Taking Healthcare by Storm: Industry Insights with Dr. Jimmy Moley

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Jimmy Moley, MD, a psychiatrist specializing in mental health care of adults and athletes. 

Dr. Moley explains sports psychiatry as a growing subspecialty focused on athletes’ unique mental health needs, from injury recovery and identity challenges to medication considerations and sport culture. He discusses how youth sports can build resilience but also heighten pressures from social media, costs, and early specialization, arguing that reducing stigma and embedding mental health professionals in team settings can improve well-being and performance.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-050826-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hi, everyone. Welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, medical director here at Quality Insights. Today's episode is a really fascinating one, especially if you've ever played sports, have kids in sports, or just care about the connection between performance and mental health. I'm joined by Dr. Jimmy Moley, a psychiatrist who specializes in the mental health care of athletes. He completed his undergraduate studies at the University of Notre Dame and earned his medical degree at the Ohio State University College of Medicine, where he also completed his psychiatry residency at Ohio State Harding Hospital. Dr. Moley has advanced training in sports psychiatry through the International Society for Sports Psychiatry, and his work focuses on everything from performance optimization to the mental health impact of injuries and even the neuropsychiatric effects of head trauma. He's also a published researcher, international speaker, and co-founder of the Sports Psychiatry Special Interest Group through the Academy of Consultation-Liaison Psychiatry. So in this conversation, we're diving into what sports psychiatry actually is, how youth sports shape mental health, the pressures facing young athletes today, and how mental health care can not only support well-being but potentially enhance performance, like it's a bi-directional relationship. I think that this is gonna be a really insightful conversation, and I, I think it's gonna change the way you think about athletes, competition, and mental health, and I'm very excited to jump in. Dr. Jimmy Moley. Jimmy, thank you very much for joining us today. Thank you for having me on. So let's start and maybe take us back for a moment. What first drew you to psychiatry, and how did that evolve into a focus on athletes and sports psychiatry specifically? It is, uh, very much an intertwined story between the, the mental health and the athletic side. So growing up, I always knew I wanted to work in athletics, and really was gearing in my medical training towards, you know, an orthopedics or, or family med, sports med route. And really in my, third-year rotation in medical school, was really drawn to the artistic, humanistic, and a personal side of psychiatry. Really spoke to me. I thought, you know, really allowed me to, to practice in a way I thought was very meaningful. And once I realized that there was a way actually to integrate that with the athletics and the sports side, that was pretty much the tipping point right there. So as I'm sure we'll talk about the awareness of the impact of mental health in sports has certainly skyrocketed, I'd say, especially in the past five years or so. So that increasing awareness has, has really created a unique, I think, career opportunity in the idea of sports psychiatry. And while there may lack some, formal organization on the national, internat- or international level, I think there's growing awareness that, is kind of a unique and exciting opportunity to actually shape, you know, the future direction of the field. Yeah, and I think it's just a fascinating subject. We were chatting before the podcast. I've had individuals who are participating in youth sports, on the podcast, and I was not aware of the impact that sports, team sports, participating in sports can have on mental health. So I, I think I wanna kind of get into that. So there may be listeners who haven't heard the term before, so can you tell us what, what exactly is sports psychiatry, and how is it different from traditional mental health care? So when we think about traditional mental health care for athletes specifically for years a-and going back decades, that, that area has been dominated by sports psychology, right? So sports psychiatry is a relatively new subspecialty under psychiatry that focuses on treatment of, you know, the mental health care of athletes. And, you know, when we look at other psychiatric subspecialties, right? Addiction medicine or CL psychiatry or geriatric psychiatry, right? What these do is they target specific issues of specific populations. So what does that mean for athletes? Well, you know, it means we see common issues that are very unique to athletes. So I'm sure things we'll talk about like injury recovery, right? Retirement, right? The fact that athletes are at higher risk in a lot of cases for substance abuse, maybe eating disorders or, or other mental health conditions. So It was born out of a recognition that there are unique psychiatric a-and overall mental health challenges faced by athletes, and that we need to work to address those in a very highly trained, specific manner. So you know, there's also other parts of the culture I think that are very unique. Uh, we always have to think a lot about confidentiality, right? We think about the impact of the medications that we prescribe, not only on mental health care, but also on sport performance. And then we also think of just the unique culture really of athletics, right? In terms of scheduling, practice schedules, training schedules, the people and the different stakeholders, right, in an athlete's ecosystem. There's just a lot, to keep in mind, and that specialized training in sports psychiatry allows us to adapt our medical training and our medical perspective to fit what is actually oftentimes a very complex situation that, requires, you know, relatively skilled and, and definitely unique subset of, mental healthcare treatment. Yeah. And I honestly, I mean, I, I love it. I think it, it needs to happen in all areas of medicine, but I'm so glad that there is this specialized area because I think it is so very necessary. we usually just talk about the emphasis on physical, the physical benefit of sport, you know, cardiovascular benefits muscle growth. But from your perspective, what impact does participating in high school team sports have on mental health, both positive and potentially negative? For sure, yeah. Tremendous impact I would say on, on both sides. I, you know, I think the more well-understood ideas are pro- are definitely the positive aspects where, you know, we talk about not only skill development in terms of physical skills, but also mental skills, right? Resilience teamwork, camaraderie, right? I think, you know, there's a sense of purpose and kinda joint effort on teams, uh, especially at high school level that really comes at a formative time for high school athletes. So I think the benefits are, are certainly well, well documented and I think and, and relatively well understood. Now, I think the negative aspects have changed a lot, especially recently. You know, I think the pressures at the different youth sports level starting even lower, even in grade school, but certainly in high school ha- have changed and are quite significant. So when we talk about recruitment, right, and now NIL and, and the changing college landscape, right? That, that puts a lot of pressure on young athletes and, you know, I'm sure we'll talk about, social media, the impact that has on, on high school athletes. But, think at, high school team sports also present, different challenges related to that athletic culture. While that may be certainly helpful for a lot of, high school athletes, it, it does run the risk you know, potential mistreatment and opportunities for athletes to really struggle, especially on the social side. And, course, does that lead to any sort of, uh, future substance abuse, risky behavior? I think these are all things that, that we think about. So I think there's certainly negative impacts as well. You know, of course, in any sport we're gonna see head injuries and, and other injuries at, in the developing young athlete, right, have a pretty long-lasting impact, right? Especially when we talk about stacking those injuries over time. So there's certainly negative aspects. Now whether or not those negative aspects outweigh the positive aspects i- is an individual discussion, right, that you have with the athlete and the family. But I think we're certainly growing in awareness, especially on the mental health side, about how these factors all play into an athlete's career. Yeah. Hopefully. And then I just will say, just for me anecdotally, seeing both high school boys, high school girls playing in team sports, I think there's a difference. So I'm really interested in hearing your perspective. Do you think there's a, a meaningful difference in the mental health pressures faced by female versus male youth athletes today? And I'm very curious, what is driving these differences? Yeah. Yeah. Z- you know, both anecdotally and if we look at the literature, uh, there certainly are differences down the gender line. Now, these aren't, you know, broad or, or applied to every single person, but I'd say especially girl high school athletes, female athletes tend to, tend to struggle more with kinda what we call the internalizing disorders, right? So we think about things like anxiety, depression, and, and body image concerns, I think are some of the main things that we see. contrasted with, you know, boy high school athletes or male high school athletes typically tend to, to struggle more at times with the externalizing behavior. So we see things a lot, whereas sometimes internal conflict can lead to coping maybe with more substance misuse than female athletes, higher rates of, of gambling, right, or, or risky behavior maybe as a way to, to cope or compensate, with some of those , internal conflicts. That's on the internal or that's on the kinda individual, I should say, level. There's also syxem- systemic stressors, right, that affect and, and go down the gender line. So this particularly relates to female athletes a- and we think about ideas that, you know, typically women's sports, female sports at the high school level especially are impacted by funding differences, right? And different kind of visibility changes as well into the high school and college levels. So there's kind of that, that big picture systemic issue too that female athletes t- tend to fight against at a higher rate, which can contribute to mental health challenges. And, you know, I think that then goes right into your... the second part of your question there. You mentioned, like, what is driving these differences. I, I think on some level there's probably some biological differences, right, as, as there are with many conditions. But then I think we really get into the more, like, social and, and structural issues that contribute, right? What, what does it mean for a girl growing up to be a female athlete, right? What does that image look like? How do we, both highlight and support female and male athletes, right? What are th- Are there differences between the two groups? And I think traditionally there, there have been. I think we've made a lot of progress certainly, right? But certainly a long way to go in terms of both kinda social and structural support that undoubtedly contributes to some of those differences. Yeah. And it's so funny, I never thought about, like, the difference in funding, right? Maybe that, uh, I guess it does if female athletes know that, y- I can imagine that it would affect them. Interesting. So I've had individuals on the podcast who have talked about the difference in the numbers of male high school athletes participating in sports versus females and this is not the same everywhere. But I think that there is maybe been some conversations around the declining participation in boys' sports in some areas versus girls' sports. I, I think girls' volleyball is, like, going through the roof with, uh, participation numbers, and maybe it's not that way with certain boys' sports. So are you seeing this difference in the numbers of participating? And if you do, what do you think is influencing participation trends among young athletes right now? Yeah. I think we're definitely seeing it i- in the clinic as well as when we look at the data. But it is, uh, a bit nuanced, Jean. So what, what we're seeing here is that there are overall I think actually higher numbers of younger individuals trying sports a- and at some point being involved with sports, but we're definitely seeing lower numbers who actually stay involved in sport and stay committed either to a single sport or multiple sports. So there does seem to be this trend, especially in the last two to three years of, athletes, especially growing up, being exposed to different sports but really not sticking with anything, right? Um, and I think there's probably a number of different factors, obviously, that influence that. I, I think the primary one, at least from my perspective often, i-is the idea of these... of just really a rising cost, right, and as a barrier to entry with many sports. Uh, and then that translates directly to this, like almost a professionalization down to the youth sports level o-of different sports. You know, there's this idea that, that, you know, being an athlete requires a hundred percent dedication, it requires a track to being a professional, right? And then I think a lot of individuals honestly do use that as a way to justify costs of, And th-that could be costs of equipment, tournaments, programs, camps, right? Th-these things have the unfortunate effect o-of pricing out many athletes especially at the youth sports level. So that's certainly one thing, and then that translates into another concern that, that I have and have seen, and that's the idea of early specialization in sport. So I think what we're seeing now more and more often are athletes who are picking a single sport at a much younger age than they were previously, and then dedicating nearly year-round training, competition and efforts into a single sport. And, while that may be helpful for a, small percentage o-of athletes, I think what we're seeing is a lack of, diversifying skill sets, right? A lack of exposure to different sports and different opportunities that, that really has a lot of benefits, David Epstein wrote a book, you know, Range, I, I believe about five years or so ago, and highlighting just the, the importance of, of trying different skills, o-of exploring different opportunities in sport. And that has actually helped a lot of even what we know now to be the some of the top professional and Olympic athletes. So that early specialization, I think, is also probably contributing to some of the declining participation. And then lastly kind of a broader umbrella is, is the idea of the just changing youth culture, right? And this idea that l- there's definitely a lot more visibility to youth a-activities and this idea that everything has to be optimized or, or really geared towards an end goal, I think probably contributes to maybe individuals being a little bit more risk-averse, right? And they think, "May-may-maybe I won't stick with this because if I do, you know, maybe I won't, you know, reach a certain level or, or make varsity by a certain age." And I think, uh, it's unfortunate because I do think you lose a lot of the values that we talked about just earlier. But this change in culture I think has some positive effects. But, uh, you know, I, I do worry about the negative mental health effects that, that I just kinda laid out there. Yeah, I, I agree. And, and you did mention social media, and you know, I, I will see. The... One of the, the, the things that I enjoy about going and watching my kids play team sports, my youngest plays volleyball, is like on a Sa- Saturday, if we go to a tournament, there's... like they just are playing and they're not on social media, right? They're not on doing TikToks while they're playing. Maybe they do it before and after, but while they're playing, they're engaged. So how has social media changed the psychological landscape for young athletes, especially when it comes to identity, performance pressure, and comparison? Yeah. It's a, it's a great point. I, I think, you know, I, I, I don't think it's overstating it to call it a revolutionary time in the past five to 10 years, especially with social media. So, you know, we think about, I think in general, the idea, it just really compresses the feedback cycle, right? It, it shortens the distance between performance and feedback. So what that means really is, you know, in social media and online, a lot of individuals work to create an identity, right? A persona. And for athletes, a lot of times that, that involves being an athlete. And what we see is that when that persona is created that almost identity fusion happens, where now I am an athlete, that is who I am, and anything that is a threat to that can cause very, very devastating consequences, right? And we think about this now in terms of like injuries, right? Where you now have to go through rehab and you can't participate in sport, Or maybe you don't make a certain level, of the team that you expected to, or, God forbid, there's like a, a career-ending injury, right? Or early retirement. So anything, it really creates that identity fusion, can be very difficult, and I think social media definitely promotes that. Uh, you mentioned, you know, performance pressure there. I think just everything across the board is more visible, right? I think that good, bad or otherwise, performance is out there, feedback is immediate. You're able to see and interact with other people nearly at all times of the day, and that, requires a certain amount of energy that you might have otherwise dedicated to recovery or extra time practicing or, you know, whatever that may be. So definitely a downside there. And then the last thing you said I think feeds right in. It, it's comparison, that there's always- Someone else doing things maybe in a way that you perceive to be slightly better, slightly stronger, slightly more consistent, right? And the comparison very often is always upward, right? There's this kinda distorted vision because other people are, are presenting a highlight version of themselves, right? You're not getting the full picture from other people. So I think in a lot of ways it, it can be very, very problematic because you are seeing that. You're comparing yourself, the normal everyday version of yourself to the best version of someone else. So that's gonna cause problems then. So I think, you know, we definitely try to, to talk with our athletes about the risks of social media, how to navigate it successfully, you know, best practices, and also too that realizing that it, it's not all negative, right? I think social media can help connect individuals, can help in a lot of ways even increase access to sport and, bring people together. So we wanna try to highlight those aspects of it while at least mitigating some of the more harmful effects. Yeah. And that's good that it's part of like the when you talk to an athlete. That's good. I wanna just touch on injuries. They can be devastating j- not just physically, but mentally. And I, I think sports teams and coaches are trying to do a better job at working with their athletes through injuries. But what are the most common psychological challenges athletes face after an injury, and what actually helps them come back stronger? It's a great question. And, and the way I like to frame, you know, or work around injuries and recovery is, is treating it more or less as a grief process, there is a loss of, you know, your former athletic self, your former self socially. And, and in a lot of ways, we need to treat that as a loss. And the way we do that is by, working through the stages of grief, of really focusing on the rehabilitation process. but like you mentioned there, there's, there's a lot of challenges that come with that. So, what I see very frequently is a loss of purpose feeling disconnected from teammates. It often leads to questioning of, of self-worth and that identity confusion, right? I mentioned before, you know, this idea that if your identity is an athlete, now if that gets taken away who am I, right? Well, what, what other parts of my identity maybe need more development? So, that's kind of the initial phase. Now, as we get closer to, to return to sport, right, we're thinking about now anxiety maybe about re-injury, right? And how do we process that? We're talking about reintegration into the team and athletic culture. So there's things that we could do kind of along the way, to kinda help process that. And, it starts off with acceptance. It starts off with, building skills and, and really creating a space for the athlete to grieve and reflect now as we work through the process, we're making sure that the athlete stays close with the team stays connected in a lot of ways a-and has very, what I like to call, a goal-based rehab, right? Athletes, I think in general are, conditioned to want to hit milestones and hit targets, and we wanna make that for the mental side as well, So how are we training skills and, and creating benchmarks to measure progress? So then as we move forward, you know, they're returning to sport, they're receiving support from their network, so parents, coaches, teammates. And then we really wanna create a system where they understand that going forward it may look different, than pre-injury, but that hopefully we can at least, you know, return to if not exceed their prior level of psychological functioning. Yeah. Awesome. I mean, it's like you're, it's taking that injury as an opportunity to get stronger. I love that. If you zoom all the way out, what do you see as the biggest mental health challenge facing athletes today? And this is a two-part question, because I wanted to get your take on that as a sports psychiatrist. And then the second part of the question is something I ask an iteration of to a- to every guest, and I, , I would think-- I think I wanna like compile a, all these answers eventually because I, I love them. Love the question, I love the answers. If you were in charge of mental health care in the United States at the federal level, what is the first change you would make? Those are great questions, right? And I'm sure the list would be pretty long. So I would say the primary issue with mental health in athletes has, has always been, and will likely always continue to be, uh, negative stigma, There is the perception and association of mental health challenges with weakness, with a lack of strength, right, and inability to overcome obstacles. I think that message, I think, has been unfortunately ingrained for several years, right? And what that translates to is that seeking help is also a sign of weakness, that's the exact opposite of what we're trying to teach and preach, right, at the athlete level. So I think we've come a long way. You know, that has been helped by a lot of, you know, even up to professional Olympic athletes here recently sharing stories of overcoming mental health challenges. But I think it also just highlights how far we have to go. So that starts at an individual level, that starts at a systemic level. Programs to increase and access care and, and that goes into kind of my, the one thing I would change is I think just more integration of mental health professionals into team environments I think normalizing sports psychiatry, sports psychology, mental health in general would go a really long way. Just, you know, I mean, if somebody I wanna ideally, I think, make it the same if somebody, you know, has a cramp or some sort of physical issue in the short term, let's make it the same if you're struggling with, a panic attack, that you feel as open to receiving treatment as you do for the physical concerns. I think it's very basic, but we have to get the athletes in front of mental health professionals to really even start the work of addressing a lot of these concerns that I've highlighted. So I think it really starts at the top. It starts with stigma. It starts with perceptions about mental health care, and an openness, like you said, to making mental health care in sport more of a proactive approach as opposed to a reactive approach. Yeah. I, and I love that the f- the fact that you said, you know, let's make it like having a cramp be the same as seeking mental health care. Yeah. I love it. So I loved this conversation. It was inspiring. Where can people find out more about you and the work you're doing, and if they need some help, how can they do that? Yeah. Thank you. So I, I operate a solo private practice just outside of Cleveland, Ohio. Uh, my website is probably the best way to, to get more information and to reach out, and that is Jimmy, J-I-M-M-Y, Moley, M-O-L-E-Y, MD.com. Excellent. Dr. Jimmy Moley, I love this conversation. Thanks so very much for joining me. Uh, thank you so much.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.