Toughness, Redefined

How 2 hockey players made mental health OK to talk about in college sports – and why your athletics department should, too

By Tony Rehagen

Justin McKenzie and Dan Divis, seniors at Saint Michael’s, channeled their concern for student-athlete mental health into a nonprofit called Hope Happens Here. They were honored April 7 at the Men’s Frozen Four with the National Hockey Humanitarian Award. Jamie Schwaberow / NCAA Photos

Divis and McKenzie share the Hope Happens Here message at a local high school. Submitted by Saint Michael’s College

There is no smell quite like that of college men’s ice hockey pads. Fresh sweat seeps through strata of bacteria, unlocking a musty stench that can never be completely soaked or scrubbed away — if, indeed, washing were ever even attempted. That distinct odor now permeates the Gordon H. Paquette Ice Arena, just off Appletree Bay in Burlington, Vermont, as members of the Saint Michael’s men’s hockey team glide around the rink.

It’s early October, two weeks before the Purple Knights’ first official practice of the 2016-17 season. This is a player-organized shoot-around, so there are no coaches or administrators, leaving hockey players free to be hockey players. The absence of supervision might account for the extra spitting and cursing on the bench and the gratuitous body checks and takedowns on the ice. There are no whistles, no stoppages or penalties — and certainly no complaints. The fallen are quick to jump back on their blades, shake off any sign of weakness and speed toward the puck in search of redemption.

One of the alphas leading this scrimmage from the point is co-captain Justin McKenzie. The senior with broad shoulders and long, dark hair that curls beneath his helmet is majoring in information systems, but he always has thought of himself, first and foremost, as a hockey player. He grew up on the ice in Hawthorne, New Jersey, where he played junior hockey and spent three years on varsity in high school, serving as captain and making all-state his senior year. McKenzie came to Saint Michael’s, in large part, so he could keep lacing up the skates. “You should’ve seen me when I first came in here,” he says after practice. “I bought into the hockey culture so much. I wanted to be the cool guy, and I’m coming to a small campus. That’s how I chose to identify myself. Everything revolved around me being on the hockey team.”

An identity wrapped up in ice hockey brings to mind a particular persona. The old-school roughneck forefathers of the sport spat teeth, played without helmets or masks, took pride in their gap-toothed grins and called the trainer only when a wound required stitches. As for mental or emotional scars, any weakness not visible to others might as well not have been there at all. No whining. No excuses. Buck up.

But just as Division II ice hockey pushed McKenzie physically, college life strained his mind. It was his first time living away from home. He alone could budget his time, spinning the student-athlete plates of work, study and sports. He was adapting socially, slowly reshaping himself to fit into a new and larger world — one more complex than that of a single-dimension hockey player.

Amid all that change, during the summer after McKenzie’s sophomore year at Saint Michael’s, a friend took his life by jumping into the Hudson River. The former high school classmate had run track at Pennsylvania before dropping out of college. For McKenzie, the suicide struck a little too close to the opposing goal. “You just start thinking about the last time you saw him,” he says. “It just rocked me how someone could ever feel that way.”

Days later, stuck in traffic on Interstate 95 South on the way home to New Jersey, McKenzie opened up to teammate Dan Divis, who had previously confided in McKenzie about his own struggles with anxiety and depression. Together, the two resolved to do something to help. They wanted to reach out to not only severely distraught athletes such as McKenzie’s friend, but also to anyone in the locker room who might be struggling emotionally, in need of professional help or just someone to talk to.

“I’m a hockey player — cool and tough. … That was the way you were supposed to be,” Divis says. “You don’t want to be that weak kid who says, ‘I’m sad. I’m depressed.’ Especially where I grew up, there was a tough-guy thing. Your feelings are just not something you really talk about.”

When the pair returned to school in the fall of 2015, they launched Hope Happens Here, a campaign to raise awareness and reduce the negative stigma surrounding mental health issues on campus, particularly among student-athletes. Divis and McKenzie’s goal is to start the conversation in classrooms and locker rooms about anxiety, depression and substance abuse, and direct those in need toward professional help. More than anything, Divis says, Hope Happens Here is about letting students who are afraid and suffering in silence know someone has their backs.

And these days, with athletics departments stepping up to help college athletes keep their minds healthy along with their bodies, Hope Happens Here isn’t alone either.

Source: American College Health Association-National College Health Assessment, fall 2011-spring 2015. See the survey.

Mental health issues are a two-faced demon: They are everywhere, yet can be difficult to see. And for many, they are not easy to confront — or even talk about.

The National Institute of Mental Health estimates at least 1 in 5 Americans ages 18-25 have a diagnosable mental illness — a statistic that does not include young adults with substance use disorders. Nearly three-quarters of those with an anxiety disorder will have their first episode before they are 22 years old. Eight percent of full-time college students are estimated to have had suicidal thoughts, according to the Centers for Disease Control and Prevention. Meanwhile, 18- to 25-year-olds are the least likely of any adult population to receive treatment for mental health issues.

Data show the anxiety begins to mount in high school. More than a third of entering college freshmen in 2015 — 45 percent of women, 21 percent of men — reported feeling frequently overwhelmed by all they needed to do as high school seniors. NCAA research data collected the same year show similar concerns among college athletes, with about 30 percent reporting being “intractably overwhelmed” in the previous month.

Healthy Approach

Experts give advice on connecting with student-athletes on mental health

Three years ago, the NCAA Sport Science Institute brought together experts from many corners of athletics and mental health: sports psychologists, youth gambling experts, sleep experts, athletics directors, team physicians. The group, called the NCAA Mental Health Task Force, created a four-point best practices guide to help athletics departments take the right steps to address student-athlete mental health.

1. Assemble the right team.

Evaluation and treatment of college athletes with possible mental health concerns should be coordinated through your school’s primary athletics health care providers, such as athletic trainers and team physicians. An athletic trainer is often the first point of contact in managing mental health concerns, while team physicians coordinate a student’s overall medical and psychological, or psychiatric, care. But evaluation and treatment of student-athletes with mental health disorders or mental illness should be conducted by a licensed practitioner qualified to provide mental health services, and certain disorders require specialized expertise.

2. Prepare the response.

Your athletics department should have written procedures for managing emergency mental health situations and referrals for more routine mental health issues. For both types of situations, the procedures should detail steps that should be taken to support a student-athlete facing a mental health challenge — and also should provide training so athletics personnel can spot signs and symptoms of mental health issues. Create these procedures with the aid of sports medicine personnel, licensed mental health practitioners, and campus or athletics officials who work on issues involving student-athlete well-being.

3. Build mental health screening into your system.

To ensure all student-athletes are being reviewed for mental health issues, incorporate the screening into the preparticipation exam that already takes place in your athletics department. Before that screening starts, ensure you have a procedure in place for specifying when and where you will send at-risk college athletes for help. A number of screening questionnaires are available, and the decision about which one to use should be made by the athletics health care team and licensed practitioners qualified to provide mental health care services to student-athletes.

4. Create a culture in athletics that supports mental well-being and resilience.

The environment of your athletics department can help the psychological well-being of college athletes by normalizing the pursuit of mental health care. The department also can create experiences and interactions that promote personal growth, self-acceptance, autonomy and positive relationships with teammates, coaches, athletics administrators and others in the campus community. Education about mental health issues, involvement from the campus Student-Athlete Advisory Committee, and buy-in from coaches, who often have the biggest influence on their teams, are ways to make athletics a safe environment for pursuing sound mental health.

But college athletics departments — sometimes thought of as havens for attitudes such as those once displayed by old-school ice hockey roughnecks — are increasingly offering students a safe environment for confronting mental health issues or learning how to help afflicted teammates. This trend toward getting help seems to have its roots in an unexpected source: the student-athletes themselves.

“The athletes have taken ownership,” says David Wyrick, faculty athletics representative at The University of North Carolina at Greensboro and director of the school’s Institute to Promote Athlete Health & Wellness. “I think that just goes to show the importance of it.”

It can be seen at the national level. The NCAA published mental health best practices for colleges and universities two years ago and recently introduced online training tools that assist student-athletes, coaches and faculty members with managing their mental health and helping others. Yet college athletes are still behind the momentum.

When Dr. Brian Hainline arrived at the NCAA in 2013 as its first chief medical officer, he began tackling an ambitious agenda of health and safety issues. Top among those, he assumed, should be the need for better research surrounding concussion prevention and recovery. But in his first weeks on the job, Hainline met with leaders of the national Student-Athlete Advisory Committees from all three divisions — and heard they had a different health issue in mind. “A little bit to my surprise, all three divisions really wanted us to make mental health a priority in our timeline,” Hainline says. “They saw that I was really putting a lot of emphasis on concussion, and they said, ‘Look, concussion is important, but mental health is even more important.’”

In response, the NCAA Sport Science Institute convened nearly two dozen scientists, clinicians, policy experts, team physicians, athletics administrators, coaches and college athletes to consider the mental health issues that confront student-athletes. It didn’t take long for their discussions to turn up several possible reasons why college athletes might be prone to mental health issues. At that stage of life, they are not only adapting to college, as all students do, but a new coach —  and data show a coach has more influence than any other factor on whether a student-athlete’s college experience is positive or negative. And coaches aren’t always approachable or understanding about issues of emotional well-being.

Other factors contribute, too, the experts agreed. The burden of a packed schedule — loaded with academic and athletic activities — and even injury can lead to depression, anxiety, substance abuse or losing personal identity as an athlete.

“Everywhere I go, when I talk to student-athletes, I ask: ‘How many of you have had a friend who’s been suicidal?’” Hainline says. “More than half of their hands go up, and they felt they weren’t well-equipped to help.”

One day, conversations about mental health in college sports might be as routine as a preseason physical. But athletics departments already can work to create an environment that makes students feel comfortable seeking help; foster a culture in which emotional issues are a regular part of the conversation about how to be healthy; and educate college athletes, coaches and athletics staff about how to be a resource for friends and colleagues who might be struggling.

In some corners of the country, that’s already happening. At Division I Temple, a women’s lacrosse team captain and psychology major who grew up with an eating disorder worked with her coach to make the team a place where mental health was discussed and teammates could feel comfortable reaching out for help. At a men’s cross country team meeting at Division III Muhlenberg, a runner shared his struggle with depression and the importance of intervening when a friend needs help.

And at Division II Saint Michael’s, Hope Happens Here is now as much a part of campus as the deep purple of the Knights’ gear.

McKenzie and Divis both will graduate this spring. McKenzie plans to work in technology; Divis is headed to law school. Submitted by Saint Michael’s College

It’s 10 a.m. on an October Saturday at Duffy Field, a quiet patch of evergreen turf in the middle of the sleepy Saint Michael’s campus, 20 minutes from Burlington. The artificial surface hosts lacrosse and field hockey, but today it features the white outline of a soccer field as the women’s team hosts Daemen College from upstate New York. Both squads are warming up on the pitch, yet there is no sign of the Purple Knights’ titular violet and gold. Instead, the home team is clad in black T-shirts reading “SAINT MICHAEL’S SOCCER” in neon green, the color symbolizing mental health awareness. Printed on the back of the shirts is a plumed medieval helmet in profile with a brain superimposed over the cranium — Divis and McKen­zie’s homespun logo for Hope Happens Here.

The Saint Michael’s women’s soccer team participated in Mental Health Awareness Games. Submitted by Saint Michael’s College

A few minutes later, McKenzie and Divis arrive, both wearing the same black-and-green shirt and each cradling a large box. They set down the boxes and fetch a long folding table from a nearby shed. Setting up near the entrance, they pick up some rocks to weigh down flyers providing statistics (“50 percent of college students experienced overwhelming anxiety last year”) and supportive messages (“I believe you”) and a centerpiece poster of a wellness wheel. The pie chart is composed of equal wedges of spiritual, social, financial, intellectual, environmental and physical well-being, along with corresponding contact info for the athletics department, the Bergeron Wellness Center on campus, and various resources within the NCAA. From the boxes, the students pull out the merchandise for sale. They arrange more soccer shirts, green silicon awareness bracelets and Hope Happens Here purple T-shirts that read “YOU ARE LOVED.”

One middle-aged man who shows up for the soccer game already is modeling a purple shirt and stops by the booth to say hello. David Landers, a psychology professor and the faculty athletics representative at Saint Michael’s, was one of the first people McKenzie and Divis approached about their traffic-jam brainchild last year. “The anxiety level of students coming into college is higher than ever because society’s anxiety is higher than ever,” Landers says. “Our students know there’s a problem, and they are taking the lead. As faculty, we need to support them.”

With Landers’ help, McKenzie and Divis built on their original idea — suggesting a mental health awareness volleyball game and the placement of informational and fundraising booths at various sporting events throughout the year. Within a few weeks, 32 Saint Michael’s athletes from 12 different sports had bought in to spreading the message in their locker rooms. McKenzie and Divis also went across town to make a presentation to the Student-Athlete Advisory Committee at the University of Vermont. It was Landers who first suggested the hockey players use their status as athletes to broaden their outreach to include everyone on the intimate 2,000-student Saint Michael’s campus. “It’s still athletically based,” Divis says. “But we go to games hoping to spread the love to students and athletes alike — to anyone and everyone.”

Last year, McKenzie and Divis drove to Enosburg Falls High School, about an hour outside Burlington, where they gave a 45-minute talk to the student body about the topic. McKenzie, the more outspoken of the two, told the assembly about an uncle who had taken his life during the recession in 2009, and how no one in his family really wanted to talk about it. Then he talked about his high school friend, whose belongings were found by authorities on the George Washington Bridge over the Hudson. Divis then opened up about his own struggles when he was in high school — the coming-of-age anxiety of trying to find yourself and your place in the world, the depression and feeling of hopelessness that sometimes overwhelmed him until he finally sought help, first from a friend and teammate, then from a professional.

“These two guys were critical to the launch of this movement,” Saint Michael’s Athletics Director Chris Kenny says. “They’re very good friends, but they’re different people. … To see them present, it’s great to see the two halves making a whole.”

In the first year of its existence, Hope Happens Here raised more than $830 for mental health charities and nonprofits. But perhaps the more visible indication of the organization’s impact is the wholesale participation of the soccer team on the field, the dozens of “YOU ARE LOVED” shirts already being worn by fans as they pass the table en route to the bleachers, and most importantly, the increasing number of students who come up to either McKenzie or Divis on campus to share their own stories. “Sometimes it’s tough. You want to do the best you can to help them, but how much are you willing to put on yourself?” McKenzie says. “But then I remember why I’m doing this. Most of the time, they just need someone to talk to. It’s about putting yourself out there and showing you care.”

The two believe the seeds they have planted with Hope Happens Here will continue to grow after they leave campus. Already, a half-dozen other student-athletes have offered to continue the work. Submitted by Saint Michael’s College

Back at the soccer game, the Purple Knights have prevailed 2-1. As the last of the fans and players exit past the Hope Happens Here booth, McKenzie starts to pack what’s left back into the cardboard boxes as Divis grabs the plastic cash cup and thumbs through the wad of bills. He stops counting at $361. Already, at their first event of the academic year, the men have collected nearly half of what they collected the previous year.

Yet questions about why the campus is so ready for the message of Hope Happens Here weigh heavy on the minds of McKenzie and Divis. Yes, they’ve worked hard to get the word out. But just three weeks earlier, the body of a Saint Michael’s student — a big personality on  the small campus — was found on a nature trail near the school. The death was ruled a suicide. The shock hit the campus hard, bolstering support for Hope Happens Here and emboldening the two students who started it.

Looking back on the brief life of a lost friend is also cause to reflect inward. While McKenzie and Divis are passionate about helping others, they also have to take care of themselves. Hockey season will start soon, with more games and workouts to balance with part-time jobs and full-time course loads. This year, they also have the added pressure of being seniors and preparing for the next transition — life after graduation — which is stressful for anyone.

Both men think they’ll take their Hope Happens Here experience forward with them on that move. Along with his information systems major, McKenzie has picked up a minor in psychology. He says he wants to live in New York and work in technology but has considered building a smartphone and tablet app as a resource for people seeking mental health help or possibly volunteering to answer the calls at a hotline. Divis is applying to law school and says he wants to pursue a law career focused on improving the lives of others. “The fulfillment of knowing you’ve helped others is just wild,” he says. “It’s something I won’t forget or let go of.”
As for what will become of Hope Happens Here when its founders have moved on, the two say they aren’t worried. After the soccer game, several underclassmen from the hockey team helped McKenzie and Divis tear down the table. They’re all wearing “YOU ARE LOVED” shirts. McKenzie says that, to his surprise, the incoming freshmen have eagerly bought into the program and the idea of tearing down stigmas surrounding mental health. Some days, he is still stunned at what he sees when he steps into the locker room: college hockey players suited up in purple shirts with hearts on them. 

Help in Hand

Looking for guidance or just a good example to follow? These programs can help.

Compiled by Tony Rehagen and Jessica Hunt

Assess the Problem

Perceived Stress Scale, Cal State Monterey Bay

As part of its preseason screenings, Cal State Monterey Bay has added a Perceived Stress Scale survey to assess student-athletes’ mental well-being.

WHAT IT IS The survey consists of questions such as “Do you experience stress that keeps you up all night?” Those who score a certain threshold or answer “yes” to a question about whether they would like help are referred to the sports team psychologist.

HOW IT WORKS The survey consists of questions such as “Do you experience stress that keeps you up all night?” Those who score a certain threshold or answer “yes” to a question about whether they would like help are referred to the sports team psychologist.

THE RESULTS Before the academic year began, 18 student-athletes reported they needed assistance, Paddack says. Two weeks in, 18 percent — about 40 college athletes — had come forward. “We’re changing the culture from ‘You’re an athlete, take care of yourself and suck it up’ to one where they felt comfortable making that initial contact,” Paddack says.

 

Partner Up

Mental health liaison, Wesleyan (Connecticut)

Two years ago, Wesleyan Student Athlete-Advisory Committee members came to their advisor, football defensive coordinator Jeff McDonald, and asked how the school could better help college athletes address mental health issues. From that initial conversation, a partnership between athletics and campus mental health services was born.

WHAT IT IS McDonald learned student-athletes were seeking out Counseling and Psychological Services at a rate disproportionately low compared with the overall student population. The athletics department and CAPS identified a liaison to athletics in hopes of eliminating some of the barriers that inhibit college athletes from seeking treatment.

HOW IT WORKS Joy Zelikovsky has become the face of CAPS for student-athletes by providing programming for teams while holding sessions built around individual student-athletes’ schedules and needs.

THE RESULTS Zelikovsky provided a “psychological first-aid” training to coaches. Now players and coaches are asking for tailored outreach for different teams. Student-athletes also are reaching out for appointments more frequently than before. “This program has shown the students that it’s OK to ask for help, that their coaches and the department encourage it,” Zelikovsky says. “That’s a hugely important message for students.”

 

Get an Education

Training modules, NCAA Sport Science Institute

The NCAA Sport Science Institute has developed a web-based educational program in an effort to normalize the subject of mental health and reduce the stigma associated with seeking help.

WHAT IT IS The three educational modules — one aimed at student-athletes, one for coaches and one for faculty athletics representatives — answer a request from the Divisions I, II and III national Student-Athlete Advisory Committees, which in 2013 identified mental health as college athletes’ top health concern.

HOW IT WORKS The modules are designed as a companion to the Mental Health Best Practices guide, published by the Sport Science Institute. “These new resources are a historic step in advancing a culture for which mental health is not apart from, but rather a part of, athlete health,” says Dr. Brian Hainline, NCAA chief medical officer.

THE RESULTS A website for the  modules was released in November and has attracted more than 5,000 online visitors so far. Staff members at the Sport Science Institute continue to share information about the site in presentations to coaches, college athletes, university presidents and athletics administrators.

 

Tap Into Resources

Athletes Connected, University of Michigan

Funded in part by an NCAA Innovations in Research and Practice Grant, Athletes Connected fights the stigma surrounding mental health issues and offers resources for help.

WHAT IT IS In 2014, Michigan athletics officials reviewed a dispiriting study that showed only 10 percent of student-athletes suffering from mental health issues sought help. “That was a staggering statistic to us,” Athletes Connected program coordinator Emily Brunemann says. “We wanted to implement something that was more than just an educational program.”

HOW IT WORKS The program includes videos featuring athletes who had gone public about their mental health issues; presentations for players and coaches; drop-in support groups; and a website with local resources and tips for identifying troubling symptoms.

THE RESULTS In recent surveys, 99 percent of college athletes say they found the program’s videos relevant and important, and 63 percent said mental health had in some way affected their performance during the previous four weeks. “We’ve seen a significant shift around creating a conversation,” Brunemann says.

 

Run a Screen

Tulane Athletics Care Team

This all-star squad of experts from an array of disciplines has joined forces to identify mental health concerns among Green Wave student-athletes.

What it is TACT started in 2012, growing from a pre-existing screening for Tulane athletes who had learning disabilities and attention deficit disorder. “There are so many other problems that pop up and interfere with an athlete’s success, like stress and the demands of being an athlete,” says Gina Manguno-Mire, a clinical psychologist and chair of TACT.

HOW IT WORKS Now, in addition to screening all incoming freshmen and transfers for mental health issues, TACT also seeks out “students of concern” — athletes who experience an injury, have a behavioral incident, are on academic alert or are reported by a peer as having issues. The board then evaluates each athlete and forms a cohesive action plan. “The problem is you usually have these silos of information — the locker room knows one thing and the teachers know something else,” Manguno-Mire says. “So treatment was fragmented. We now have a one-stop shop.”

THE RESULTS Each year, about a third of all athletes screened are referred to TACT and eventually diagnosed with a learning disorder, ADD or a psychological disorder, such as depression, anxiety or adjustment disorder. Those students receive TACT support throughout their time at Tulane.

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