Mental Health Best Practices
Mental health is a vital part of overall health. As such, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports developed the Mental Health Best Practices: Understanding and Supporting Student-Athlete Mental Health. The Mental Health Best Practices provide evidence- and consensus-based recommendations to member schools for supporting and promoting student-athlete mental health.
The NCAA Constitution requires all athletics programs to be conducted in a manner designed to protect, support and enhance the mental and physical health of student-athletes. Additionally, NCAA legislation requires all schools to make mental health services and resources available to student-athletes consistent with the Mental Health Best Practices.
Create Healthy Environments That Support Mental Health and Promote Well-Being
Schools should have a written plan related to mental health promotion efforts that is responsive to risk and protective factors at multiple levels, including individhttps://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-useual, team, athletics department, campus and societal factors. This plan should be developed in collaboration with a licensed mental health care provider. Diversity, equity and inclusion are important influences on mental health and well-being that should be addressed in this plan.
Resources for Member School Consideration
- American Psychological Association Health Advisory on Social Media Use in Adolescents
- In this document, psychological scientists examine the potential beneficial and harmful effects of social media use in adolescents.
- Can the Metaverse Be Good for Youth Mental Health?
- This resource was developed by the JED Foundation to discuss youth-centered strategies for ensuring and enhancing the mental health and safety of young people in the metaverse.
- Mental Health First Aid
- The National Council for Mental Wellbeing offers Mental Health First Aid training as an option to teach ways to assist and support others who may be experiencing a mental health or substance use challenge.
- Digital Safety Kit for Public Health
- Created by the Harvard T.H. Chan School of Public Health, this tool kit is designed to help prevent and reduce the harm of online harassment in public health, including strategies for recognizing and responding to online harassment, as well as protection strategies.
- IOC Certificate in Mental Health in Elite Sport
- This certificate program is a 3–6-month program for all members of the athlete entourage other than physicians or licensed practitioners who are qualified to provide mental health services. The program was developed by the International Olympic Committee and focuses on salient aspects of mental health in elite sport.
- Moonshot
- Moonshot offers online threat monitoring and online violence prevention services, including identification of social media harassment.
- Signify
- Signify offers services to protect individuals from online abuse, including the detection and identification of social media harassment.
- Sleep and Wellness for Collegiate Athletes
- This document provides recommendations that were a product of the NCAA’s Interassociation Task Force on Sleep and Wellness.
- United Against Online Abuse – Safeguarding Guide
- This resource was developed by United Against Online Abuse and provides strategies for responding to and reporting online harassment.
- U.S. Surgeon General’s Advisory on Social Media and Youth Mental Health
- This advisory was developed by the U.S. Department of Health and Human Services and the Office of the U.S. Surgeon General to describe the impacts of social media on children and adolescents, as well as outlines steps to mitigate risk of harm.
Procedures for Identification of Student-Athletes with Mental Health Symptoms and Disorders, Including Mental Health Screening Tools
Identification of student-athletes with mental health symptoms and disorders may occur in multiple settings; however, screening for mental health symptoms and disorders is one important way to identify student-athletes who may benefit from further support. Using a validated screening tool, all student-athletes should be screened for psychological distress at least once annually. Screening tools should be used in consultation with the primary athletics health care provider and/or licensed mental health provider.
Resources for Member School Consideration
- Sport Mental Health Assessment Tool – 1
- This tool was developed by the International Olympic Committee Mental Health Working Group. It is a standardized assessment tool aimed at identifying elite athletes at risk of or already experiencing mental health symptoms and disorders.
- Sport Mental Health Recognition Tool – 1
- This tool was developed by the International Olympic Committee Mental Health Working Group. It is a tool that can be used by athletes, family members, coaches and non-clinical staff to recognize, but not diagnose, mental health concerns.
- IOC Relative Energy Deficiency in Sport (REDS) Clinical Assessment Tool Version 2 (CAT2)
- The IOC REDs CAT2 is a clinical assessment tool for the evaluation of athletes suspected of having problematic low energy availability (LEA) leading to REDs. It is based on the 2023 International Olympic Committee REDs Consensus Statement.
- NCPG Screening Standards Manual
- The National Council for Problem Gambling developed the NCPG Screening Standard Manual, which provides a non-exhaustive review of problem gambling screening tools and resources.
Mental Health Action Plans that Outline Referral Pathways of Student-Athletes to Qualified Providers
All member schools should have written and rehearsed mental health action plans with well-defined pathways to mental health care, addressing both routine and emergency mental health care needs. While mental health action plans will look different across schools as a result of differences in organizational structures and in campus and community resources for mental health care, all mental health action plans should address the full spectrum of care from identification of student-athletes with mental health symptoms and disorders to ongoing treatment, follow-up and reentry when indicated.
Resources for Member School Consideration
- Navigating a Mental Health Crisis
- This resource was developed by the National Alliance on Mental Illness to outline warning signs of and strategies for managing and deescalating a mental health crisis.
- 988 Suicide & Crisis Lifeline
- The 988 Lifeline provides free and confidential support for people in distress 24/7, as well as prevention and crisis resources.
- Suicide Hotline for LGBTQ Youth
- This hotline, provided by The Trevor Project, is available 24/7 to connect youth to counselors that understand LGBTQ young people.
- Teen and Young Adult HelpLine
- This HelpLine is provided by the National Alliance on Mental Illness and offers a nationwide teen peer-support service for teens and young adults with mental health conditions and/or experiencing a difficult time in their life.
- IOC Mental Health Guidelines for Major Sporting Events
- These guidelines were developed by the International Olympic Committee to provide uniform guidelines and standards of service for the planning and delivery of athlete and entourage mental health measures at major sporting events.
- NCPG Helpline for Problem Gambling
- The National Council on Problem Gambling provides a helpline for individuals who may be experiencing problematic gambling behavior. The helpline is available through call, text or chat.
Licensure of Providers Who Oversee and Manage Student-Athlete Mental Health Care
Formal evaluation and treatment of student-athletes with mental health symptoms and disorders should be performed by a licensed mental health provider acting within the scope of activities covered by their clinical licensure. The licensed provider who is qualified to provide mental health services may be employed by the athletics department, sports medicine department or by an administrative unit outside of athletics such as student health services or campus counseling. The provider may also be a local, off-campus provider or telehealth provider.
The NCAA Mental Health Advisory Group consensus-based recommendations note that mental health care for athletes, which includes formal evaluation and treatment, should be performed by a licensed mental health care provider within the scope of activities covered by their clinical licensure. This may include:
- Clinical or counseling psychologists.
- Licensed clinical social workers.
- Licensed mental health counselors.
- Licensed family therapists/licensed marriage and family therapists.
- Physicians with mental health training, including psychiatrists and primary care physicians.
- Nurse practitioners with mental health training, including psychiatric and primary care nurse practitioners.
- Physician assistants/physician associates with mental health training, including PAs with a Psychiatry Certificate of Added Qualification (CAQ) or primary care PAs.
Resources for Member School Consideration
The NCAA Mental Health Advisory Group consensus-based recommendations note that mental health care for athletes, which includes formal evaluation and treatment, should be performed by a licensed mental health care provider within the scope of activities covered by their clinical licensure. This may include:
- Clinical or counseling psychologists.
- Licensed clinical social workers.
- Licensed mental health counselors.
- Licensed family therapists/licensed marriage and family therapists.
- Physicians with mental health training, including psychiatrists and primary care physicians.
- Nurse practitioners with mental health training, including psychiatric and primary care nurse practitioners.
- Physician assistants/physician associates with mental health training, including PAs with a Psychiatry Certificate of Added Qualification (CAQ) or primary care PAs.
- IOC Diploma in Mental Health in Elite Sport
- This diploma is a one-year program aimed at sports medicine physicians and other physicians who work with athletes and licensed practitioners who are qualified to provide mental health services. The diploma was developed by the International Olympic Committee to provide professional development for clinicians who work with elite athletes.
- Critical Considerations before Contracting with a Teletherapy Vendor
- This brief was developed by the American Council on Education to provide a roadmap for campus leaders who are considering teletherapy providers. It outlines key factors campuses should consider and raises questions that schools may bring to potential vendors.
- NCPG Gambling Assessment Manual
- The National Council for Problem Gambling developed the NCPG Gambling Assessment Manual, which discusses assessment that may occur after screening for potential problematic gambling.
Resources for Consideration in Support of Mental Health Best Practices Foundational Principles
Frequently Asked Questions
The Mental Health Best Practices provide Association-wide guidance and recommendations for schools to support student-athlete mental health. The Mental Health Best Practices are not intended as a substitute for the independent clinical and/or medical judgment and care provided by health care professionals to individual student-athletes.
The Mental Health Best Practices were developed by the Committee for Competitive Safeguards and Medical Aspects of Sports, as informed by expert- and consensus-based recommendations from its Mental Health Advisory Group. The Mental Health Advisory Group consists of over 30 representatives from scientific, medical, sports medicine organizations and all divisions of the NCAA membership.
The Mental Health Best Practices is an inter-association consensus document that was first published in 2016 (updated in 2017 and 2020) following the convening of the NCAA Mental Health Task Force. After the 2020 Diverse Student-Athlete Mental Health and Well-Being Summit, the Committee for Competitive Safeguards and Medical Aspects of Sports determined the need to further update the Mental Health Best Practices. To accomplish this, the Committee for Competitive Safeguards and Medical Aspects of Sports created the Mental Health Advisory Group in 2021.
The four best practices remain substantively the same. However, the document has been restructured to emphasize that establishing an environment that promotes mental health is a foundational step to supporting student-athlete mental health and well-being. The restructuring also reflects the way the care system often applies on campus. The document now contains:
- Resources. Resources with supplemental information and implementation strategies for the Mental Health Best Practices are available on a webpage, so the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports can regularly consider new resources and update as appropriate.
- Foundational Principles: Foundational principles provide further education on risk and protective factors related to student-athlete mental health and a lens through which each best practice can be operationalized by member schools. The foundational principles consider the role of coaches and other stakeholders, the impact of maltreatment/discrimination/trauma, social media, the importance of collaboration and the importance of continuous improvement processes.
- Best Practices (core components and additional elements): As with the first edition, the updated document contains four best practices. Each best practice contains “core components” that should be incorporated into each school’s approach to supporting student-athlete mental health and well-being, as well as “additional elements to consider” that may also be of benefit for school to consider in their approach.
- Checklist. An updated checklist that clearly identifies each best practice, core component and additional element for consideration.
| Highlights from Second Edition | First Edition | |
|---|---|---|
| Foundational Principles | The foundational principles consider the role of coaches and other stakeholders, the impact of maltreatment/discrimination/trauma, social media, the importance of collaboration and the importance of continuous improvement processes. | N/A |
| Best Practice 1: Promoting Healthy Environments | Core components include development of a multi-level (SEM) mental health promotion plan that is created in collaboration with a licensed provider and responsive to diversity, equity and inclusion; Emphasizes the role of coaches in creating a culture that fosters wellness and normalizes health care seeking- including considerations for support and training; Acknowledges the importance of trauma-informed approaches to interacting with student athletes. Additional considerations include name, image and likeness, engagement with families and prospective student-athletes, supporting student-athletes experiencing a transition in and/or out of sport and continuous improvement efforts (monitoring and responding to dynamic multilevel risk and protective factors). | Best Practice 4 |
| Best Practice 2: Identification & Screening | Core components include screening for psychological distress at least once annually using a validated screening tool. Screening may occur at any point in the academic year with consideration for screening at multiple points including high stress times; Screening should be done in collaboration with a licensed mental health provider. Additional considerations include screening that addresses social determinants of health, building trust with student athletes, training in mental health literacy and provides strategy considerations for continuous improvement efforts. | Best Practice 3 |
| Best Practice 3: Action Plans | Core components include the rehearsal of written routine and emergency action plans; acknowledges the need to address the full spectrum of care in plans; simplifies language of recommended components to include in emergency and routine action plans. Additional considerations include regular outreach about action plans; developing a trauma-informed approach; creating a post-crisis plan; providing strategy considerations for institutions to develop a continuous improvement framework that regularly reviews the plans and incorporates SA feedback and other performance indicators. | Best Practice 2 |
| Best Practice 4: Provider Licensure | Core components include ensuring providers who oversee and manage student-athlete mental health, including the formal evaluation and treatment of student-athletes with mental health signs, symptoms and conditions, have a license to provide mental health care. Additional considerations include developing a diverse and inclusive staff; discussing with student-athletes their preferences and needs; and soliciting feedback from student-athletes to continuously improve care strategies and efforts. | Best Practice 1 |
| Additional Resources | Includes a list of resources to support planning and implementation of each best practice including the SAMHSA Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services, Sport Mental Health Assessment Tool – 1, Sport Mental Health Recognition Tool – 1 and Navigating a Mental Health Crisis, among others. | N/A |
Association-wide legislation requires all schools to provide mental health services and resources consistent with the Mental Health Best Practices.
As schools vary in size, geographic location and local resources, member schools have flexibility to determine how each best practice may be best implemented on their campus. The Mental Health Best Practices includes a checklist which clearly identifies the core components of each best practices. The core components of each best practice have been identified by the NCAA Committee for Competitive Safeguards and Medical Aspects of Sports as the most necessary to providing services and resources consistent the Mental Health Best Practices. In addition to the core components, the Mental Health Best Practices include foundational principles that provide important contextual considerations for all of the best practices. Additional elements of consideration are also noted in each best practice and provide additional options to be considered by each school.
The following resources are available:
- Mental Health Best Practices Checklist: The Mental Health Best Practices include a checklist that identifies each best practice, core component and additional element for consideration.
- Mental Health Best Practices Resources: A webpage that includes resources, supplemental information and potential strategies to assist schools in implementing the Mental Health Best Practices. The list of resources is intended to evolve over time, as the Committee on Competitive Safeguards and Medical Aspects of Sports will regularly consider review and update as appropriate.
- Additional Resources: The NCAA Sport Science Institute mental health website contains additional educational materials, including mental health fact sheets, videos, learning modules and more.
Additionally, a variety of educational opportunities specific to the second edition will be made available to the membership, which may include additional SSI Spotlight sessions, learning modules and other materials. Specific questions can be submitted to ssi@ncaa.org.
The Mental Health Best Practices are effective August 1, 2024. The first edition of the Mental Health Best Practices remains effective until then.