When a student-athlete breaks a bone or strains a muscle, athletic trainers and team physicians tend to the injury quickly and expertly. However, a strain of the mental or emotional sort could go unnoticed, unrecognized and untreated.

Student-athlete mental health is an issue that is coming into focus for student-athletes, coaches, athletic trainers, administrators and members of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS). More and more athletics departments are hiring psychologists dedicated to helping student-athletes deal not just with issues related to their sport and competition, but also to concerns that other college students might encounter, such as eating disorders, substance abuse, depression and anxiety. In January, the NCAA education services staff will host a session at the 2005 NCAA Convention called, "Increase Performance, Decrease Liability: Attending to Student-Athlete Mental Health."

Student-athletes often are seen as "having it all" -- athletics and academic success, popularity and high self-esteem. However, participation in organized sports does not make a student-athlete immune to the same stressors and demands that nonathletes face during their college years.

"Athletes have (mental-health issues) the same as everyone else," said Mary Wilfert, NCAA assistant director of education outreach. "This needs to be attended to with the same resources we give to physical-health issues."

Wilfert said the longtime negative stigma attached to mental-health issues in the sports environment has been related to the "culture" of athletics, a culture that might prevent an athlete from seeking help. Wilfert said she and others are working to raise awareness in the membership through events such as the session at the Convention and a February panel discussion of clinical sports psychologists to address mental-health issues student-athletes face. Panel organizer Chris Carr, a clinical sports psychologist for the Methodist Sports Medicine Center in Indianapolis, hopes the meeting will spawn an organization similar to one already in place for athletic trainers (National Athletic Trainers' Association).

Colleges and universities are beginning to give the issue much-needed attention, too. Boston University recently announced that a sports psychology services unit has been created for all Terrier student-athletes, making the school one of the few in the nation to provide such a service.

Boston University Athletics Director Mike Lynch said the mission of the department is "to provide all student-athletes with the most consistent, effective, and efficient assistance possible in order to enhance their performances on and off the field."

Lynch said the sports psychologists and the school's sports psychology graduate students will work closely with student-athletes to deal with issues relating to anxiety, stress, performance enhancement, depression and other related areas that are judged appropriate by the sports medicine and student-athlete support services staff.

"This unit will assist all of our teams and coaches as they deal with the increasing challenges of handling issues ranging from stress and time management to more serious challenges such as depression and anxiety," Lynch said.

Pam Gill-Fisher, associate athletics director at the University of California, Davis, said that as people become more educated about the issue of mental health in student-athletes, they are moving away from labeling those athletes with difficulties as weak or cowardly.

"The attention to the total person is much more widely recognized as being important in terms of performance," Gill-Fisher said. "As people are more educated about the issues, which occurs as student-athletes bring these issues to their (student-athlete advisory committee) or individually, the issue is getting administrators' attention, and they're starting to provide resources or access to the resources they already have."

As the stigma surrounding mental health dissipates in everyday life, it will become less stigmatized in athletics as well, Gill-Fisher said.

Ross Flowers, a psychologist and sports consultant at UC Davis, said the stigma of student-athletes entering counseling is something he is trying to address by making himself available and visible in the athletics department, attending practices and weight-lifting sessions.

"I may be a psychologist, but I'm a human first," he said. "I'm not going to diagnose you as crazy right away. We are trying to offer our services to student-athletes by going out into their environment."

Flowers said that in each of the five years he has been on staff with the athletics department, he has seen an increase in student-athletes using his services. That in itself points to a decrease in the shame or embarrassment surrounding mental-health issues.

"It has to be out there, and people have to talk about it for it to be less stigmatized," Gill-Fisher said. "We've come a long way in terms of alcoholism and drug addiction going from people being weak and unable to control themselves to the point where we understand it as being a health issue that has to be addressed. Dealing with mental-health issues is similar."

Educating the coaches, Flowers said, is an important step to promoting an atmosphere of mental health among student-athletes. Many programs and educational tools exist for student-athletes, athletic trainers, coaches and others interested in learning more about mental-health issues, both nationally and at individual schools.

The Jed Foundation (www.jedfoundation.org) is a nonprofit group dedicated to reducing the suicide rate and improving mental health among college students. The foundation is collaborating with the NCAA on a special program aimed at student-athletes. The QPR Institute (www.qprinstitute.com) is a training organization also aimed at suicide prevention and education.

Because of the pressures in some sports to maintain low body weight, and the general pressure within athletic performance to strive for perfection, some student-athletes may be at greater risk of developing eating disorders. As part of its efforts to address both the physical- and mental-health issues associated with eating disorders, the NCAA operates an Internet site, www.ncaa.org/nutritionandperformance, dedicated to promoting an environment that addresses optimal nutrition, positive body image and peak performance. Resources at this Web site are designed to assist coaches, student-athletes and athletic trainers to prevent or detect eating disorders.

Gill-Fisher said educating everyone in the collegiate athletics world is an important first step toward de-stigmatizing mental-health issues, and professionals should not overlook the most valuable resource they have: student-athletes.

"The first thing we have to do is educate ourselves about the issues and understand what the pressures are by talking with the student-athletes, going to team meetings and letting them know that you're available," she said. "Let them know you're not going to stigmatize them or hold it as a negative in terms of their evaluation.

"Let them know what the challenges are and talk about it openly, and them provide them with resources that are available."