Home Grown

Why the most important play in mental health, like soccer, is the one nobody remembers

Please tell me you have been watching the World Cup. I say this knowing that soccer (or football, depending on which country you live in and might be reading this) is not everyone’s jam, but man, the level of competition, skill, and cultural mashup has been so much fun to watch. And I’d I encourage you to watch the games on Telemundo because IYKYK.

I’ve seen brutal takedowns, last minute game winners, running speeds that used to only be seen on a track, and most of all, a sport that requires a team to work together. Truly, while we talk about most sports being team sports, soccer feels like every player on the field is critical for the team’s success. And at this level, the level of best in the world, all it takes is one mistake to find a team moving on and one going home.

Photo by Fauzan Saari on Unsplash

This post is not about critiquing teams, analyzing which red card was deserved (or not), or even an analysis of who should win. No, this post is about what it takes to get to this level of competition.

I ran across this clip (and below) of David Beckham talking about academies; the training pipelines pro clubs run to grow local talent before they’re ever good enough to sell tickets or play pro. It’s fascinating on so many levels.

First, when Beckham landed in LA, he asked the MLS commissioner a simple question: how many academies exist across the league? The answer was zero. Beckham’s response, more or less: “How is that possible? Where do the players come from?” He’d been raised inside an academy system himself. He knew what it produced, and he knew a league without one was borrowing talent instead of building it. So he pushed. Every MLS club now runs one.

But I also paid attention to what he didn’t do. He didn’t just sign better players or try and out-coach anyone; no, he built the infrastructure that makes good players possible ten years from now, for a league he wouldn’t be actively playing in by the time it paid off.

That’s the part we skip in mental health.

We talk about health as a team sport constantly. Multidisciplinary care, integrated systems, the whole vocabulary and jargon, but if you show up to most training and education programs, it’s still one player, alone, learning to dribble in a room with no one else on the field. No passing. No sense of who else is even suited up. We specialize early and isolate early, then act surprised when the system that produces those specialists can’t actually function as a team once they graduate into it.

It’s a disturbing yet predictable pattern.

Here’s the thing, this isn’t a hunch, we know working together on a team is better for all. It’s one of the more settled findings in health services research. For example, the CDC’s Community Preventive Services Task Force rates team-based care as a proven strategy with strong evidence, internal and external validity, and independently replicated across multiple randomized controlled trials.

Evidence says team-based care works yet the question is why we keep training people like it doesn’t.

Photo by Izuddin Helmi Adnan on Unsplash

So how do we actually start?

I think we have to fix the culture before we fix the org chart. Medicine’s been running on a two-century-old factory model, which splits the patient into parts, hand each part to a specialist, and hopes nobody has to talk to anyone else. A recent review of the field made a distinction worth sitting with: specialization itself isn’t the problem, it’s the sub-sub-specialization or hyperspecialization that is. The danger shows up when training rewards depth in isolation and never asks anyone to learn how their piece connects to the whole. Doctors and researchers spend a decade in separate tracks and come out speaking two different languages, unable to collaborate even when the same patient needs both of them at once.

That’s the “it’s only about me” problem, dressed up in a pretty white coat. And while this may seem grim, and yes I know it’s not all the same, it is a reality too many people face daily. Oh, it’s also not unique to physicians. This shows up anywhere training rewards individual mastery and doesn’t focus on the other skills like those you need to pass the ball.

Mental health is everyone’s responsibility. Not just clinicians’. Everyone’s. But we won’t learn that without an academy for it; a place where community health workers, coaches, doulas, peer specialists, and clinicians actually train together instead of scrimmaging in separate gyms that never play each other.

The framework I wrote about recently calls one piece of this just “equipping everyday people.” It’s giving the coaches, barbers, and neighbors who are already the first point of contact the basic skills to notice, respond, and connect someone to more help. That’s an academy type of pipeline for mental health. It shouldn’t be seen as a downgrade from clinical care, but more of a complement or upstream opportunity to do more in the moments that matter.

Beckham didn’t wait for the MLS to ask for an academy system, he told them to build one because he’d already seen what happens without it. It’s the talent that has nowhere to go, and a league stuck importing what it should be growing.

We have the evidence. We know team-based care works. What we're missing is the academy or the local infrastructure that trains people to actually play together, clinicians included, before they're thrown onto the field.