How Simone Biles and Naomi Osaka Are Changing the Mental Health Conversation

Simone Biles competing in the Olympics.

Verywell / Getty Images

Key Takeaways

  • High-profile athletes such as Simone Biles and Naomi Osaka brought about a shift in the national conversation around mental health.
  • Athletes are susceptible to mental health struggles on various fronts, from depression related to personal failure to anxiety from excessive media attention.
  • Experts say we must use the momentum of this moment to take a more holistic perspective toward athlete health and wellbeing.

As the 2020 Tokyo Olympics come to a close, conversations about athletes and mental health that emerged from the games are expected to linger.

In the last week of July, gymnast Simone Biles stepped down at the Tokyo Olympics due to mental and physical health concerns. Her decision arrived, after just a few months ago, Olympic tennis player Naomi Osaka also made headlines when she stepped away from a press conference, and then the French Open tournaments, to care for her mental health. 

Biles and Osaka are two young elite athletes; often lauded by many as the Greatest of All-Time (GOAT) and expected to go for nothing other than gold.

Now they're leading the way in publicly acknowledging their mental health struggles. Through their actions and words, they're expressing "It's OK not to be OK."

Typically, athletes are expected to "persevere" and push through any ailments, physical or mental. But Tiffany M. Stewart, PhD, a scientist and clinical psychologist at Pennington Biomedical Research Center in Louisiana, and former athlete herself, tells Verywell that we need to pay attention to this moment.

"It's an organic time that we have come to that we couldn't have created even if we wanted to, that allows this discussion to happen," she says. "If we don't take this as an opportunity to have this discussion in a real way, we're going to lose the moment."

Mental Health Toll for Athletes

When asked how she felt about taking home silver and bronze medals, rather than her expected gold at the Tokyo Olympics, Biles said, "It's not how I've wanted it to go, but I think we've opened bigger doors and bigger conversations."

Gymnasts that go on to the Olympics typically start training as young as 4 and spend most of their time outside of school practicing.

This often results in sacrifices and opens the door for severe injuries. Many athletes struggle with mental health following injury.

There's also the looming threat of failure. Some studies find that the higher your rank among elite athletes, the more susceptible you are to depression, particularly in relation to a failed performance.

For those high-ranking athletes, the press can add a layer of stress. When Osaka backed out of press conferences at the French Open in May, citing "disregard for athletes' mental health," she received backlash on many fronts: From tennis officials, the media, and even in the forms of a $15,000 fine and possible tournament expulsion.

Amidst all this, Osaka pulled out of the tournament.

"She's basically saying, 'Look, can I back away from the media when I'm not doing well?'" Stewart says. "And she gets so punished for that that she bails out of the competition. That's horrible. Why not say, 'You know what? It's okay. Back off for today.'"

It all might have ended differently, she adds, if that had been the official response.

Support Is Crucial

But Stewart adds that this doesn't mean high-ranking athletes don't have support. There are sports psychologists, coaches, team members, and often friends and families there to help.

Still, to offer the support that may be needed now and in the future, Stewart says, we'll need to see a paradigm shift.

"True change has to come from a holistic perspective and looking at the athlete from a person-centered focus, not a performance-centered focus," she explains. "The drive has been, 'This is a body, it's a machine. Here are the results we want, and so we're going to do a hundred beam routines to get to this result.'"

In the process, she adds, people break down. "It's what I call a core philosophy change, a shift in focus beyond performance at the moment to include health in the long-term," she says. "And if that were to happen, there would be a lot of logistical change."

At the very least, there could be training for, or the ability to opt-out, of press conferences. "We're in their face with media interviews and all of these sort of requirements that go along with sport," Stewart adds. "Nobody really prepares these athletes for that."

In an article for Time about her initial decision to pull out from press conferences, Osaka wrote that she's never been "media-trained." Her decision to skip a few, she wrote, in order to "exercise self-care and preservation of my mental health," didn't need to be reacted to in the way that it was. "The intention was never to inspire revolt, but rather to look critically at our workplace and ask if we can do better," she wrote.

"I think we do need to work with the athletes for mental health robustness and resilience skills training," Stewart says. "But we also need to look at our culture and environment about our expectations, and about all this pressure and all the media interviews, what's really required, and how can we make this culture a little less punishing."

What This Means For You

If you are experiencing a mental health crisis and need immediate help, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255); contact the Crisis Text Line by texting TALK to 741741; or contact SAMHSA’s Disaster Distress Helpline at 1-800-985-5990.

Women of Color Are Disproportionately Impacted

Juggling mental health as an athlete can be especially challenging for women, especially women of color. "It's hard, but it's harder being a female athlete because everybody prays for your downfall and wants you to mess up," Biles said in interview earlier this month.

"Female athletes, in particular, are under pressure from many sources," Stewart says.

For instance, consider uniforms. Women have been fighting against them for decades, from mandatory full-length dresses in the early 1900s to skimpy beach volleyball bikinis in the present day. "Why do female athletes have to be naked to compete in the same sports as men, who are wearing clothes?" Stewart asks.

And for women of color, in particular, there's a slew of harmful stereotypes that exist that are often used against them. Like, for example, the "strong Black woman" trope.

Biles has competed through broken toes and kidney stones. She also continued to compete as she coped with the mental trauma of being molested by trusted team doctor Larry Nassar. "And we're standing here questioning her toughness," Stewart says. "It's ridiculous."

"These expectations and stereotypes are even more intense for women of color," she adds. "They're more intense for female athletes than they are for male athletes, and then you amplify that even 10 times more [for women of color]."

How to Put the Person Before Performance

When asked about what needs to happen for sports culture to change, Biles said, "I definitely think we're on the right road for a different path. In the next generations, you can already see it. They have some different rules in place for basically everything now."

Against the backdrop of Biles and Osaka's publicized mental health struggles, many are pointing to a larger generational shift—Gen Z, people born after 1996, are carrying forward conversations on mental health and wellness.

In order for circumstances to change, however, it's going to have to involve sports, and American culture overall, becoming less performance-obsessed and more prevention-minded. "From my perspective, if you can head this off at the pass and the athlete never becomes depressed, that's the win," Stewart says.

Logistically, that might look like athletes having some sort of mental health activity per week, more time off, and again—media training, or at least the option to opt out of a press conference every once in a while. Osaka even proposed changing the traditional conference format.

This all could have implications for mental health for athletes everywhere too. In her work, Stewart develops and tests e-health technologies and community-based programs in order to disseminate mental health-related prevention and treatment efforts.

One program Stewart and colleagues developed is called S.C.O.R.E. (Sport Carried Onward for Resilience and Enrichment), which uses evidence-based methods to inform and train athletes on how to put mental health and resilience skills into action—both while in sport and when transitioning out.

"The idea would be that we would have this telehealth app," Stewart says. "We've deployed a similar tool in the army for nutrition, fitness, sleep, and mental resilience skills training, and we wanted to do that for athletes."

Stewart's is one program of many that could be implemented for athletes in schools, with the potential to hop onto the momentum of Biles and Osaka's public decisions.

And now, after the initial shock, Biles is being applauded for prioritizing her health. When asked what she's taken away from this entire experience, she said: "Put your mental health first. It doesn't matter if you're on the biggest stage. That's more important than any other medal you could win."

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kiliç, Ö, Aoki, H, Goedhart, E, Hägglund, M, Kerkhoffs, GMMJ, Kuijer, PPFM, Waldén, M, & Gouttebarge, V. (2017). Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: a longitudinal analysis of 12-month follow-up data. Knee Surgery, Sports Traumatology, Arthroscopy26(3), 946–954. doi:10.1007/s00167-017-4644-1

  2. Hammond, T, Gialloreto, C, Kubas, H, & (Hap) Davis, H. (2013). The Prevalence of Failure-Based Depression Among Elite Athletes. Clinical Journal of Sport Medicine23(4), 273–277. doi:10.1097/jsm.0b013e318287b870

By Sarah Simon
Sarah Simon is a bilingual multimedia journalist with a degree in psychology. She has previously written for publications including The Daily Beast and Rantt Media.