Mental Health & Basketball

What free throw shooting and mental health reform have in common.

In a few hours, I have the distinct honor of giving a grand rounds presentation – a presentation where a faculty member (or guest) uses their research or real-life experience to share their insights and expertise – at Stanford School of Medicine for the Department of Psychiatry and Behavioral Sciences. This department provides me with an adjunct appointment, for which I am very grateful.

I tell you this as my remarks today are related to what we’ve spent the last several weeks discussing. We have been talking about what it takes to make policy change, to make change in the mental health field.

But as we know, change is hard. Even if we know all the steps, it’s still hard to convince others that change is needed. And sadly, too many of us don’t see how bad the needs are until it’s too late – until it’s a friend or a family member in a situation where they need mental health support and they fall through the cracks of our siloed system.

We know there is a better way, but for a variety of reasons, we don’t change and don’t see the field change.

That’s why today at Stanford, I will talk about how to build a social movement for mental health, featuring comments from my experience working side by side and learning from my friends at Civitas Public Affairs Group, and by way of the story of Wilt Chamberlain.


Well, first and foremost because I am a basketball fan. I have always loved the game. If you are ever on a Zoom with me, ask me about the Seattle Supersonics and I will probably show you this one very special hat, which means the world to me. (It’s got a great story to go with it, too! Tell me if you want to hear about it in the comments and I’ll share there). 

But more to the point, I’m talking about Wilt because mental health is kind of stuck in a similar rut.

If you know anything about Wilt Chamberlain you know he was horrible at free throws. And like other big men e.g. Shaq, he was not alone. While he holds impressive stats – 72 NBA records, 68 of those his alone – for me, it’s his free throws that stand out. He averaged right at 51% for his career free throw percentage.

By comparison, the NBA average is around 76.6%. And Rick Barry, another phenomenal basketball player, hit close to 90% of his free throws. He led the NBA in free throw percentages the last three seasons of his career, finishing out at 94.7% in 1978-79.


The difference between Rick and Wilt is how they shot the ball. You see, Rick shot underhanded, a technique that he believes is more accurate than the traditional free throw shooting approach. See how he explains it here:

The evidence supports Rick. In fact, when Wilt began shooting underhanded, he increased his free throw percentage by nearly 11% from the previous season up to a career high of 61.3%. He used the technique during his historic 100-point game, too. You can see a compilation of the many different ways Wilt shot free throws below:

But even though Rick’s underhanded “granny shot” technique seemed to work well for him, Wilt stopped. Why? Well, that’s where all this connects back to mental health, as the answer is a much longer story that speaks to the challenge of how hard it is to change and the power of history and culture.

In the same way that many people think talking about mental health is “weak,” shooting underhanded has been called “shameful.” Wilt said that when he did it, he felt “like a sissy.” And in the same way there is a solution to help basketball players hit free throws, when it comes to mental health, we know there is  a better way, but we also keep doing the same thing over and over, expecting different results.

So, how can we score better for mental health?

I’ll dive deeper into this in my next post – and shortly during my grand rounds presentation at Stanford – but here’s a sneak peek of priorities:

1) Like any player would have to do to change their free throw technique, we need to make progress on mental health improvement by first training a new generation of mental health advocates and professionals.

From our clinicians to friends and our family, we all need to not only demand something better for mental health, but be better for each other by educating ourselves on what to ask and what to do. We play the way we practice, and in health care, too many of us are not practicing enough together – talking about our thoughts and feelings and referring each other to less intensive community supports – before we enter into the more intensive health care arena. Team-based approaches to care are often far superior to just going it alone ­– and it appears NBA teams were taking that very approach just a few months ago.  

2) Once trained, we have to encourage health care professionals to set aside any longstanding history of siloed care and take a team-based approach to mental health reform by integrating it into all the places that people need it.

Mental health screenings and treatment should be available everywhere! But for health care settings, the area where they will likely have the greatest impact is in primary care. Bringing mental health and primary care together in a seamless and comprehensive way should be the standard of care. There is robust evidence on why this needs to occur, but the policies that would promote integration and produce those improvements – some of which were released just yesterday in a report by the Bipartisan Policy Center – have not changed as quickly to support it.  

3) With the means to support more people, we have to shift mindsets and change the culture so that mental health is seen less as a specialty just for when you are sick, to something that is for everyone, all the time.

In one survey by Benenson Strategy Group, more than one in three people said they likely would not talk to someone – not even friend, let alone a professional – if they were having difficult feelings. We make it so difficult to get care to the point that many of us don’t even want to seek it, and sadly, a lot of health insurers reinforce this by often requiring a diagnosis or a prior authorization before a person can get the help they need. But, when the public begins to create demand for something more, it usually happens.

There’s so much more to say on this topic, but for now, I look forward to reporting back after grand rounds, and also seeing who wins the 2021 NCAA tournament. Who are you rooting for?!