'A Swiss Army knife for players': inside the National Women's Soccer League mental health setup

The Mind Room speaks exclusively to Dr. Brett Haskell, the NWSL's Director of Clinical Mental Health and Performance, about building a league-wide support system for women's soccer players

Soccer and mental health aren’t necessarily natural bedfellows. This year’s European season has been dominated by coaches and players bemoaning the psychological impact of an ever-expanding fixture list (involving journeys that saw one international travel over 150,000km in 2023). US women’s soccer isn’t immune to these pressures, either: national team players such as Naomi Girma have spoken candidly and courageously about their teammates’ struggles with conditions such as anxiety and depression.

Girma and co have also backed-up words with action. In 2022, their trade union - the National Women’s Soccer League (NWSL) Players’ Association - struck a Collective Bargaining Agreement (CBA) with the NWSL that forces every club within the league to employ a licensed mental health provider.

It’s a clause which more-established, better-resourced competitions, such as the English Premier League, are still yet to implement. The CBA is, and should be, a source of pride among those connected with the NWSL.

But teams have adopted very different approaches in attempting to meet their obligation. Some sides choose to rely on the support of staff from hospitals they’re affiliated with, whilst others hire practitioners for a fixed number of hours each week.

At least one team has a full time mental health and performance specialist permanently attached to their backroom setup, with other clubs electing to split the ‘mental health’ and ‘mental performance’ parts of the position into two roles.

Enter Dr. Brett Haskell. A current Major League Baseball (MLB) psychologist, Haskell was appointed as the NWSL’s first Director of Clinical Mental Health and Performance in December 2023. Within her wide-ranging remit was a simple aim: ingrain some consistent principles across the range of approaches currently on show.

One of the pillars she’s spent the last 11 months encouraging clubs to adopt is a commitment to ensuring practitioners are embedded within backroom teams and have a real presence at training grounds.

“When the mental health provider has boots on the ground and they get to see players regularly, they’re perceived more consistently with the rest of the medical team, which is around the squad on a regular basis and have relationships with the players,” says Haskell.

“So it (mental health support) doesn't seem like this bigger issue that you have to be secretive about: the providers are normal people and a normal part of the medical staff, just like your physical health providers.”

Whilst the aim of Haskell’s approach is simple, ensuring the NWSL’s 14 clubs sing from the same hymn sheet is far from straightforward. Take the supply of mental health providers as an example. In some areas of the States, teams are picking from a limited roster of licensed professionals, relative to sides from densely populated parts of the country.

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It’s an issue that Haskell is keenly aware of and one of the reasons the she’s avoided an overly prescriptive mental health policy, focusing instead on a couple of baseline standards clubs are encouraged to meet.

“I don't want to get too pigeonholed, but I think some minimum expectations are that every mental health provider associated with a club is in front of the athletes a minimum of a certain amount of times per year,” she says.

“We haven't yet defined that, but I think at the very least, they should be involved in the screening procedure pre-competition and they should do a workshop or get in front of the athletes to explain preventative mental health as well as reactive mental health.

“I think a lot of times when we think about licensed mental health providers, we exclusively think in terms of reactive mental health, which is, ‘I'm ill and I'm hurting and now I'm going to see somebody.’

“But there's a lot of wonderful things that can be done preventatively. We treat athletes' bodies that way: we foam roll and we do ice baths and contrast baths, and we do all kinds of things to make sure that we’re preventing injury risk. We want to do the same thing with their brains.”

Haskell has held recent discussions with two teams about how to adopt some of the underpinning principles she’s championing and points to an example of the creative ways in which clubs can make the most of the resources at their disposal.

“Our insurance provider has really good mental health benefits and our players actually have a $20 co-pay for any mental health service if they have a diagnosis,” she explains.

“So, a club could theoretically go and recruit a mental health provider, get them paneled and offset some of the costs by billing insurance for some of the costs of care.”

Haskell is conscious about the confusion that sometimes surrounds US regulation of mental health and mental performance practitioners - an issue mirrored in European sport - and is working closely with clubs to raise awareness of issues such as provider pay rates.

“When we look at ACLs, for example, nobody's questioning what surgery should cost or what a surgeon's rate should be, but because there is a lot of confusion around mental health rates and reimbursement rates for a Master's level clinician versus a PhD clinician and things of that nature, I think clubs often minimise what the expenditure should be for high quality care,” she says.

“We wouldn't do that in a sports orthopedic or sports medicine area, so some of the work is about helping our clubs understand the value in having highly qualified people who may cost you a little bit more, but maybe save you more on the back end.”

Haskell, who spent over 20 years working in the US college sport system before joining the NWSL, is also using her experience to help players.

The MLB psychologist is on-hand to support NWSL squad members with issues ranging from undiagnosed ADHD to finding providers trained to deal with conditions such as anxiety and depression.

“I think of myself a little bit like a Swiss Army knife for players,” says Haskell.

“In moments of crisis, I can certainly be a resource and triage and help manage the crisis for them.

“So, when they need specialty care like neurocognitive assessment, I can be an access point to get them connected with the right service provider.

“If they feel uncomfortable receiving mental health support through their club, I'm also an access point for them to find the right kind of person within their local market.”

Beyond the ‘reactive’ support which Haskell provides and signposts, the league run an on-call service providing players with immediate virtual access to a counselor, a psychiatrist or a psychologist.

The NWSL also offer help for those approaching, or thinking about, the end of their careers. The ‘Beyond The Field’ program helps athletes prepare for retirement and what Haskell describes as “one of the most critical mental health experiences that an athlete will go through”.

But away from flagship programs, its the links which Haskell is building between NWSL teams which she returns to regularly during our conversation.

Haskell has started bringing together teams’ mental health and mental performance providers for a monthly meeting to talk about issues they’re facing and look for solutions to some of the challenges they’re facing. It’s already led to discussions about developing a preventative mental health app, an idea initially tabled by players in meeting with providers, illustrating the value of the collaboration Haskell is helping to coordinate.

“I think about my role as like connective tissue,” she says.

“You could have all these parts that have been thoughtfully built and in theory should work really well, but if you lack the connective tissue to make those parts work well together, often the whole system fails.

“I really believe that mental health is a system-level issue in sport and that we can't address mental health at the individual level, just at the club level or just at the league level.

“We have to intervene at all levels in a variety of ways, taking into consideration what people are telling us, and I think that requires this connective tissue to be dynamic in responding to all those parties and finding the best solutions, given what we have and the problems we're facing.”

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