At the Tokyo Summer Olympics last year, star gymnast Simone Biles shed light on the mental health issues many Olympians face when she decides to retire from competition.

Now, the best figure skaters, skiers and snowboarders in the United States will compete for gold medals as they also face the pressure of a global pandemic for the second year in a row.

“The Olympics present particularly unique challenges for elite athletes,” Dr. Joshua Norman, a sports psychiatrist at Ohio State University’s Wexner Medical Center, told ABC News. “Many of them train their whole lives for this unique moment and many of them are removed from their support systems.”

He continued: “With the isolated experience of being in the Olympic Village, with such an intense focus on competition…and especially in the current climate with COVID-19 with athletes being tested multiple times a day, then they are still more isolated for fear of contracting COVID-19, it is a very unique experience that can physically and mentally tax elite athletes.”

For the Beijing Winter Olympics, Team USA has made it a priority to treat and protect the mental health of its more than 200 athletes.

Athletes will have access to therapists and psychiatrists throughout the Olympic Village and venues, the ability to attend individual or group therapy sessions and a crisis hotline that they can call, said Dr. Jessica Bartley, director of mental health services for the U.S. Olympic and Paralympic Committee. a media summit in October 2021.

She said most athletes have had multiple mental health screenings.

“The majority of our winter athletes, we’ve actually done mental health screenings around anxiety, depression, eating disorders, sleep disorders, alcohol and drug use at the over the summer,” Bartley said. “And then we’re going to repeat that. And just try to keep an eye on them for a bit too.”

Team USA has also compiled a list of advisors that athletes can contact and will allow free access to wellness apps.

In addition to competitive pressure, Olympians will have several strict rules in place during the Games, including staying within the closed-loop system which does not allow outsiders, daily screening and testing, wearing masks at few exceptions and avoid hugs or handshakes, according to the Olympic booklet.

Norman said the athletes were doing what they could to be physically and mentally prepared, but some of the strict measures could be difficult to manage.

“Certainly once you get there and it’s such a strange experience – especially for those coming to the Olympics for the first time – it can be an overwhelming experience at times,” he said.

Dr. Leela Magavi, a psychiatrist with several student patients and professional athletes, offered some advice for athletes. For example, instead of training all day, athletes can take mindful walks, write in a journal, or spend time talking to family members.

She also recommended that Team USA advocate for athletes to openly express their thoughts.

“Rather than asking a closed question, ‘Are you depressed or anxious?’ ask, ‘How do you deal with anxiety?'” Magavi told ABC News. “When they’re anxious and internalizing those feelings, they don’t sleep as well, they don’t eat as well, they don’t play as well.”

Norman said it’s important not only for athletes to keep up to date with all current treatments, but also to have constant communication with their support staff for any new or evolving conditions that may affect them.

Biles isn’t the first athlete to speak out about mental health. Michael Phelps, the most decorated Olympian of all time, has been candid about his struggles with ADHD, depression and even suicidal thoughts.

However, Biles is perhaps the most high-profile athlete to step back from events to focus on her mental health after revealing she has “the twisties”, which is when a gymnast loses. the sense of where it is in the air.

“Whenever I think of Biles’ decision, it really helped people speak out,” Magavi said. “I’ve had people say, ‘I never thought you could even do this. If you were experiencing something like twisties, it might even say that. I think his decision bridged the gap between mental and physical health.”

And it seems some professional athletes have followed suit.

Before the NHL announced that no hockey players would be making it to the Olympics due to Beijing’s strict COVID measures, Las Vegas Golden Knights goaltender Robin Lehner said he would not play for the Swedish national team, citing mental health issues.

Lehner, who has been open about his diagnosis of bipolar disorder, said after consulting with his doctors, he made the difficult decision to stay in the United States instead.

“The reality is that this [has] says it won’t be ideal for my sanity,” he tweeted on Dec. 6. “Took a long time to make [a] decision with my psychiatrist and my family. my well-being [has to] coming first and being locked up and not knowing what happens if you test positive is [too] a lot of risk for me.”

Experts praised Lehner for his decision and called it “courageous”.

“It takes enormous self-confidence to speak out,” she said. “Athletes are used to internalizing their feelings. When athletes are unable to sleep, eat or function, it is often linked to poor athletic performance.”

Magavi said she hopes more athletes speaking out about mental health will take away some of the pressure they face.

“Athletes are human beings like you and me,” she said. “Athletes have all kinds of insecurities. They want to win gold as much as we want them to win it for us. But they also have the right to determine if they want to play.”

“They’re more toned down with their bodies, their emotions, and if they feel like the time isn’t right, that’s their decision,” she added.

Norman said athletes speaking out could also break down the stigma around mental health for everyday Americans and help them realize how common mental health issues are.

“You’re not alone. Extremely successful people like Simone Biles, Michael Phelps, a lot of elite athletes, also have mental health issues,” he said. “I think having people like that with those kinds of platforms speaking out, it really helps not only other athletes but also people within the general population who can look up to those athletes. It can help them help get treatment.”

The psychiatrists added that giving Olympians a chance to address their mental health issues will lead to better performances and, in turn, lead to more medals for the United States.

“If we come back with healthy and safe players, we could also bring gold,” Magavi said. “It’s a win-win situation.”