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Addressing student-athlete mental health issues: prevention, access to services, and treatment

This is an excerpt from Athletic Director's Desk Reference 2nd Edition With HKPropel Access by Donna A. Lopiano & Connee Zotos.

8.21 MANAGEMENT TIP

Addressing Student-­Athlete ­Mental Health Issues: Prevention, Access to Ser­vices, and Treatment

Addressing student-­athlete ­mental health in the final section of this chapter does not mean the issue is of lesser importance. In fact, the authors believe it is extremely impor­tant. However, attention to ­mental health has been overlooked by many coaches and athletic administrators. A review of NCAA rules manuals indicates that it ­wasn’t ­until 2019 that Divisions I, II, and III ­adopted rules requiring ­mental health ser­vices to be available to athletes.

Athletic departments have come to realize that student-­athletes’ ­mental health can no longer be ignored, and we believe this ­will be one of the biggest challenges athletic departments must face. More and more studies are being conducted related to student-­athlete ­mental health. For example, Cox et al. (2017) found that 33.2 ­percent of 950 Division I student-­athletes reported symptoms of depression, with female athletes reporting higher rates than male athletes. Putukian (2020) links physical health with ­mental health, stating that “for some student-­athletes, the psychological response to injury can trigger or unmask serious ­mental health issues such as depression, anxiety, disordered eating, and substance use or abuse” (p. 1). In 2020, the NCAA commissioned a study on how the pandemic was affecting student-­athletes. A survey was e-­mailed in the spring and a similar survey was sent again in the fall. Almost 25,000 athletes completed the survey. In both semesters, athletes indicated elevated rates of depression, ­mental exhaustion, anxiety, and hopelessness. ­Mental health concerns ­were highest among ­women, ­those living alone or away from campus, ­those on the queer spectrum, and ­those reporting ­family economic hardship.

Strategies to address student-­athlete ­mental health concerns should begin with an examination of behavioral practices within the sport culture that may exacerbate ­mental health issues. Additionally, institutions must clearly communicate how athletes can access the ­mental health ser­vices available to them and must have strict protocols in place for ­actual treatment.

  • Sport Culture. ­There is no doubt that the sport culture is fraught with perceptions and practices that can undermine the physical and ­mental health of student-­athletes. The expectation that athletes must be strong, resilient, and never show weakness encourages a culture in which athletes often hide injuries or feelings of emotional and ­mental distress. This is exacerbated by the fact that many coaches use abusive strategies and practices to “toughen up” athletes. Reardon et al. (2019) found that psychological abuse, physical abuse, and sexual abuse ­were the three most common forms of nonaccidental vio­lence committed by adults with power over athletes. Unfortunately, the only cases of abuse that ­people become aware of are ­those that make national media headlines, such as the avoidable death of University of Mary­land football player Jordan McNair, the ­women’s soccer players at the University of Houston that suffered from rhabdomyolysis ­after being subjected to grueling workouts, and the hundreds of gymnasts at Michigan State University and USA Gymnastics that ­were sexually abused by team physician Larry Nassar.
  • ­These cases are the tip of the iceberg. Many head coaches, assistant coaches, and strength coaches routinely use verbal and physical abuse and circumvent policies and rules regarding time spent in athletic activities that result in athlete depression, loss of confidence, overuse injuries, eating disorders, lack of sleep, and many other physical, emotional, and ­mental issues. ­These coaches live by the man­tra “more is better” and reject evidence or science that does not support their narrative. They put athletes in untenable situations where they cannot keep up with their studies yet they also pressure them to get grades that ­will maintain eligibility to participate. Coaches justify ­these practices as imparting the discipline and control that is needed to create a winning program. ­There is no sign that ­these abusive practices are abating. A primary reason for this abuse is that the United States, unlike many other developed countries, does not require any nationally accredited educational standards or certifications to become a coach. Some states require courses for high school coaches but the quality of ­those programs varies greatly. Typically, college coaches only need a college degree, even if that degree is unrelated to teaching, sports physiology, sports psy­chol­ogy, or other relevant fields of study. Therefore, without the appropriate education and a recognized professional organ­ization like the National Education Association or the American Medical Association that could provide professional development and monitor abuse, ­these practices are perpetuated.
    A second reason that this abuse prevails is ­because some athletic directors fail to: (1) establish standards of professional conduct, (2) monitor staff conduct, (3) act decisively when coaches or other support staff use abusive tactics, and (4) establish systems for reporting abuse and protecting whistle­blowers. Athletic directors may believe that coaches need complete autonomy and that the athletic director should not interfere in team administration. Some coaches wield enough power with alumni or boards of trustees that supervisory oversight is difficult. Other athletic directors may want to protect the brand of the department, team, or coach and refuse to take action that may induce a critical review of the program. Chapters 6, 7, and 11 provide information that ­will help the athletic director establish standards of professional conduct and implement policies and procedures that work ­toward eliminating student-­athlete abuse.
  • Communicating Access to ­Mental Health Ser­vices. Most student-­athletes have access to sports medicine facilities that are staffed with certified athletic trainers and, in some cases, team doctors. Coaches and athletes rely heavi­ly on ­these professionals to tend to athletes’ physical injuries and rehabilitation needs. In contrast, many athletic departments have never addressed the ­mental health or counseling needs of student-­athletes. Coaches or administrators have rarely promoted the ­mental health ser­vices that are provided to all students on campus and only encouraged student-­athletes to utilize ­these ser­vices when they ­were faced with serious ­mental health issues. The stigma attached to emotional or ­mental health concerns as signs of weakness made it a topic that was avoided or ignored.
    As noted, in 2019 all NCAA member institutions ­adopted legislation to make the provision of ­mental health ser­vices for athletes required. The 2020–21 NCAA Division I rules manual states:

An institution ­shall make ­mental health ser­vices and resources available to its student-­athletes. Such ser­vices and resources may be provided by the department of athletics and/or the institution’s health ser­vices or counseling ser­vices department. Provision of ser­vices and resources should be consistent with the Interassociation Consensus Report: ­Mental Health Best Practices. In addition, an institution must distribute ­mental health educational materials and resources to student-­athletes, including ­those transitioning out of their sport, coaches, athletics administrators, and other athletics personnel throughout the year. Such educational resources must include a guide to the ­mental health ser­vices and resources available at the institution and information regarding how to access them. (p. 254)

The Interassociation Consensus Report mentioned above was created by members of the NCAA Sport Science Institute and leading ­mental health organ­izations across the country to understand and support student-­athlete ­mental wellness. All athletic directors, coaches, and staff that work directly with athletes should read this comprehensive report and access the NCAA Sports Science Institute website, which includes numerous resources and educational materials related to ­mental health and other student-­athlete wellness and safety protocols. However, it is impor­tant to note that this NCAA resource falls very short in addressing the elephant in the room: the proclivity of coach abuse that can lead to student-­athletes’ physical, emotional, and ­mental health issues. The authors concur with a Drake Group position statement (2019) suggesting that the Sports Science Institute should develop and require ­every coach to take an online ­mental health training program and coaches should be expected to comply with an NCAA code of conduct that prohibits physical, psychological, and sexual abuse.

The consensus report does address the need for coaches to be supportive of student-­athletes when they become aware of emotional or ­mental concerns. Providing ­mental health resources to student-­athletes ­will not have much effect on be­hav­ior if coaches continue to demonstrate frustration with athletes who are struggling or if they fail to openly espouse trust in the ­mental health ser­vices provided. The impor­tant role coaches play in reducing the stigma associated with ­mental illness and appearing weak cannot be understated. This is particularly true for Black athletes. A study completed by Evans (2017) found evidence that Black student-­athletes resisted addressing ­mental health issues ­because ­mental health ser­vices have been stigmatized in the African American community; time is ­limited to access ser­vices due to athletic, academic, and social obligations; and Black athletes already are dealing with the combined stigmas perpetuated by some students and faculty that marginalize them ­because they are Black and a student-­athlete.

  • Protocols for Treatment. Treatment should only be provided by clinical licensed ­mental health care professionals. The authors feel strongly that ­these professionals should not report directly to anyone whose primary employment is in the athletic department. ­There is too much at stake to risk a conflict of interest that results in a coach digging for information or putting pressure on an athlete’s counselor ­because s/he is frustrated with the athlete’s per­for­mance. We have seen this dynamic far too often between coaches and athletic trainers, so we can safely assume it would happen with ­mental health professionals. Counselors must be ­free to resist any interference by athletic department staff. It is also impor­tant to create a situation where confidentiality is less likely to be breached and student-­athletes feel safe to share their experiences with someone outside the control of the athletic department. This does not mean that the licensed professional cannot be ­housed in a discreet location in the athletic department. In fact, Gill (2020) contends that some athletes ­will not go to campus-­based counseling centers out of fear of being recognized or for other reasons. The NCAA also recommends that student-­athletes should be provided with a list of licensed prac­ti­tion­ers so they can self-­refer to someone who is completely outside of the athletic department if they desire. We believe such a policy ­will increase the chances of student-­athletes asking for help.