May 26, 2017
Stopping the Stigma
Timothy Neal

Athletes spend a great deal of time and effort on their physical fitness. Preparing themselves for competition, student-athletes spend untold hours on cardiovascular work, weight training, skills development, and functional movements to enhance their physical prowess. While physical preparation is important to athletic success, how much time does an athlete spend on their mental health and wellness to handle the numerous stressors that accompany physical training and competition? Unfortunately, the answer is probably not much.

More and more light has been shed on the importance of mental fitness for both the non-athlete and athlete. Studies have shown that one in every four adolescent and adult Americans meet the criterion for a mental health disorder. Being an athlete doesn’t provide immunity from mental health disorders, either. Rather, the stressors of being an athlete, if not managed effectively, may in fact exacerbate an existing mental health disorder or serve as the starting point of a mental health disorder.

If an athlete is struggling with a mental health disorder, psychological assistance should primarily be in the area of evaluation and care by licensed mental health care professionals. However, the athletic trainer, coach, strength coach, equipment manager, and administrator play an integral role in the lives of athletes and should also be made aware of behaviors to monitor in order to approach and refer the student-athlete to the team physician or mental health care professional for an evaluation and treatment. The important points for athlete mental health and wellness are: education on mental health, destigmatizing mental illness, awareness of stressors, stress management techniques and building resiliency, behaviors to monitor, and knowing where to go to receive an evaluation and assistance for mental wellness issues.

Athletic trainers should also be aware of the stress an athlete feels when they sustain an injury or go through long-term rehabilitation. It’s important to normalize their emotions and make them at ease.

The student-athlete should be asked questions regarding their mental health, including questions on eating disorders, substance abuse, exercise addiction, sleeping patterns, and general mental health, at their preparticipation physical exam/recheck on an annual basis. Any potential issues listed or detected warrant follow-up testing and referral for an evaluation and assistance.

Then, the student-athlete should receive mental health information as part of their annual team meetings and receive on-going education on mental health and wellness throughout the year. Topics can include general information on mental health and wellness, destigmatizing information on receiving help, stress management skills, sleep recommendations, behaviors to monitor, and how the referral mechanism set up at the school for assistance works.

Athletic trainers and team physicians should also be aware of the stress an athlete feels when they sustain an injury or go through long-term rehabilitation. It’s important to normalize their emotions and make them at ease by informing them that anger, denial, uncertainty, and being “down” are all part of the grieving process of being injured. I can’t tell you how many relieved athletes I’ve seen when I would reassure them that their response to an injury was normal. The athletes were often visibly relieved and sighed out loud when I spent a few moments reassuring them on an emotional level. Athletes identify themselves as athletes, and when that identity is threatened because of injury, emotional turmoil results, sometimes placing the recovery at risk because of a psychological injury sustained by the athlete.

The bottom line is mental wellness is as important as physical fitness to the student-athlete. Spending more time and effort in the area of mental well-being will benefit the student-athlete on and off the field.

Athletic trainers are strongly encouraged to learn as much as they can on the psychological concerns of athletes. The NATA has sponsored two inter-association consensus statements on psychological concerns of athletes, a 2013 version for the collegiate student-athlete (found here) and a 2015 document for the secondary school student-athlete (found here).


Timothy Neal, MS, AT, ATC, CCISM, is Assistant Professor and Program Director of Athletic Training at Concordia University Ann Arbor. Previously, he spent more than 30 years at Syracuse University, serving in a variety of sports medicine roles. He can be reached at: [email protected]


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