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Solving the mental health puzzle

Athletic trainers can play a key role in helping student-athletes manage mental health challenges

NOTE: This story is excerpted from the Sport Science Institute’s soon-to-be released book, “Mind Body and Sport – Understanding and Supporting Student-Athlete Mental Wellness,” a comprehensive look at the student-athlete experience from a mental health perspective – from their relationships with faculty, peers, administrators, coaches and fans. The book will be released on NCAA.org and Amazon.com in late September.

Rachel Sharpe

I know the story of a talented young football player who played at South Carolina right before I got here. After an outstanding college career, he was selected in the fifth round of the NFL draft. In just his second year as a pro, though, he was sidelined with two knee injuries in eight months.

While recovering from his second surgery, he returned to his alma mater for a game and stood waving from the field to all his college fans. The infectious smile on his face is a lasting but misleading image for many, as only a few days later he was found dead in his apartment from a self-inflicted gunshot wound. The ensuing investigation led authorities to believe that the athlete felt so overwhelmed by an enormous gambling debt and the need to provide for his 1-year-old son that he believed suicide was the only option.

For weeks, I watched this young man’s former teammates and friends mourn his loss, and I experienced for the first time the immediate reality and consequences of mental health issues in athletes. Even during the time it took for me to begin and complete this article, one of my former student-athletes attempted to take his own life, further emphasizing that student-athlete mental health needs to be addressed.

Mental health in intercollegiate athletics is a large and complicated puzzle. While athletic trainers are only one piece of that puzzle, we’re a pretty vital one. We are hired as athletics departments’ primary medical professionals, but along the way we find ourselves as confidants, motivators, encouragers and even friends to the hundreds of student-athletes we serve. ATs in fact interact with student-athletes about as often or sometimes even more than anyone else on campus, except perhaps their teammates.

That leads to a unique level of trust. Athletic training rooms are similar to locker rooms – they’re a place of comfort and camaraderie. Here, players let their guards down, and for a brief time they’re not worried about impressing their coaches, performing for their teachers or obligingly smiling for their fans. Such close interaction allows us to notice subtle changes in student-athletes’ behavior.

And as Aaron Taylor said in the first article of this chapter, it’s our responsibility to help establish the locker room as a safe place.

As a member of the team dedicated to student-athlete wellness, it also is our responsibility to keep our eyes and ears open for conversations or changes in behavior suggesting that a deeper mental or emotional issue may be present.

Helping student-athletes maintain their mental health is part of our job, but it’s a complex task filled with speed bumps along the way.

SPEED BUMP NO. 1: Connecting at-risk student-athletes with the right people who can help

It’s hard to design a template or referral approach that fits a diverse NCAA membership ranging from larger institutions with an army of support staff and resources to smaller schools with limits in both. Some schools – even some athletics departments – retain mental health professionals on campus, while others provide expertise through the campus health system or community. And while some schools’ athletic training structures allow referrals to come directly from the AT, others prefer the team physician as the tip of the funnel. These various scenarios – as well as the lack of a model structure and the fact that not all schools have access to the same resources – can make efficient and timely referrals difficult.

SPEED BUMP NO. 2: The atmosphere surrounding athletics

The very culture of athletics tends to discourage athletes from expressing any kind of mental health issue, since it is often construed as a weakness. Miami-based sports reporter Dan Le Batard noted, “Outside of the military, there may be no workplace less conducive to treating mental illness than sports. The culture works against someone who has the misfortune of being combustible in any way … Explanations are excuses, and feelings aren’t explored amid all the testosterone. Sensitive equals soft. Asking for help is viewed as weakness.”

A large part of the mental health battle is creating an environment that counteracts this stigma. But it’s no wonder that athletes have an incentive – often a financial one – to mask their issues. Take basketball player Royce White, for example. The Iowa State product slipped down the first round of the 2012 NBA draft because of a well-publicized anxiety disorder. Royce himself told Huffington Post Live host Marc Lamont Hill that NBA higher-ups wanted him gone, “because business is about convenience, not about doing what’s necessary. It’s about cutting overhead … And a lot of times, what’s best for us as human beings doesn’t meet the criteria for business people.”

With stories like this, can we blame our student-athletes for not disclosing their issues and concerns?

SPEED BUMP NO. 3: Once there is disclosure, who needs to know?

Who all needs to know if a student-athlete is experiencing a mental health issue, and to what extent? Coaches, parents, the AT, the team physician, and in some cases the psychologist, are all involved in the student-athlete’s life, but is it necessary for all of them to know? What about patient confidentiality – or the notion that knowledge of a mental issue could affect playing time?

ATs are the medical liaisons for our team, so should we know? And if so, how much information should we share with the coaches?

SPEED BUMP NO. 4: The hidden risks

It’s hard to convince people of a potential problem when they can’t see it. Mental health issues do not present with swelling, bruising, obvious pain or other evidence that accompanies physical injuries. You just have to trust the word of the student-athlete in this case.

Hopefully, the current conversation surrounding concussions will help. Although not overtly visible, recent research on concussions continues to show that they are definitely worth our attention.

So, how best to navigate all these speed bumps?

First, we need to start the conversation. Mental health has a tendency to be overlooked in the student-athlete’s total wellness package. Let’s do our part to change this. Begin with a discussion among your own medical staff. How are you currently meeting your student-athletes’ mental health needs? Is your referral structure adequate and efficient? What resources are available to you?

We can also initiate these conversations with our colleagues and within our professional organizations. Determine ways to make the topic more comfortable in conversation with, around and among our student-athletes.

What role can we play in changing the negative attitude associated with mental health issues?

Also, we need to look at our individual institutions and how we handle mental health concerns. Have you evaluated the resources available at your institution or within the local community? It is important to identify a licensed mental health professional, and then determine who else should be a part of your mental health team.

And finally, let’s continue to encourage more research in this area. It’s a great opportunity to facilitate studies concerning the effect of injury on a student-athlete’s mental health state. Mental health inventories could be included in a student-athlete’s pre-participation exam to obtain a baseline and address any initial issues when the student-athlete arrives on campus.

ATs have a responsibility to fulfill our role and affix our piece in the mental health puzzle. There is still much that needs to be decided and discovered, but someone has to initiate the conversation.

Why not us?

Rachel Sharpe is in her fourth year as a member of the athletic training staff at the University of South Carolina. She works primarily with the football team and provides secondary coverage to the cheerleading squad. Rachel served as a graduate assistant athletic trainer also at South Carolina from 2009-11 while working toward her master’s degree in physical education with a concentration in athletic training. The Jefferson City, Tenn., native received her bachelor’s degree in athletic training from Samford University in 2008. She is certified by the Board of Certification and holds membership in the National Athletic Trainers’ Association and several other state, district and national athletic training and sports medicine organizations