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Mind, Body and Sport: Best practices for athletics departments

An excerpt from the Sport Science Institute’s guide to understanding and supporting student-athlete mental wellness

By Chris Klenck

While the previous chapters in this publication have expertly documented the unique challenges student-athletes face regarding mental health, individuals charged with caring for student-athletes need help recognizing and managing these concerns.

The purpose of this article is to identify “best practices” for establishing mental health services at the collegiate level. While “best practices” are defined as “methods or techniques that have consistently shown results superior to those achieved with other means,” medical “best practices” often are considered to be no more than expert opinion.

In addition, individual athletics departments (and campuses overall) vary regarding the resources they have available to allocate toward mental health services. Thus, perhaps the best approach is to suggest key components believed to be consistent with “best practices” for establishing mental health services at the collegiate level, while allowing individual institutions to formulate their own consensus as to the best way to incorporate these components into the fulfillment of their unique needs.

The following eight components are suggested for constructing mental health services on college campuses:

Identifying members of the mental health services team. While institutions will vary greatly with respect to human resources available to them, all collegiate athletics programs should have both an athletic trainer and designated team physician who will serve as core members of the mental health team. These individuals may not be mental health experts, but they can serve as a “point person” for referring student-athletes to the appropriate professional for evaluation and treatment.

Other ideal core members should include a psychiatrist, a clinical psychologist or a licensed clinical social worker with experience in mental health counseling. As these professionals may not be readily available to all athletics departments, it is critically important that the institution collaborate with on-campus services such as university counseling services or student health services, or off-campus services such as community mental health facilities or hospital clinic, private psychiatric, psychological, or other psychotherapy practices, and disordered eating clinics.

Establishing these relationships before a specific need is particularly important when timely referrals are essential. Additional team members may include sport psychologists, licensed drug and alcohol counselors, a team chaplain, academic counselors, sport dietitians, athletics directors or sport administrators, and coaches. Finally, the confidentiality of the student-athlete should always be of utmost importance and taken into consideration when involving various members of the team.  

Raising awareness of the mental health services available. The goal is to ensure that every student-athlete or athletics department member is familiar with the services available and how to access them. Potential ways to accomplish this goal include: (1) presentations at team meetings; (2) presentations at coaches or staff meetings; (3) printed handouts or pamphlets with program information and contact numbers; (4) information posted on athletics department websites; and (5) use of social media (such as Facebook). Increased awareness will enhance the likelihood of self-referrals by student-athletes or referrals from teammates, coaches or other staff, and improving the timely evaluation of those student-athletes in need.

Screening, recognition and appropriate referral. Screening student-athletes for psychological concerns such as depression and anxiety is extremely important for early recognition and intervention. Pre-participation physical examinations (PPE) afford an excellent opportunity to screen for and discuss issues such as depression, anxiety and disordered eating. Many PPE questionnaires specifically address these issues and can be a useful tool for screening. Other validated screening tools include the PHQ-9 Patient Depression Questionnaire.

It’s also important to ask about current and past prescription medications, recreational drug and alcohol use, and family history of mental health issues, as these are important indicators of possible psychological and psychiatric concerns.  

In addition to screening, it is important that both student-athletes and those working with them are able to recognize signs and symptoms of potential mental health issues. Behaviors such as missing classes, uncharacteristically poor academic or athletics performance, frequent physical complaints, disheveled appearances, and fighting with teammates or coaches can suggest an underlying mental health issue.  

Educational sessions with student-athletes and staff about the recognition of mental health concerns and the importance of timely referral will help improve outcomes for those affected. Special emphasis should be made to discourage unqualified individuals from attempting to counsel or treat student-athletes in need of professional care.  

Communication among members of the mental health services team. Communication among appropriate team members enhances appropriate follow-up and helps track progress. As confidentiality is always a chief concern, it is important early on to identify those individuals with whom the student-athlete will allow to share information, and to obtain appropriate written releases as indicated.  

The mental health services team should meet weekly to discuss the care of student-athletes. These sessions help identify those student-athletes who are not attending appointments or making progress toward their goals.

HIPAA-compliant text messaging or emailing can also help facilitate communication among providers.

Medication management. It is important to help student-athletes manage medications that may be prescribed to them. Many medications, such as antidepressants, may have undesirable side-effects or provide inadequate efficacy, which leads to poor compliance. Consideration should be given to having one provider, such as the team physician, prescribe all medications when indicated. The team physician frequently interacts with the student-athletes and athletic trainers. As such, this strategy may improve communication of adverse effects and will allow monitoring of refill requests to ensure compliance and appropriate use.  

Crisis management. A student-athlete may present in “crisis” at any time. Issues such as active suicidal or homicidal ideation, acute psychotic episodes, or death of a family member, teammate or staff often require immediate professional attention. Having an established crisis management plan prevents lapses in care and improves outcomes. Every student-athlete who is at risk of a crisis should have a “safety plan” developed with a member(s) of the mental health team. He or she should be provided with contact numbers and a written plan of how to access services at any time if a crisis should arise. In addition, collaborating in advance with local resources such as crisis stabilization units, mobile crisis evaluations, or emergency rooms at hospital facilities will streamline care when needed.

Risk management. Mental health service members and athletics department staff should be aware of their responsibilities to report specific behaviors to appropriate institution officials or law enforcement officials when indicated. Examples of such behaviors may include expressing intent to harm another person or suspected sexual involvement with a minor. Educational sessions with university officials involved in risk management are strongly encouraged so each mental health services team member is aware of his or her legal responsibilities while providing care.

Transition of care. A final component for establishing mental health services is the transition of care for student-athletes who are leaving the athletics department. As student-athletes graduate, transfer, are dismissed from teams or are removed from continued participation due to their condition, a plan should be in place for the timely and orderly transition of their care to another provider. Helping the student-athlete identify a primary care physician, mental health care professional, or other provider in his or her community will ensure appropriate follow-up and continued care. Providing written information about mental health resources available to the student-athlete in his or her community may also facilitate his or her care. Finally, providing the student-athlete with a sufficient supply of prescription medications until he or she can establish care with another provider, and arranging for delivery of medical documentation to appropriate providers, will ensure a smooth transition of care.  

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While diagnosis and treatment of physical injuries and illnesses are critical to the success of student-athletes, so should management of their mental health needs.  

Mental health services should be a part of the comprehensive care provided to student-athletes at the collegiate level. In successfully integrated healthcare programs, mental health issues are treatable, and positive outcomes through timely access to care are likely.  

Even though available resources vary from one athletics department to another, all institutions should be able to establish certain basic components for establishing mental health services. Care that encompasses the entire well-being of the student-athlete is certain to translate into success both on and off the playing field.

Chris Klenck was named team physician at the University of Tennessee, Knoxville, in November 2006 after a primary care sports medicine fellowship at Indiana University Medical Center. During his fellowship training, Klenck was an assistant team physician for the Indianapolis Colts preseason training camps and at Purdue University (his alma mater), and he worked the NFL Scouting Combines in Indianapolis. He has NCAA championships experience and served as a team physician in the Indiana high school ranks. Chris earned his doctor of pharmacy degree from Purdue before completing his doctor of medicine degree at Indiana University School of Medicine. He is a member of the American Academy of Pediatrics, American College of Physicians, American Medical Society for Sports Medicine and America College of Sports Medicine.