LOS ANGELES -- Larry Sanders doesn't watch a lot of television, but, from time to time, when he comes across an NBA game, he says he can easily identify players who are dealing with mental health issues.
"I'm not sure it's obvious to everyone,'' Sanders said, "but I know the signs.''
Sanders was once a young, rising NBA star whose elite defensive skills earned him a four-year, $44 million contract with the Milwaukee Bucks in August 2013. He was long, active and athletic on the court, yet his physical gifts could not offset the anxiety and depression that eventually consumed him.
He chose to self-medicate with marijuana to alleviate his anxiety and isolation. That led to four violations of the NBA substance abuse program, two suspensions and the stunning decision to walk away from pro basketball in 2015 at age 26. Sanders checked himself into Rogers Memorial Hospital in Wisconsin and enrolled in a program to combat anxiety, depression and mood disorders. Before he did, he posted a video on the Players' Tribune detailing his struggles.
Recent public revelations by current players Channing Frye, DeMar DeRozan and Kevin Love about grappling with mental health issues has naturally captured Sanders' attention. So has news that the league and the union are formulating a more robust mental health program to address the needs of its players.
League and union sources confirm that once the new, more comprehensive mental health program is unveiled, it will function as its own entity, extricated from the league's drug policy.
Both league and union officials concur that having mental health lumped in with the substance abuse policy was a deterrent to players who needed and wanted help with mental health concerns.
Sanders says this is a huge step forward. His struggles, he says, were exacerbated by his drug suspensions, which under the collective bargaining agreement required him to receive drug treatment when what he really was seeking was assistance with his mental wellness. As a result, he says, his "treatment" felt punitive instead of therapeutic.
"It was very frustrating,'' Sanders said. "They were dealing with the byproduct [marijuana], not the issue. There was lots of chastising for the byproduct instead of digging in and investigating the cause.''
League and union officials have been working together for more than a year to destigmatize mental health issues. According to both camps, there will be an announcement in the coming months to name a director of health and wellness.
While significant progress has been made, some formidable obstacles remain, including the thorny subject of confidentiality. Some NBA owners, who have invested millions of dollars in their players, believe they should have the right to access the medical files of their athletes, including their mental health reports.
Michele Roberts, executive director of the National Basketball Players Association, says initial discussions on how to shape mental wellness going forward involved "very little pushback on the concept of confidentiality.''
"But the devil is always in the detail,'' Roberts told ESPN. "As we began to talk about what this would look like, and what we could actively communicate to the players, there were some conflicts.
"Every team has an interest in knowing about the well-being of their players both in terms of their physical and mental health. We understand that. But that does not mean the players' privacy can be waived or compromised. Now, if a player is unable to perform because of his issues, that opens up a different discussion.
"But, short of that, our position is none of our players' business is the team's business as long as they perform.''
The Los Angeles Lakers experienced the very public and poignant mental wellness battles of forward Ron Artest, who, after sparking the Lakers to a championship in 2010, eloquently expressed his gratitude to his psychologist. He has since changed his name to Metta World Peace and has become a fierce advocate for mental health awareness. That experience, says Lakers owner Jeanie Buss, has enabled her team to be proactive in tackling mental wellness.
"We've invested in all these state-of-the-art facilities and cryogenic chambers, hydro pools and all that, but we haven't focused on mental health,'' Buss said. "That's the next level of care.''
The Lakers have partnered with UCLA to provide myriad mental health options for their players and, Buss says, they have guaranteed them full confidentiality.
"[The players] have to feel their conversations will be private,'' Buss says. "They need to feel safe about going outside the team to find solutions. We, as owners, have to navigate this the right way."
Both the league and the union offer mental wellness services for all players, but there is no uniform mental health platform across team lines. Teams can spend lavishly on mental wellness or only provide bare-bones services. Some teams prefer to keep their mental services in house, which raises issues of conflict of interest. Others, such as the Boston Celtics, encourage their players to seek mental health services outside the team.
"I encourage every player, whether they show signs or not, to get some sort of help," Celtics president of basketball operations Danny Ainge says. "I also believe everyone should have someone to talk to that's not associated with the team to help them deal with what's ahead of them. Some do, some don't.''
"I've always looked at mental health issues as no different than, 'Does [a] player need glasses?' Most mental health issues are something players need to maintain. If they stick to a maintenance program, it's going to help them. If they don't, it won't."Danny Ainge, Celtics director of basketball operations
Sanders says the reluctance to acknowledge mental health issues stems from ingrained societal machismo views that dismiss any form of therapy as a sign of weakness. Often, when people struggle with anxiety or depression, those closest to them don't acknowledge it because they don't understand it.
"Part of the problem is, you can't see it,'' Sanders explained. "If you have a sprained ankle, there it is. It's swollen, black and blue. I can watch it heal; I know when I'm ready to go again. But when you have something wrong emotionally, you can't see it, can't pinpoint it, so it makes it harder to treat it.''
In an interview with ESPN during All-Star weekend in February, Love acknowledged one of the most difficult components of mental health is finding the courage to talk about it.
"I believe people want to share,'' Love said. "Sometimes you don't know how.
"One of the tough parts for me was trying to explain to somebody what I went through, and what I'm going through today. I always had it in the back of my mind that I really didn't know what others are going through. So many people have it so much worse.
"But that's no excuse for not getting help. For so long, I kept telling myself, 'I don't need help.' But I did. You worry what people will think. And that's really sad.''
It's also very common. Dr. Stephanie Pinder-Amaker, the director of the College Mental Health program at McLean Hospital in Belmont, Massachusetts, has worked with NBA players and said the first step in treating elite athletes is breaking down stereotypes about mental health, then trying to normalize their issue. Pinder-Amaker says that while some mental health issues require medication, the majority of them don't and can be helped with coping mechanisms such as meditation.
"People have no idea how many [NBA] players are dealing with mental health issues and thriving because they have the resources and are taking advantage of them,'' Pinder-Amaker said. "But a big part of that is confidentiality. The players must have it. Most of them prefer not to be identified.''
In the past, the league's position was that while players could solicit mental health opinions outside the framework of the team, the final decision on a course of treatment would be made by the team physician. That, too, is under review as the new policy unfolds.
The main focus remains helping players feel comfortable enough to share their struggles with their team, whether it's with a coach, the GM or another staff member, so he can benefit from services that make sense for his specific issue.
"I've always looked at mental health issues as no different than, 'Does [a] player need glasses?' '' Ainge said. "Most mental health issues are something players need to maintain. If they stick to a maintenance program, it's going to help them. If they don't, it won't.
"The biggest challenge for us is to get them to utilize the tools available to them in the first place.''
Sanders says if the league really wants the mental wellness program to succeed, it needs to hire the best experts in the field, just as they do for players who suffer a serious knee injury.
"Get the best people you can find who know how to deal with all the emotions we're experiencing,'' Sanders said. "And then let it be private.
"What the league is afraid of is a player saying, 'Oh, I'm depressed; I just want to smoke weed.' That's their biggest nightmare. There were a lot of medications people [in the NBA] wanted me to take that I refused to be on. My personal stance was to smoke marijuana. That's not a popular stance with the NBA.''
Roberts acknowledges that a number of NBA players deal with mental health issues by self-medicating with drugs and/or alcohol.
"We don't deny that for one second,'' Roberts said. "Larry is onto something. It's another issue we've got to address.''
Roberts says in spite of some of differences between the league and the union regarding mental health wellness, she does not anticipate that any of them will halt the progress of the program.
"We haven't hit any brick walls -- at least not yet,'' Roberts says. "I think we'll get through this because I don't see how we can't. We're all in agreement [about] how important this is.''
Last year, the NBA hired the Jed Foundation to help them assess their mental health policies. The league is in the process of incorporating mental wellness into its Junior NBA program as well as the NBA Fit campaign. Former NBA player Keyon Dooling, who publicly shared his own battles with depression, has been named the players' wellness counselor.
The NBA also hopes to rely on powerful testimonials from current players with mental health concerns to reach young fans who idolize these stars and who might be struggling with their own issues. DeRozan was in New York recently meeting with commissioner Adam Silver and pledged his support.
DeRozan's struggles are not the same as Love's. Mental wellness encompasses a broad spectrum of conditions including ADHD, anxiety, depression, mood disorders, OCD, bipolar disorder and schizophrenia. Some of those conditions raise red flags with teams that could affect a player's future value. As the league and the union move forward, they must find the balance between serving the needs of the player and the team's investment in the player.
Sanders says he is heartened by the support he has received through the years from NBA players, many of whom, he says, have confided they have issues of their own. While his NBA days appear to be behind him at the age of 29 -- a brief comeback attempt in 2017 ended when the Cleveland Cavaliers waived him after five games -- Sanders is still rooting for a mental wellness program that will benefits his friends and former teammates.
"What's considered normal is evolving, and that's a good thing,'' Sanders said. "It feels like we're finally going in the right direction.''