Your Therapist Needs Therapy 28 - Supporting Athlete Wellness with Melissa Perkins

This week Jeremy is joined by the head athletic trainer at Illinois-Wesleyan University Melissa Perkins. Jeremy and Melissa go way back, having worked together in college athletics. They talk about the importance of work-life balance in the helping professions, supporting mental health through difficult transitions, and some of the progress and some of the ongoing challenges around athlete mental health. 

If you are interested in learning about some of the mental health changes happening at the NCAA level, you can learn more here.

More info about Jeremy and his practice can be found at Wellness with Jer.

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Podcasts about therapy do not replace actual therapy, and listening to a podcast about therapy does not signify a therapeutic relationship. 

If you or someone you know is in crisis please call or text the nationwide crisis line at 988, or text HELLO to 741741. The Trevor Project has a crisis line for LGBTQ+ young people that can be reached by texting 678678. 

Transcript

Your Therapist Needs Therapy - Melissa Perkins (2023-10-04 11:58 GMT-5) - Transcript

Attendees

Jeremy Schumacher, Melissa Perkins

Transcript

This editable transcript was computer generated and might contain errors. People can also change the text after it was created.

Jeremy Schumacher: Hello and welcome to another edition of your I'm your host, Jeremy Schumacher, licensed marriage of family. Therapist, Melissa Perkins is joining us today.

Melissa Perkins: Hello.

Jeremy Schumacher: And I was gonna call you Melissa there, and I just could not make it happen. I know Perks worked with me, when I was coaching volleyball, she was the athletic trainer for our team at that time. So, we've traveled a lot together and worked very closely together in the past and I will forever know her as perks. Even after she's married and has a different last name, it'll still just be perks.

Melissa Perkins: I don't think I'm taking it so I'll be perks forever.

Jeremy Schumacher: There This is unplanned to record in the podcast to batam, Becoming a Perkins is that we're just gonna

Melissa Perkins: I wish I'm always trying and it is too, but Tom season,…

Jeremy Schumacher: Okay. I thought.

Melissa Perkins: we have stickers galore, the beers

Jeremy Schumacher: Perks significant other is a brewer. It works at a brewery and so yeah weren't there T-shirts. Or was that just like That's amazing.

Melissa Perkins: Yeah. Yeah.

Jeremy Schumacher: You could be tuba Melissa Perkins, just take it as a prefix.

Melissa Perkins: He can be the band nerd for the both of us.

Jeremy Schumacher: This.

Jeremy Schumacher: Is coming from a certified licensed marriage and family, therapist.

Melissa Perkins: Perfect.

Melissa Perkins: Yeah, absolutely. So I grew up in a theater, played soft on my whole life. I actually went to boarding school for high school so I was a full math and science academy all nerds. Everyone knew exactly what they wanted to be. They're like I want to cure cancer. I want to be a doctor. I want to be a scientist. I want to be physics and I have no idea what I want to do. so I wound up getting to know our high school athletic trainer.

Jeremy Schumacher: Yeah.

Melissa Perkins: Took him a little bit and he kind of gave me some insight but I wasn't fully sold yet. I was like I want to go to PT school. I think that's a good fit for me and if the college I choose has 80 maybe I'll pursue that.

Melissa Perkins: So then I wound up going to Concordia University of Wisconsin. I played softball there and for my first day of clinicals, I just fell in love. I knew that I loved being on the sidelines and working with teams but still getting to do the medical side of it and kind of solving puzzles while also helping people. And so I really just kind of fell in love with it as I went on there. from there, I did an internship at Division One and then I did grad school at Division One and really, I feel like my passion is just continued to grow, but I have seen a lot of need for mental health. In athletics that I don't think was really disgusted when I was in school, even I was on a team for four years, and I can't pick out one of my teammates really being open or struggling with mental health and I graduated in 2016. So it really wasn't that long ago, but to really be so deeply intertwined with athletics, as we are as an athletic trainer.

Melissa Perkins: Here, I really seen it change a lot and it's one of my passions in terms of athletic training and I'm really lucky to have worked at the institutions. that have put a high value on that.

Jeremy Schumacher: Yeah, for Your experience with the high school trainer sounds positive. Were you dealing with some injury stuff, then in your career?

Melissa Perkins: Not as much. Luckily, I've stayed pretty healthy. I had a few little injuries in high school but nothing that kept me out for more than a couple days. And then again in college I just had shoulder pain here and there as a pitcher, but nothing that really kept me out long term, but I have had, teammates that I've seen kind of go through longer term injuries and kind of see how much it affects them. And so, that's something that I've been able to take with me. Is even though I haven't had to sit out for anything. I have seen other people go through it and how hard it can be.

Jeremy Schumacher: Yeah, and I'm older than you so maybe the profession has improved. It might just be my little private school. I went to had a bad trainer, but I had a trainer who popped out one of my shoulders and then was like, that shouldn't happen and then proceeded to do it with the other shoulder because he was I guess. trainer Troy from back in the day my nemesis So yeah,…

Melissa Perkins: Yeah.

Jeremy Schumacher: a athletic trainers are super awesome and as somebody who's worked highly in and highly close with them both on mental health and then as a coach of my team super great like any profession similar to therapy, too, if having a bad trainer can be a miserable experience, versus having a trainer who's a good fit who's really listening to and…

00:05:00

Melissa Perkins: Absolutely.

Jeremy Schumacher: working with So I don't mean to disparage the profession. I hold it very highly. I personally had a bad Experience for High school trainers.

Melissa Perkins: Yeah, there's plenty out there that kind of give us a bad rap and it's really hard to kind of bridge the gap of working with athletes that don't really respect what you do as much, because they have a bad experience. So you have to do twice, the work of rebuilding that relationship, letting them know that. not only do you know what you're doing, but you also care about them and you value their opinion. because I've worked in places where I kind of had to redo what the person before me had done. So if we have fully different treatment styles and getting a new person that really buy in, especially, I tend to be a lot more rehab based and do your exercises. Other people, tend to just feel good stuff and so convincing someone exercises that are hard and can sometimes be painful are gonna be better for you than sitting on a stem machine for 15 minutes and then still going out to practice doing the same things over and over again. So really a lot of it is

Melissa Perkins: That relationship building much like therapy. You need someone to buy in, you need someone to believe what you're saying and what you're doing to get the results that you want.

Jeremy Schumacher: Yeah, let's talk some of the sports specific stuff. You're working with football. What are some of the things with?

Melissa Perkins: Mm-hmm

Jeremy Schumacher: What's the challenge of working with a stereotypical macho type sport like that? When you're looking for things, like mental health, or you're looking for somebody who's maybe struggling with their mental health while they're injured? how do you relationship building with the individual but in your role How do you kind of bridge that gap maybe to a culture that is Rub some dirt on it or get back in there and play through it. How do you kind of bridge that gap?

Melissa Perkins: It has been really difficult. Honestly, I think finding members of our staff that maybe isn't the head coach, or maybe isn't a coordinator, but maybe some of the younger assistant coaches that have a little bit more understanding has been really helpful. So here, at my institution, we have a care team, which are a few individuals, within our whole department that are a little bit better trained and our mental health action plan and basically just willing to put our name and number on a magnet. If you have any questions, don't hesitate to reach out. Obviously, we're not your therapist needs.

Melissa Perkins: Understands your sport, he understands what's going on, feel free to talk to him and know that, it can stay between you and you can kind of get the help that you need. But it is really difficult to try and encourage these athletes, to get what they want, or encourage them to get services, even if maybe they don't want it, or they're not totally open to it because I think it is really hard. I will say that even working with the men's team for the first time in a while.

Melissa Perkins: I've noticed a huge difference in generations, so, our freshman,…

Jeremy Schumacher: That's true.

Melissa Perkins: our sophomores are way more open to talking about this and being open and honest and saying, I need this or, that's not working for me. And so, I think that's a big culture shift that we're working in a sport. That's so used to suck it up, right? But seeing younger athletes that's not inappropriate response or that's not helpful to me. And being able to kind of speak up for themselves. Is a really, really interesting dynamic change that I'm very happy with obviously and very glad that we're seeing this shift,…

Jeremy Schumacher: Yeah.

Melissa Perkins: but it still is really hard. Like you said to kind of bridge that gap between them and some of the coaching staff and the rest of the department.

Jeremy Schumacher: Yeah, and I don't want to dip into ages. I'm here Maybe I'll brush up against it. But that old school mentality and some of those older coaches. I remember, even in my role working as specifically, a mental health person for athletes and being like, you can't have your kids bags gate. And for those people who don't know, peg skating is, it's basically making your players skate for ice hockey skate until they puke, which is bad. that's not healthy for them. But that's the culture in some of these sports is like, there are consequences. If you lose their consequences.

Jeremy Schumacher: You skip practice or you're late or whatever. So here's a punishment and realizing and working to change the cultures around those things. Being like, that's not healthy. We've had athletes over the past couple of years who have died on the punishment runs, we've had people who have, So we've seen the negative outcomes and those have existed since the 80s, That's not new, It's talks about differently now. And I think that culture shift starts in my opinion with coaches, but yes, definitely athletes. Gen Z and Younger are much better about advocating for themselves and knowing that mental health is a thing. So it'll be interesting. I think as coaches to start to get younger and younger, you see in the professional ranks and it always takes a little bit longer to filter to D3, kind of in that order. And then,…

00:10:00

Melissa Perkins: Yeah.

Jeremy Schumacher: I would say, in the club coaching scene, too. I see a lot of young coaches, who are much more savvy with it than some of the older scream at your players, until they're crying. And the huddle type coaches, they see that it still exists unfortunately, but I see it last.

Melissa Perkins: Yeah, I have an interesting dichotomy, too, because I work football in the spring and then I work softball or football in the fall and softball in the spring. And my softball coach is the most precious baby angel God's gift to this world. just phenomenal supportive human They have a well-known policy that you can take a mental health day. No questions asked mental health comes School comes before athletics should be the bottom of your priority list and so just seeing that type of culture and environment and we still win games. We still want a conference championship last year. Very similar to when I was with you guys with volleyball, you can be nice and be understanding and still shape athletes and push them to be great and not have to

Melissa Perkins: kind of take that hard-ass, route all the time, you can be nice and they will still respect you and I think that that's what's really hard to kind of understand sometimes.

Jeremy Schumacher: Yeah.

Jeremy Schumacher: Yeah, for And I think it's interesting too, I don't know if you experienced this but my experience as a coach, a lot of it was filtered through doing opposite of what I was coached, every single coach I had in my life, I played baseball growing up, I play volleyball at University of Minnesota, every single coach I've had in my life, got my face and screamed at me and I as an athlete, don't respond to that. I shut down f*** you. I'm gonna play poorly just to keep pissing you off because I'm mad at you. Which isn't immature response. so me coaching was like I'm not gonna raise my voice, not gonna yell at people, I'm not gonna get in their space. we're gonna talk through things and cheating. I'm a therapist. What the bad coaches you've had.

Melissa Perkins: A little bit. Yeah, and I think for me too, obviously being a female athlete. My first couple jobs. I worked with primarily female athletes for four years. So, coming here and working football, it is a very big shift even for me, personality wise, because there are some football guys, where if I'm too nice to walk all over me. I know that I need to kind of buck up a little bit in a way and be firm and set those boundaries and set those expectations and give them consequences of things aren't being that. But my consequences are You're not gonna get better, right? Like I for me,…

Jeremy Schumacher: Yeah.

Melissa Perkins: I don't really see much in terms of making someone run because they don't show up to treatment if you don't care enough about your body to get better than Know either, I'm gonna check out. It's not worth my time if it's not worth yours but definitely my personality shifts a little bit where I have a little bit higher, expectations and firmer boundaries with football players because they need those and…

Jeremy Schumacher: Sure.

Melissa Perkins: they're just not meeting if you don't give them a timeline, if you don't give them a deadline, They're just kind of gonna float through space. so I can tell that my personality shifts a little bit But I've never been a yeller. I've never been an aggressive because I know that doesn't work for me, If I get into a confrontation with someone,…

Jeremy Schumacher: Yeah.

Melissa Perkins: whether it's an athlete, a coach, a co-worker, I'm gonna cry, I really wish. I'm so frustrated knowing that I care about something and have a lot of emotions and know that I'm right. A lot of times, my body is natural, reaction is to cry, and it just makes me look so weak, but as a woman in a position of power in this department, I try so hard to try and keep my composure and keep that kind of firmness. but yeah, I try to be better than people. I've worked with because I've also had people that I've just kind of learned in the past too about being either too nice or two, joking or too goofy. And so kind of found that balance that I think works best for me.

Jeremy Schumacher: and I think it's an interesting thing when you're working with athletes because they need different things from you different That's something I had no frame of reference for maybe because I was Head in the clouds, not a surprise as athlete myself.

Melissa Perkins: The.

Jeremy Schumacher: But as a coach you learn how so many different athletes approach things differently and so for me winning Was always the natural motivation, but there's so many athletes who are motivated by their teammates being happy, or their parents being happy, which I would say is unhealthy. But there's different things. So one athlete might need. Hey this is going to get you back to being on the field sooner. One athlete might need. Hey this is gonna make you feel better, this is gonna help you sleep or…

Melissa Perkins: Yeah.

Jeremy Schumacher: get back into classroom or whatever. So your role is figuring out not like my way or the highway but figuring out. How do I help this kid, how to meet this kid where they're at so that they can meet their goals?

Melissa Perkins: Absolutely and goals is a big thing. So special, when we get to, our long-term cases are people that are really struggling to kind of see the light at the end of the tunnel goal. Setting is something that we really use a lot to try and be like maybe it is just a goal of you can shower standing up and not be in pain, you don't need to use a shower stool anymore or you can walk to class without crutches or something like that. these small little goals for some people mean, I have a kid who's been in a cast post-surgical for four weeks and he just is now switched to a boot, he still can't walk on it, but that excitement was such a big deal, I'm like, hey now you get to scratch your foot when it

00:15:00

Melissa Perkins: Isn't that exciting? And he's like,…

Jeremy Schumacher: Yeah.

Melissa Perkins: Yeah, yeah, it really is like, you can shower little things just to keep giving them, especially some of these surgical, where it's such long-term six to nine months. giving them those little wins along the way is what that person needs. Whereas maybe another person is like, Can you play football today? That's the question, and if you can cool, we'll deal with it later, we'll figure these things out along the way, so it really is just so different person to person sports a sport, gender to gender. all of these things, is really interesting to kind of see these differences in athletes.

Jeremy Schumacher: Yeah, what's kind of the shift right now in the field of athletic training as on a professional level? What's Maybe getting normalized or talk about more around mental health, because I know there are shifts going on. You said, you graduated 2016 and as an athlete, it wasn't talked about. But as a professional, what are you kind of seeing the fields wrestling with? Whether that's the NCAA or even your specific schools that you've worked with? What are you kind of seen?

Melissa Perkins: yeah, I think a lot of places have made a good shift towards I feel like a lot of it is breaking the stigma and just trying to talk about it a little bit more. so I'm on the kerosene but I'm also on an athlete wellness committee. So it's a combination between me. Our director of ethic wellness, who does one of the mental health side, one of our track coaches who's nutritionist and then our strength and conditioning lead. And so just kind of getting All of our opinions and trying to put them together where maybe it's not even just mental health but just athlete wellness. In general. How are they feeling? keeping our finger on the pulse in a way of what athletes are doing and how they're feeling has been really helpful? So I think

Melissa Perkins: Us specifically that's been a great opportunity but athletic training in general it's just a lot more talking about it but I think the problem is we're gonna hit a point where we plateau, not counse we're not licensed therapist needs.

Melissa Perkins: There's so much information coming into the world for athletic trainers, whether it's through NCAA and the Gatorade Science Institute is doing a mental health series, and all of these things. And I just keep look joining in all these webinars and I just feel like this is the same thing I've already got. So I feel like the issue is the people that care and that are trying have plateaued and kind of tapped out on how much more information or how many more things we can do, or

Melissa Perkins: posters to put up lectures to host or groups to put together and it's just if athletes don't want to do it, there's only so much we can do. even now you can host all these things but if athletes don't want to go like there's only so much and so I think that's kind of the issue and athletic training and then on the other side of it you have people that aren't aren't changing any of their ways. So I think we're just kind of splitting into this little bit tapped out and what we can do and then not really caring to do much more and move forward.

Jeremy Schumacher: Yeah, and I think This will segue nicely into another topic but self-care for the professionals. But the difference between the D1 Sports program and a D3 sports program is they're not comparable, they're comparable because that's sports, but when you're looking at budget and resources, like it's fantastic, you're at a D3 program, you have a nutritionist that's so good.

Melissa Perkins: Yeah. Yeah. don't we are incredibly lucky and I feel like That's part of the thing is me, personally, I've chosen institutions that I know have that type of support system because I value that so much in conjunction with my care as a healthcare provider. But I also worked at a small naia school where it was me and to graduate assistant that, we were just there for six hours a day. I never even really meant the counselor and it was one person for the entire campus. We had no one that talks about it in sports, like it, I mean, we had not very much at all. So I choose to kind of put myself.

Melissa Perkins: Situations because at Concordia the same thing. I knew that we had a little bit more support. It was talked about, we had a larger staff, more money, that kind of thing. But most D3 schools do not have what we have. And so I'm very blessed with what we have. But it really is a problem that I think that I listened to your last podcast of the director from Marquette, and I'm like, D1. That's great. I'm so excited that you have all that. I like I mean there's D2 schools that don't even have more than two athletic trainers, let alone any of these other staff members.

00:20:00

Jeremy Schumacher: Right.

Melissa Perkins: So I think just getting these resources to schools money That's not part goes it's the hardest problem.

Jeremy Schumacher: Yeah, and it's stigma on not just getting athletes to participate but also right I experienced as a director, trying to secure funding and coming out of covid that was a nightmare. so, all these things like when we're looking at it as athlete wellness, there's that stigma around mental health, but What does sleep hygiene do for an athlete? a kid who's staying up late cramming for a test stressed? About school is not going to perform as well as a kid who's well rested. And that's obvious to people who know that stuff, but that's not the culture that's promoted on most college campuses. Most if it's normalized, you're not going to get attentive sleep and you're gonna cram for tests and that's normal and that's not healthy. We got to stop. So I think looking at a wellness perspective is really key and…

Melissa Perkins: Yeah.

Jeremy Schumacher: a holistic approach for how does this entire athlete? D1 Program has a dentist on staff, what's like? that's so great. But also,

Jeremy Schumacher: if you're Ohio State and you're making a billion dollars in profit off of your football program, you can afford to do that versus a school that's struggling to break, even

Melissa Perkins: Yeah, absolutely. And I mean, even now we're still dealing with budget stuff like as big of a staff and as much stuff we have going on, there's still things that we want to do that. We're being told. No? And so you just have to kind of make do and figure out what you got. And we are lucky to have a big staff, but right now we are covering every sport. So even I have football all week. Friday night is remember my night off because it's the night before game and I have a softball game to cover and so we're all spread. So thin that not only are we trying to take care of those athletes and take care of other teams and all of our off season sports. But then try and find time to take care of ourselves too.

Jeremy Schumacher: Yeah, let's talk about that. No, I still get invited into talk every semester. About mental health. So helping students, who are studying athletic trading to know, kind of what to look for and how to refer appropriately. But also I make a point to talk about self-care because I think it's a thing that isn't talked about enough, it's one of those professions that we're the first ones on campus and the last ones to leave and that's good. Somehow

Melissa Perkins: I hate it.

Jeremy Schumacher: Yeah, it's a podcast so y'all can't see this but parks just roll their eyes real hard.

Melissa Perkins: I also hate that. I did a seminar this summer for women leaders in athletics and even the host of it were like Get there before your boss. Stay later, work more for less money. Don't ask about salary. And I was like, What are we saying? And we did a little breakout group and all the girls in the group were like, we don't agree with that, but this person, I might be moving across the country for a job. I need to know if I can live on that money and things like that. And so I think athletic training as a whole. Luckily, we are pushing for more money, to kind of offset the hours. But I've been working 60 to 70 hours a week since August 7th. right now, I'm in the middle of a push where I have three weeks without a day off. And normally my day off is, I only have to go to football for two hours. Not a true day off. So

Jeremy Schumacher: Yeah.

Melissa Perkins: So, we're in the thick of it, and I'm very lucky to have an assistant athletic trainer. So, we have two people working football. So I do get some mornings off that I chose to teach as well, which, that was interesting choice on my part.

Jeremy Schumacher: Mm-hmm

Melissa Perkins: So I think it's as much as we want more money. I think we just need to kind of change the idea of what we expect of athletic trainers, because there's just so much that we are expected to do, we're expected to be there and…

Jeremy Schumacher: Yeah.

Melissa Perkins: do rehab and treatments in the morning. I'm expected to set these doctors appointments, make sure that The doctor's appointments talk to parents when they have questions about insurance or I'm not getting better. Then prep all the water for an 85 degree football practice in October. Then cover two hours of practice, stay for 45 minutes. they'll do the ice tubs right on my notes to make sure that's out to date and then some days I have meetings because I'm an administrator and we have drug testing and so it's just like there's so much that's put on our plate. That the most frustrating part is how much people outside of athletics, don't even know what we do. that's really the uphill battle. Of, I get that my football coach knows how long I'm here, how much work I'm putting in. But, a thank you, is not a raise. And I think dealing with the, salary battle for how much work and stress, and all this stuff that we're under, that's been the most difficult part and athletic.

00:25:00

Melissa Perkins: Think people because you're not paying well enough and then having the stress of being short-handed and trying to replace and not stressing, your other employees who probably aren't getting paid enough. And it's a very vicious cycle right now in the world of athletic training.

Jeremy Schumacher: and as much as we can talk about wellness for the athlete wellness for the provider, as well, because staffing across the board, athletic training, I see it in nursing. I work with a ton of Health care providers, which athletic training is under that umbrella, but it's Specialized, I guess but it's a thing in nursing. There's one strike going on right now for Kaiser Healthcare, which is a large healthcare provider in the nation. So it's it's not money, it is money, but it's really more about quality of life. it's being able to have a day off, being able to rest and recuperate, to be able to show up for your athletes and not miss a diagnosis or not miss something, because you're just burned out, or you're sleep deprived, or you got back from travel late or whatever. It looks like, there's so many things that we want to provide well for the athletes. We need providers to be taken care of, as well. So it gets back to support and looking at kind of a systemic or holistic approach instead of

Jeremy Schumacher: this is just the number in the budget, so that's what we're gonna do.

Melissa Perkins: Yeah, And I am lucky with the staff that we have that. I know that this summer, I bought concert tickets for next Wednesday and there was not a question in my mind, whether or not, I'd be able to go, I was like, I have eight employees, someone can sit out at football practice and I can go do this thing that I want to do or I have a couple weddings, I'm able to kind of figure it out. And so we are very lucky with the staff that we have, but Just because it's not as bad as other people doesn't mean it's perfect. and…

Jeremy Schumacher: Yeah.

Melissa Perkins: that's what's really weird is just trying to find that balance and then add on top of it. My work and stress and also taking care of athletic trainers under me and making sure that their needs are being met and they're getting their time off that they need while we're covering 20 sports at the same time right now.

Jeremy Schumacher: Yeah, and your work sometimes it's wrapping an ankle but sometimes it's delivering bad news to a kid that they're gonna miss the rest of the season or dealing with a kid, who's in their senior year, who's not getting to play because they're injured There's an emotional toll to what you do as well. It's not just, hey, all this stuff know how to do these things. there's the relationship building and there's the time spent to have those relationships. And there's working with kids through difficult stuff. being injured sucks and takes a big toll on people,…

Melissa Perkins: Yeah.

Jeremy Schumacher: emotionally and mentally.

Melissa Perkins: Yeah, especially when I don't know what else to do to help you. that's the hardest thing is I'm like you have had the scans you've had the injections you've had all these things and nothing's helping. So now we come down to do you want to play your sport? And if you do I will try my best to control your pain but I don't know how else to help your house to fix you and there's nothing more defeating to me than someone coming in and being like I'm in a lot of pain today and me being like

Melissa Perkins: which of the five things that we've thrown at the wall and none of them stuck. Do you want to try again and see if it helps And so, it just kind of dealing with that never-ending frustration where sometimes in football injuries pop up and they get better and they go back and kind of move on and then other times, and any of my sports, it's just very cyclical of good days and bad days. And I mean, even now, softball doesn't even play until the spring and I have athletes and I'm like, all right, we're gonna get you through seven more months and that is very taxing of every time they walk in. I feel like a little disappointed or a little defeated and then try not to carry that into the appointment or throughout the rest of the day and just be like, how can I still show up for them when I'm frustrated and they're frustrated one of us has to pick up the slack today if you're having a bad day. that's on me to either play some fun. Music in the training room or switch it up, and

Melissa Perkins: Be like a fun day of rehab or maybe just sit there and talk about…

Jeremy Schumacher: Yeah.

Melissa Perkins: how much it sucks, And so really spending time to still connect with people, when I have maybe 10 other football players across the room or something like that. I think can be really hard too, where it's like, you want to be there for them, but you only have so much bandwidth at any given time. And I'm only here for so many hours a day.

Jeremy Schumacher: Yeah.

Jeremy Schumacher: Just shaking my head at it. and it's one of those things where again I think you brought it up like the football.

Melissa Perkins: Yeah.

Jeremy Schumacher: Coach might know these things, but the athletic director probably does and the random fan and the stands definitely doesn't know it. I would say even professional sports most people don't know. it's not a guarantee that They all have athletic trainers at the professional level but mental health providers is still a new profession. the Packers have one person on staff for mental health. The NFL has billions of dollars to help athletes find people and providers but again it's slowly becoming normalized but that starts at the professional level then goes to D1 and then we're really not super seeing this stuff at D2 or D3 yet.

00:30:00

Melissa Perkins: We'll catch up eventually.

Jeremy Schumacher: Eventually. Yeah.

Melissa Perkins: I'll be working in the clinic,…

Melissa Perkins: and who knows?

Jeremy Schumacher: And…

Jeremy Schumacher: you talked about the turnover, I The burnout cycle is problematic, I see this with social workers to see with nurses to see with other things. We're taking people who are passionate about it, coming out of school, have good training on it and then are only in it for five years before. They're gonna go take a job at a hospital. I have a cousin who's an athletic trainer who's selling ankle braces…

Melissa Perkins: Yeah.

Jeremy Schumacher: because he makes so much more as a salesperson. Yeah and…

Melissa Perkins: You hear more than me.

Jeremy Schumacher: he likes sports and he's interested in doing what he's doing and he's good at what he does but it's just one of those things like you have kids or you go through life transition and you have to make that cost benefit analysis, make sense for you.

Melissa Perkins: Yeah. Yeah I know the burnout is tough. Especially in college athletics. I would say that that is probably the hardest because You did a lot of people but most of those high school, athletic trainers aren't going in into one or two. Is like we open at 8am every day and I am not leaving until 7:00 7:15 and granted. I don't do all the 8am's but still just knowing that

Melissa Perkins: I mean today I got here at 7:45 and I'm not gonna leave until 7:15 tonight and that's a normal Wednesday. So dealing with that this is a clinic.

Jeremy Schumacher: Yeah.

Melissa Perkins: You go in work, eight to four, you get your nights off, you get to hang out with family and those clinical positions pay better. it's hard to avoid. I think looking back to I graduated with 19 other athletic trainers in my class and I'm the only one still actively working in athletic training. They are all there.

Jeremy Schumacher: Yeah.

Melissa Perkins: There's a firefighter someone's working at stretch lab up in Wisconsin. And I and she's still probably makes more than me it's one of those things that the people just slowly trickled away and as much as I still have the passion for, it's really hard to push through the burnout, especially the time The heart of football season. I've spent maybe five conscious hours with my fiance in the last week and half of that's cleaning my house or cooking dinner or staring at my dog saying I'm sorry, I'm too tired to go play. Fetch with you right now.

Jeremy Schumacher: And I think there's a difference between in season and out of season, but when you're short staffed,…

Melissa Perkins: Absolutely.

Jeremy Schumacher: You don't get that out of season break…

Melissa Perkins: Wow.

Jeremy Schumacher: if you're having to cover a sport or somebody leads.

Melissa Perkins: Yeah.

Jeremy Schumacher: And We got covering one trainer who left unexpectedly so again it gets back to that support. If our staffing is not good enough, you're going to have to pick up the slack somewhere.

Melissa Perkins: Really or you're gonna have to bend in your coverage. And that's the thing is right now because we've covered every practice, we travel with every team. If we were to lose any staff members or be short staff going into another year, I'm sorry, we can't go to every basketball game on the road and the coaches are gonna be upset because that's a huge selling point for our school and their team. It's nice to have your own athletic trainer who knows everyone and can handle everything correctly, but there's gonna be a point where it's not gonna work anymore.

Jeremy Schumacher: Yeah, yeah, and again I think people non-professionals have a weird view of it because you see the NFL game, where the trainers, the training staff comes running on the field and they're just on the sidelines and they're there all the time. that's not normal outside of a professional setting.

Melissa Perkins: Yeah, we're very lucky that we get to travel places but if they're playing a game that means there is an athletic trainer there. It just might not be yours, right? And so I think just kind of giving it and…

Jeremy Schumacher: Right.

Melissa Perkins: especially in the NCAA every coach is CPR certified. So in an emergency you can handle it. I've worked at a place where coaches had to kind of deal with injuries, until we came in the next day, and it can happen. So I feel like we always have to remind them not to take advantage or forget that we are very lucky to have the setup that we have and that's pretty common across all D3 schools of you we have a large staff. That is a huge selling point for us. And so just kind of Remembering that we need to be taken care of too. Even though there's this, many of us, it's still tough work.

Jeremy Schumacher: Yeah, yeah. So I know you and I have talked, I'm gonna share a little bit of some things we've talked about in the past but changing a job for you it was good for your mental health like getting that reset looking, you said being very intentional for picking employers who are going to support you the way that you need to be supported. But can you talk a little bit about that experience of, I remember texting with you and being like I believe you said pretty much word for word. My mental health has done a 180 so

Melissa Perkins: so I think for me when I was choosing to leave Concordia, that was the biggest thing. It was really hard decision. I was very happy. There was very comfortable there and then once covid hit I kind of had a different perspective because that time was really hard. It was fall of 2020. We were pushing athletes back into sport and I was having a huge, moral dilemma of Are we doing this to help the athletes? Or are we doing this to keep them on campus? Keep their ition. Keep our jobs. So that was very hard on me, mentally. And I remember vividly, there was a day where I had the point where I was just like

00:35:00

Melissa Perkins: I don't ever in such a depressed mood, where you just say, whatever the f*** you want, because you're like, what's the worst that could happen. What are the consequences? And one of my co-workers was Perkins, you were on Wednesday. I was it's called depression. Get used to it and they were just, dying laughing at me, It's really funny. I'm really sad. and so I was also a long distance relationship at the time. So that was a huge factor as well. So I was living with my best friend and her girlfriend, so just seeing love every day. knowing that I was away from my partner and then really struggling at work. I was like I needed to make a change and so that was a huge factor of why I started looking for other jobs.

Melissa Perkins: And I moved back here and that was when I went to an nai school so it was like you come in ten to six every day except for games. it was a very set schedule. it was the perfect reset for me and…

Jeremy Schumacher: Yeah.

Melissa Perkins: I got to move in with Tom until that was great and so that really was like a huge 180 and I was happy there but I was missing kind of I liked traveling I liked getting to know my athletes a little bit better so instead of going to practices we just kind of sat the training room and had people come to us if something came up. So I wasn't getting that same connection that I had had at some of my other jobs and then we found out that school was closing. And so when they closed, I wound up here which it's a very familiar vibe, it's very similar to the waking Cordy Iran. And so I think for me this has been the best fit and I am very happy. my mental health is a lot better. I'm obviously, exhausted and burnt out in football season, but I know that I'm often winter. So, come November 12. I will be in a much better mood. I get

Melissa Perkins: Summer's off. So as much as I like kind of harp on how I feel right now I do have a really really good life balance in general. So football stuff…

Jeremy Schumacher: Yeah. Yeah.

Melissa Perkins: but football stuff everywhere like that. It is what it is. I'm still excited to come to work. I'm not at the point of absolutely dreading some Sundays,…

Jeremy Schumacher: Yeah.

Melissa Perkins: I tend to dread it like a JV game on a Sunday that'll get me to be like Okay, yeah we're doing it. let's go one more day.

Jeremy Schumacher: and I think this is relevant to burnout in general, but also athletics, if you're not having fun, if you're not showing up looking forward to it, like I remember I was hurt. I was playing baseball. I was getting recruited to go play at the collegiate level. I was pretty good athlete, but I was injured and I didn't get along with my coach. I was a good kid. I'll put that in quotes, but I didn't drink and party on a real drinking and partying team. This was in high school, so I didn't fit the culture, the coach. And I did not see One of the coaches was my dad, we definitely didn't see eye to eye. I was injured and I just remember being like I'm not looking forward to the season like I put in all this work, I put in all this effort, I was rehabbing, I was doing all the stuff to be healthy enough to play and I wasn't excited to play.

Jeremy Schumacher: And that's what burnout looks like, where it's just like the joy is sucked out of it. You're doing it and then circling back to more present times like going through Covid was really just It's brutal for the athletes because for a lot of them, their number one, coping skill was sports and that was taken away spiritual for athletic trainers, getting up at 5:30 to run covid, tests and swabs, and all that stuff hiring. But also then Is this okay? I was doing mental health at the time, so I was miserable and it's like you do all this fighting. For this job, and then you step away from it. You're dang, like that wasn't good for me for a long time. Like that.

Melissa Perkins: .

Jeremy Schumacher: As you said, that breath of fresh air is really helpful to kind of take stock and reevaluate where your morals, what's going to be congruent for what you want to be doing?

Melissa Perkins: Yeah for me the biggest thing is I love game day, I'm so excited. It's awesome to watch people play that have maybe been out for a couple weeks and they finally getting back at it so that for me is the big tell if I'm going to a game barring horrible weather or something like that, if I'm dreading a nice beautiful sunny afternoon football game that's when I know it's time to go but even this weekend I had a really long week, I was really tired and we got on the football field and we got our first win of the season and I was pumped it all pays off and that time and then Sunday. Normally my day off I went and traveled with softball and I was still excited to watch softball and watch these girls who had done their whole fall season and this was their chance. So that is very much. So for me to tell is when I don't want to go to a game anymore like that's when it's time to give yourself a little check.

00:40:00

Jeremy Schumacher: Yeah, for Let's talk about mental toughness because again, I think that's a sports are so weird in the stigma around mental health. But everybody acknowledges that mental part of the game is a big deal. And I was a pitcher playing baseball growing up. You were a pitcher. Let's talk about how that gets talked about, How were you kind of coached? How did you kind of make sense of that as a player yourself, when you're on the mound, maybe you're struggling. You're not having a great game like What are you kind of do? As an athlete. When you're out there.

Melissa Perkins: That's a great question. I haven't thought about playing sports in a while. I'm long retired, but it Huge thing as pitching especially is a big one, because I remember when I was in high school, I was the only picture. So I think for me, that was what got my start? Because I knew that, no matter how s** I threw that day, there was no one else to come in. you just got a great embarrant and figure it out and try and find another way to beat a hitter or at least, not let them hit another home run. And so I think for me that was what kind of prepped me and then college was just like

Melissa Perkins: A whole new ball game I would throw a great first three innings and you'd get through the second time, the lineup and they would know what you're gonna throw because you haven't changed anything. And so I think just every level it just got a little bit harder, I think, getting mentorship or even just talking about the mental side of the game is huge because I feel like we didn't talk about it a time, we would go to practice they'd say, be mentally, tough, figure that out. But I don't think I was given any skills, whereas, our softball team, they do picture catchers meeting once a week in season, where they just do some sort of activity. Whether it's team building, whether it's mental toughness, whether they listen to a podcast or watch a video and talk about it, but the mental side of the game is actually discussed. And then again, we're very lucky, we have some sports, interns that will do individual training sessions with athletes, and we really give them a lot of information on imagery and mental reps and confidence and these

Melissa Perkins: Marketable skills, like actionable items for them to kind of do in practice that I think is a great resource and tool to use in sport because you don't realize how much the mental side of Effects how you play. So I think a big part of it too is just having coaches and understand that. And if the team's having a bad mental day and they can't figure it out How can you as a coach shift this? practice and be like, Alright, take a few minutes discuss, what's going on? Come back in five minutes and we're gonna play better. I don't know what you need to do, but whatever this is is not working and maybe give some of those actionable items and some of those skills that they can kind of use in that sense.

Jeremy Schumacher: And you said mental reps which was one of the things I talked about all the time because athletes are so familiar with the repetition is important. And then skipping the mental part but you can sit down, you can visualize you can do something that's good for your body rest and…

Melissa Perkins: Me.

Jeremy Schumacher: recovery and still, get your mental reps. You can watch film, you can do all these different things. So I love that for me, working with athletes. I was always my in to get them thinking about their mental health was like, you always say 90% of the games mental, this is part of that. What does that look like and so demystifying? destigmatizing, As you said actionable items players, athletes want to practice something. They're used to reps.

Melissa Perkins: Yeah.

Jeremy Schumacher: They're used to drills. If we give them mental drills, they'll do them. that makes sense to them.

Melissa Perkins: Yeah.

Melissa Perkins: And especially anyone who's injured. I'm always trying to get them to practice. I want you there. I Watch your teammate, play your position and do that. Think about feeling your body doing that, and being able to get your mind to feel those motions watch. It happen is a lot more than sitting there and playing candy crush would be. So, it's better than nothing. And then, my biggest thing is trying to get them to do anything that they possibly can in practice, I had a girl who was out, with an upper extremity injury. I'm like, you can run bases, get out there, do the team warm up, like move around, do something to move your body through space and get active and feel like you're part of your team. Because a lot of the mental side of it, too, is inclusivity. So feeling like you're still part of your team is huge for not only healing but your own mental health and kind of keeping eyes on the prize, If you're out there and you're dressed for practice, even if you can't go, you're gonna feel like more of the team if you can get in and help pick up balls, or something like that. And

Melissa Perkins: Really feel included. That's a big part as well.

Jeremy Schumacher: Yeah, And for a lot of athletes, if you're in concussion protocol or you've got, turf toe or whatever, some of these aren't on crutches, some of these people aren't in a boot. So the difference between being visibly hurt and just being not cleared to play is different. So, being included and doing what you can really helps kind of keep people from getting in their own heads about my teammates are judging me or any of that type of stuff.

00:45:00

Melissa Perkins: Especially concussions, that's such a huge one because everyone is so unique. I've worked with concussions that have lasted three, four, five months, and mental health. Affects it so much. So the more prone to depression anxiety, ADHD, any of those things worse in your chance of close concussion syndrome, which is just long-term symptoms. So, being able to Address that mental health aspect, even if it is like you need to have more appointments, If you already seeing a provider Do we need to change the timing of it so that you're able to be a little bit more focused on it, but really approaching handling the mental health side, even

Melissa Perkins: Even if you don't have a diagnosis, Even if it's not something that severe addressing the mental health can help improve the concussion symptoms or at least know that they go hand in hand and that you have to look at both because I think a lot of times that goes overlooked of we just see a number on a sheet, Every day they come in and they feel at this list and we're like, all right, you still a little bit headache, blah. Can't play basketball today, like sorry, good luck. We'll try again tomorrow. And if you're not digging deeper and getting any more information, there's so many other things that you're missing out on In terms of how you can help them, and how they can help themselves.

Jeremy Schumacher: Yeah, for sure.

Jeremy Schumacher: I'm gonna avoid a concussion discussion because I think that's an extra hour on the podcast but it's fascinating.

Melissa Perkins: Yeah.

Jeremy Schumacher: I will say for people who are maybe not in the know or, you're mad that your favorite fantasy football. Star is out this week with a concussion again, like the science behind it is, we're constantly learning new things. It's such a weird, quirky kind of thing that we're still working really hard to unravel from the neuroscience perspective.

Melissa Perkins: yeah, so much of the perspective has changed even again from when I graduated a new consensus statement, came out this summer when I was in school, it was lay in a dark room. Don't talk to anyone for 48 hours. Don't look at your computer screen. Don't do anything that might make you feel worse. Definitely, don't do any physical activity and now the research is like you can go 48 hours where you don't do a ton. But after that get on a bike go on a walk like any sub maximal. Exercise is gonna be great for you go to class, look at that computer screen, Do things that are gonna kind of test you a little bit, so it might make you feel slightly worse in the moment but as long as you come right back down, That's great for you. And so I think just seeing how even just the treatment alone has completely flipped 180 is crazy to me, I'm very grateful for it. I've seen a lot better results of getting people moving and getting people active and you're losing, are You're

Melissa Perkins: Decreasing their deconditioning. So when they do come back, they feel better and they're better shape, they're boosting their mood by letting them be able to do something other than sit in a room and stare at a wall. I had concussions in college, and I remember laying on my couch, just staring at the wall, not watching TV because my head hurts so bad and knowing that I could have been on a stationary bike or I could have done something that might have made me feel better other than just be much new research, I'm excited to see where it goes. But also always scared because Football is bad for the brain, a lot of times. I mean it is…

Jeremy Schumacher: Yeah. Yeah,…

Melissa Perkins: what it is.

Jeremy Schumacher: and recurring what the science around recurrence and stuff like that. We had an athlete who Took a ball off of a bounce in a drill and got a concussion and for most kids that happens. I got hit in the head all the time as a coach like You're just walking through the court or talking to somebody in Aaron Paul comes and hits you and somebody's that's nothing and they respond appropriately and that's going to be a concussion and that's going to be a concussion. We're out for three months. So the variability of it is just crazy high.

Melissa Perkins: Yeah.

Melissa Perkins: in getting athletes, parents coaches to understand that how hard they got hit is not gonna fully predict everything else. So getting someone to understand there's still symptomatic, I can't let them play. And they only got someone just hit him in with the it wasn't that bad. I'm like, I cannot predict any of this. All

Melissa Perkins: Is treat the person in front of me, how they're feeling what they're saying today, and so much of it is subjective too. I'm relying on the athlete. To be honest with me. I'm relying on them to tell me what symptoms they're feeling and use that to make my decision that could be life or death. So it's very stressful and…

Jeremy Schumacher: Yeah.

Melissa Perkins: very like intense. But that's another thing that I think with this generation that they're a little bit more understanding and I think they value their body and their health, a little bit more than maybe people 10, 15 years ago, I think so much of it was like sport or bust and now people are realizing that sports are for now. Your body is forever and so really seeing that small shift in kind of the generation and no Melissa, I would not lie to you about my symptoms. I understand how serious this is. I feel like I can take a little bit of weight to that and be like okay I feel like I can trust them I can make this decision confidently where maybe six years ago. I don't know if I would trust it as much I would just have to rely on my gut and my gut.

00:50:00

Jeremy Schumacher: Yeah. Yeah. Any and on the flip side of it and in my line of work, I mean it's fascinating I assess for something like a history of concussions. Now, when I work with couples because sometimes that's going to Explain or contribute to an explanation for why someone has anger issues or why there, so emotionally touchy uncertain things. So, the science, not just for athletes, It's fascinating. That's where a lot of money is NFL studying concussions constantly but it's one of those things where we're seeing some of the long-term, fallout of these things too and realize in, You're saying that your body is forever like sports for now, bodies forever, so, it's on the flip side, on the back end, It's interesting to see the research that's being done as well.

Melissa Perkins: And I'm still dealing with people where This season is more important than having pain the rest of their life and I can only do so much to convince you. But college athletics is wild because you're dealing with adults, on the one hand, you have one kid that says I don't want to do this because my mom says no. And the other one that goes, I don't care. I'm gonna do what I want. my choice, I'm an adult, I'm gonna do this and if it's not and truly inherent risk for death like There's only so much, if I say okay and a doctor says, Okay, we just got to go for it and hope for the best and figure it…

Jeremy Schumacher: Yeah.

Melissa Perkins: along the way. so I try and at least have that, heart to heart of This could be a lifelong issue if you keep going and they're like, Yeah, no, I know and I'm okay with that. And I was

Jeremy Schumacher: yeah, that 18 to 22 year old brain is in a developmental somewhat impervious to long-term consequences stage, still, so depending on that maturation process and where they're at in their development. I mean, 19 year old Jeremy, did a bunch of stupid stuff that 35 year old. Jeremy would not do so.

Melissa Perkins: and then, yeah.

Jeremy Schumacher: Be therapist.

Melissa Perkins: Yeah, first thing. hard. Cannot recommend it enough boundaries. I did not have great ones when I was a younger athletic trainer and it pushed me to my breaking point mental health wise taking on the front of other people's mental health when I was absolutely not prepared for it. So any new student I work with any new employee, that is one of the biggest things I harp on is You can be a resource for them, but you should not be a counsel, you should not be there therapist.

Melissa Perkins: If it gets to a point that you feel like they are needing too much from you, you need to immediately refer. So I think that in the past I have had an athlete that I knew had a history of suicidal ideations and had opened up to me about some mental health stuff and I just never cut it off. So I was getting text in the middle of the night. It was like every time I saw this person's name pop up on my phone. I was like, okay if I don't reply right now they're gonna kill himself and it is my fault. And so being able to tell my stories to younger athletic trainers and remind them, how important it is to put yourself and your mental health. First is the biggest thing and then from there, recognizing what needs to be referred? So kind of understanding Is it just general I'm kind of struggling with school but I'm doing okay. Or is it, I feel like I can't get through my day without crying or I can't get out of bed, I don't want to do anything anymore and really listening for some of those red flag. Type things that

Melissa Perkins: Good, warrant, a referral. And then, I just always be as blunt as possible. I think kind of sneaking around the answer or speaking around the questions or being just, very vague is not helpful to anyone where I would always just be like, Okay, have you seen a mental health provider in the past? Is that something that interests you would you like me to connect you to a resources on campus? And I've reached out directly to our counseling services and I'm like Hey this is the Situation that I have, I think that they would benefit. Do you have any times available? So just knowing that. you can put on the card, You can give their little business card, here, make an appointment, but if you pick up the phone and dial it for them, they're 50% more I mean I made the number up, but they're definitely more likely to go and have this help and get this information than if you were to just give it to them and they shove it in their backpack and don't do

00:55:00

Melissa Perkins: Anything. So I think that that's one of the biggest things that I've found and…

Jeremy Schumacher: Yeah.

Melissa Perkins: we are lucky to have counseling services on campus, but I have been it institutions in the past where we then have to deal with insurance. And maybe I don't want my parents to know that I'm getting this but I'm on there insurance. And so, really just trying to reach out to even counting providers. I think I had an athlete use free counseling services through a church at the health department. And so, just knowing that you have resources out there that you don't have to be this person's mental health care provider. There are other options. So, those would be kind of the big things of setting boundaries and then kind of knowing when to refer, what your resources are that you have available and if those aren't available and can you find? What else can you kind of piece together?

Jeremy Schumacher: Yeah, for And I think it's one of those things too, where the appropriate I've had eyes coached at the club and college level. I remember an athlete went down with an ankle something and I'm a young coach, I had a plane career but no experience around injuries. And I

Jeremy Schumacher: Helped my player off, and got into the bench and got him, some ice and had no idea what to do. And that's the same for something like a mental health crisis. if you're an athletic trainer, you don't have that frame of reference to know how to do that. You just say Hey, let's look at what the support's available to you and get in touch even as a mental health professional. sometimes, I'm still recommending that somebody go to the hospital. Sometimes, I'm still contacting parents to come pick a kid up, like that's just the reality of it. But yeah, not taking on too much and knowing that sometimes that's actually doing more harm than good because if I would have tried to take the kids ankle not offering any actual support, I don't know what I'm doing. So yeah, I think that's really key. It's tough. I mean, certainly as a mental health provider, I don't take insurance so I see some of it where it's sucks to Someone away. Who can't afford working with me or whatever, or to see a campus counseling center that has four week or six week waiting period. again, there's an issue of support that's kind of systemic here, but being able to have those healthy boundaries,

Jeremy Schumacher: Refer where appropriate. I think that's really the goal.

Melissa Perkins: Yeah, absolutely.

Jeremy Schumacher: Perks. This was awesome.

Melissa Perkins: thanks. I had fun.

Melissa Perkins: have anything to plug.

Jeremy Schumacher: All right, yeah, it's kind of weird with when I get college sports people on Go follow Marquette,…

Melissa Perkins: Yeah. Yeah.

Jeremy Schumacher: Athletics question Mark.

Melissa Perkins: I agree.

Jeremy Schumacher: At least it was an alum from our cat, I feel. Okay, I shunned them and…

Melissa Perkins: Yeah.

Jeremy Schumacher: speak poorly of their counseling program, but if they're doing well, in the NCAA tournament, I'm gonna be like, I went there, …

Melissa Perkins: Yeah, of…

Jeremy Schumacher: that's me.

Melissa Perkins: Yeah, I'm not really have anything. Support your athletic trainers. Pay them. so, I got

Jeremy Schumacher: Yeah. Support your local brewers. They're awesome.

Melissa Perkins: Yeah.

Melissa Perkins: We like that, too.

Jeremy Schumacher: Yeah, for sure.

Jeremy Schumacher: This has been great parks. Thanks so much for coming on.

Melissa Perkins: Yeah, of…

Melissa Perkins: Thanks for having me.

Jeremy Schumacher: And to all our wonderful listeners thanks for tuning in.

Jeremy Schumacher: Once again we'll be back next week with another new episode.

Meeting ended after 00:58:31 👋