student that wasn't necessarily a student athlete, but maybe it was a student athlete that tried to kill himself and other people were privy to that or saw that. So how does that affect How does that affect teachers? How does that affect other students? How does that affect you?

34:53

Things like that. Who is gonna know? Who knows what? Things like that. All those things need to be considered.

35:00

How is the mental health of of all these related parties? Ruminates. Ruminates are a huge factor at the university in the university setting. Their roommates sometimes see and know more than anyone. And is are are they safe?

35:14

Are they is their mental health safe? Do you have do you need to refer them to somebody? Things like that needs to be considered. Obviously, this is never enough. This is kind of a crazy question to even ask.

35:26

Do you have enough mental health providers? No. Nobody has enough mental health providers, but do you have a mental health provider? Do have somebody in the community that you can call? Do you have somebody if you've went through a mental health emergency, a mental health crisis, with a student athlete, and you were left scrambling or had no idea or felt like you had it all on you It's time for you to look and research and find somebody that can help you.

35:54

And the athletic trainer should not be that person. Document. Documentation is so very, very important. Anytime I refer or our student athlete, we we want we want documentation on that. So let's we we need to all I thought our trainer just need to do a really good job with documenting, you know, kind of every step of the way.

36:18

Also, it it comes up later with mental health waivers that happens in the collegiate setting, so you wanna make sure that you have your resources, your mental health waiver. And then pretty soon for those of you that are collegiate studying, the NCAA's gonna come out with an NCAA posteligibility insurance, and this is gonna include mental health issues. So mental health disorders. So you're gonna wanna make sure that you have proper documentation at your institution. These are my references that I've used, and thank you for attending this presentation.

36:57

Alright, Mickey. Excellent. I'm looking for some questions that people might have. I know I have one that just just kinda wouldn't go away during this presentation, and that is I relate this to the role of an athletic trainer where they are sort of the hub of information that flows back to the health care providers and mental health is an information flow because quite often we hear and see things that don't get reported when they're sitting in somebody's office. Right?

37:31

And then they don't bring reality. And so have you found or whatever you found to be the most effective communication tools to make sure that the physician or the provider who's making big Decisions has the right information besides your written documentation. You find yourself needing to go with them, more so than you do a a a a orthopedic checkup. On mental health related issues?

38:05

Yeah. Absolutely. We do. We oftentimes go with them. You know, I I there have been times that not even with general practitioner when they have to go to the physician, when we have to go to mental health, themselves, sometimes we as athletic trainers will even go and say we'll say to the soon athlete.

38:29

Need to make sure that they're understanding everyone's on the same page. And so sometimes we might sit in for the first 5, 10 minutes, and then obviously get them their privacy and let them discuss But those are some things that we really really need to it's so important. It's so important. You know, we're we're lucky though. We we're we have access to our physicians all the time.

38:48

So for me to walk down the hall and say to my physician, hey, this happened to practice. So when you meet with him and you know that this has happened, but All of that goes into our EMR. So the doctor can pull up all of that at any given time, and that's really important for us to be able to do.

39:05

I know in the high school setting, we're dealing with a minor. It just got, like, incredibly complicated because asking a parent to participate, to be a gays, and you have to wait for the final result, which is quite often like, yeah. They're cleared, and you go, like, No. No. That that that I see evidence that they are not ready to enter back into sport.

39:31

How do you handle that where you go, like, I see something, but the parent and the provider says, full go ahead.

39:39

That actually happens even on the collegiate level, and that's where developing those relationships and having that collaborative care team So everyone kinda have a voice at the table and say, you know, I'm I'm not comfortable with this. I'm not ready for this. As the athlete trainer that is going to be traveling with the student athlete or be with the student athlete all the day. I'm seeing this, and I'm not comfortable with this. At the end of the day, Ronnie, when they want to pursue that, we document.

40:06

We document and say that we were not comfortable with it, and that's that's something that's important for us to make sure that our voice is heard. And and there's times that we take it we take it a little higher up if we have to because, man, just the athletic trainer's role and is so so important and critical.

40:28

So Alright. Well, I don't see any more comments on this topic, and we've wrapped up the force speaker on mental health. And as I said, going into this, Ray and I strongly believe that this mental health needs to be more common, more discussed. We need to go deeper when we talk about EAPs and and emergency equipment and protocols, mental health needs to be upfront and center as it has been today. So Hopefully, everybody who has watched this live and all those who will be watching it on demand got a lot out of it.

41:09

And It probably prompted more questions because this is not as common. But, oh my goodness, it it's it can consume you because you see mental health issues in front of you and go like, man, I don't even know where to begin. Processing some of this. So you you can't just ignore. You have to put steps in place to start framing it up and having a plan to execute.

41:36

And including the follow-up care that Mickey just outlined for us here as well. So making any last final thoughts to wrap this session on it?

41:46

No. I can't I can't urge you enough, though. You're right. Know, start having these conversations now before something something critical happens at your institution or at your your score or, you know, if you're a contractor with a hospital, you know, you need to have those con wherever you are, you need to have those conversations. Because it's if you haven't had something yet, your time, unfortunately, is coming.

42:12

So The

42:13

only advice I can give to those who have tried to put frameworks up and got frustrated. Don't give up. Don't get frustrated. Keep plowing, keep pushing, keep pressing, keep documenting. Be be bullheaded on this topic because it is it is something that that requires your attention.

42:35

It it's a so it's something easy to sweep under the rug and just pretend that it's not there, but it requires effort on just like developing your EAP or your rehab protocols or your policy procedure manual. That requires effort and consistency to accomplish your goals. So don't give up, and you can accomplish it at any setting. It doesn't have to be at LSU. You can any setting.

43:01

It's just a matter of priority. So, hopefully, you will see this as important as your EAP. Is managing this. So, Mickey, thank you so much. Good to see you again.

43:11

Thank you. Good to see you. Good to see you. Good to see you.

43:13

Your time.