Beyond the Sidelines: The Evolving Role of Sports Psychiatry

Derek H. Suite, MD

In the high pressure, fast paced, professional sports environment, mental health often struggles to keep pace with its dependence on the doctor’s office hours, the need for structured sessions, and lengthy treatment plans. A football safety grappling with performance anxiety cannot always wait for next Tuesday's appointment. A basketball player working through a potentially season ending injury needs support where and when they feel ready to talk. The unique demands of the sports world challenge traditional notions of how psychiatric care is delivered—one that trades the couch for the court and the clipboard for courtside conversations.

For over 2 decades, Derek H. Suite, MD, has pioneered this evolution in mental health care delivery. As founder of Full Circle Confidential and lead sports psychiatrist consulting with 4 iconic franchises within the NBA, NFL, NHL, and MLS, his unique approach centers on the ability to successfully navigate the complexities and challenges unique to the sports environment.

"Traditional psychiatry often assumes a controlled environment where the patient comes to you," Suite explains. "But in sports psychiatry, that model is flipped. You're stepping into their world—a high stakes, high pressure ecosystem where every moment counts. Nearly everyone an athlete encounters wants something from them, so establishing trust and demonstrating that you are there without an agenda takes time and consistency—and there are no second chances."

Suite explains the delicate how and when of administering treatment when working within the rapidly moving sports environment. Working within a team's schedule means being creative with intervention strategies. Sometimes, a crucial therapeutic moment happens during warmups or in a quiet corner of the training facility.

"Traditional therapy focuses on the 50-minute hour," Suite notes. "We focus on the meaningful moment, wherever and whenever it occurs."

Within these moments of opportunity, Suite adds that building authentic trust and protecting it is critical to achieving lasting success in the sports ecosystem. The best medications science can develop will not work if they can not cross what Suite calls the “performer trust barrier"—a barrier that can be just as tough as the blood-brain barrier itself.

The Challenges of Sports Psychiatry

A major difference when consulting athletes is the change of pace. Suite shared: "It is mental health and mental performance on the move—it has to be portable, fluid, flexible, and feel personalized. And you are not just treating an individual; you are navigating a complex ecosystem of players, coaches, trainers, medical, and support staff, and all the organizational dynamics. It is also important not to forget important external influencers of the ecosystem—by that I mean family, agents, and friends who can be a hidden source of major influence with players.

Success in this world requires understanding and a readiness to address the unique pressures of every part of the ecosystem, not just the player. You have to be flexible and prepared to wear many hats and be able to flow from helping key staff manage game day demands and pressures to helping a player process intense public scrutiny and negative press.

Building trust in this ecosystem requires a nuanced approach. The doctor must be willing to be observed, respond honestly to random questions about their background, be willing to take on an assigned nickname—and allow the clients (players) to create and publicly share their own formulation about them. This vetting process happens partly because athletes are naturally cautious, as they are constantly surrounded by people who want or need something from them. My role, as I see it, was always to be the 1 person in their orbit without an agenda—which can feel a bit odd as a psychiatrist, because we are trained to ask lots of questions and provide guidance.”

For Suite, seeing the athletes thrive as people keeps him in the profession. "What keeps me here is witnessing athletes rediscover their humanity and see themselves as people—not just performers. Recently, I worked with a player who had developed severe anxiety after a high profile mistake, and because he lived in his athletic identity for so long it was extremely difficult for him to let go of the error and to forgive himself, which led to a notable decline in his performance.It took some time to help him reconnect to himself and his personal identity, but once it clicked for him, and once he saw ‘himself’ and how much bigger his life was than the situation, he returned to the game with renewed confidence, having processed not just the setback but its meaning in his narrative—that is what makes this work so fulfilling meaningful to me."

Navigating Complex Waters

The biggest challenge, according to Suite, lies in balancing confidentiality with team dynamics. "In the professional sports ecosystem, information is king! You must accept that you are working in an environment where everyone—from coaches to management to owners—wants updates. Maintaining players’ trust while respecting the professional relationships requires careful navigation, sophisticated communication skills, and clear boundaries. You cannot ever be afraid to say, ‘I am not at liberty to discuss this matter.’ At the same time, you can always offer to educate staff on the broader issues and inquire with the player on how much they would like you to share.

Using the Science of Sleep to Build Trust and Credibility

“An often overlooked aspect of—and opportunity in—sports psychiatry involves managing sleep and circadian rhythm issues,” says Suite. "Sleep is foundational to mental health and athletic performance and is a natural domain for the sports psychiatrist. We just do not seem to take full advantage of it.”

Suite explains that his work with teams goes beyond treating insomnia to creating comprehensive sleep hygiene, jetlag mitigation, and mental recovery strategies that account for cross country and international travel, night games, and varying practice schedules. “This work requires a unique blend of medical knowledge, performance psychology, sleep science, and environmental science,” Suite explains, "A sports psychiatrist’s understanding of how factors like blue light exposure, altitude changes, and time zone shifts affect both sleep architecture and athletic performance and ability to work with teams to develop personalized sleep protocols that might include everything from light therapy and/or melatonin timing to optimal nap schedules during long road trips is ciritical to peak oerformance."

The results can be quite dramatic. "I have seen teams significantly improve their away game performance just by implementing strategic sleep management plans," Suite notes, “and vice versa. I have seen teams lose games due to fatigue because they did not pay attention to circadian rhythm science and strategies for jet lag prevention.”

Advice for the Newcomers

For young psychiatrists interested in entering the field, Suite emphasizes the importance of adaptability. "Understanding performance psychology is crucial, but so is your ability to work effectively in nontraditional ways and settings. You will have to be willing to step out of your comfort zones and work in high emotion spaces like the locker room, training room, or sidelines. You will have to learn the art of blending in and yet maintaining your identity. You will have to get comfortable with feeling like an outsider at times and like a trusted confidant at other times—sometimes that can happen on the same day. Seek out mentors who can guide you through these unique challenges, as this work can be quite isolating. And try to find mentors willing to share their mistakes as much as their triumphs. Learning from mistakes is a huge part of the sports ecosystem.”

Forging Ahead: The Future of Sports Psychiatry

The evolution of sports psychiatry, as exemplified through Suite's pioneering work across multiple sports, highlights the unique value and contributions psychiatrists bring to professional sports. Beyond traditional mental health treatment, psychiatrists offer a sophisticated understanding of the intricate connections between sleep science, neuroscience, performance anxiety, clinical disorders, medication management, and the complex dynamics of team environments. This solid medical foundation, combined with the willingness and flexibility to deliver care outside conventional settings, positions psychiatrists to play an impactful role in sports mental health.

Suite's journey and approach offer several key takeaways for the next generation of sports psychiatrists. First, success in this field requires moving beyond the traditional doctor-patient dynamic to build trust within a complex ecosystem of players, coaches, agents, families, and support staff. Second, effective care demands a willingness to adapt—whether that means conducting sessions during warmups, doing group sessions in the cafeteria, sharing PowerPoints in the locker room, or developing comprehensive sleep protocols for international or cross time zone travel. Third, sports psychiatrists must master the delicate balance of maintaining clinical boundaries and confidentiality while becoming trusted members of the team environment.

As professional sports continue to recognize the need and embrace the importance of mental health care, the demand for psychiatrists who can navigate these unique challenges will only grow. The field offers an opportunity to blend medical expertise with performance psychology, creating innovative approaches that benefit not just individual athletes, but entire organizations—or ecosystems, as Suite often says. For psychiatrists daring enough to go beyond their traditional training and practice models, sports psychiatry represents a chance to literally be a “game changer” in shaping the future of sports by helping to optimize athletic performance and mental health delivery.

Suite's journey from traditional practice to pioneering sports psychiatrist demonstrates that success in this field requires more than just clinical expertise—it demands vision, adaptability, creativity, and a deep understanding of team dynamics. As he often reminds his mentees, "In sports psychiatry, we are not just treating athletes, we are treating an entire ecosystem.”

Dr Mirhom is the immediate past president of the New York County Psychiatric Society, an assistant professor of Psychiatry at Columbia University, codirector of the PPF Express Program, and the Chief Wellbeing Officer at Athletes for Hope.