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Publish date: Sep 25, 2013

NATA, NCAA and others announce mental health recommendations

Inter-association task force unveils guidelines to help athletics personnel address student-athlete mental health

By Brian Burnsed

Will Heininger suffered in silence.

The 2011 Michigan graduate was a defensive tackle on the school’s football team and a four-time Academic All-Big Ten winner. Despite playing Division I football at a storied program and thriving at one of the nation’s most prestigious public universities, Heininger quietly battled depression. He hid the affliction from his teammates, friends and coaches.


An inter-association task force that included the National Athletic Trainers Association and the NCAA developed these nine guidelines to help college athletics programs support student-athletes with mental health needs.

1. Refer the student-athlete for psychological evaluation and care

Having a team in place to address these concerns is important. This team should include the team physician(s), athletic trainers, campus counseling service and community-based mental health professionals.

2. Address mental health concerns during pre-participation exams

These exams are the optimal time to ask about a history of mental health problems. Any affirmative answers about mental health should be brought to the attention of the team physician so he/she may discuss with the athlete and determine appropriate follow up.

3. Approach the student-athlete with potential psychological concerns

This can be uncomfortable and should be handled once the health care expert has the right facts and is in a position to listen and encourage the athlete to talk about his or her challenges and seek a mental health evaluation.

4. Schedule a routine referral for a mental health evaluation

Once the student-athlete has agreed to undergo psychological evaluation, he or she should be referred as soon as possible to the mental health care professional. If possible, the athletic trainer should help that individual make the appointment. Having pre-existing relationships with the mental health experts will help facilitate the referral.

5. Discuss confidentiality issues?

For a routine referral, the athlete should be informed that although it is confidential it may be helpful to notify the coach and parents of appointments. The athlete is not compelled to do so. With regard to use of medical insurance, the athlete should also be informed that parents will receive notifications of treatment and an explanation of benefits from the insurance company.

6. Know when emergent mental health referrals are necessary

If a student-athlete demonstrates violence or imminent threat to him/herself, others or to property; or reports feeling out of control, unable to make sound decisions or incoherent or confused, an emergent mental health referral is recommended.

7. Be aware of suicide and student athletes

More than 30 percent of all undergraduates in a national college health assessment reported feeling so depressed that it was difficult to function and few youth or young adults receive adequate mental health care. Therefore the possibility of suicide is ever-present.

8. Address campus counseling services and catastrophic incident considerations

Student-athletes are concerned with team status and playing time and may be negatively affected if their coaches become aware of their mental health problems. The athlete is more likely to favor therapists that understand this challenge and as a result, it is important for the counseling center to have a relationship with the athletic department to ensure good communication and care. Having a primary point person in that department can be beneficial and may fall to the athletic trainer.

Catastrophic situations may require support, time and resilience. Early intervention can be helpful in resolving traumatic stress. The collaborative approach to care may be most beneficial with the athletic trainer providing initial support until the mental health expert is identified.

9. Consider risk management and legal counsel

University administrators face the challenges of managing risks associated with mental health and student athletes and should be aware of the following:

Develop a plan to include a policy statement and related procedures for identifying and referring student athletes with potential health concerns to appropriate administrators and counselors;
· Carefully evaluate the institution’s insurance policies that may be triggered in the event of a mental health incident;
· Protect confidentiality; and
· Consider an interdisciplinary approach where individuals from different departments collectively confront the complex problems of mental health in student athletes.

His story is not uncommon. Roughly one in five American youths suffers from some sort of mental health disorder. Mental illness rates among 18-to-25 year olds are twice that of their middle-aged counterparts. So among a pool of 450,000 NCAA student-athletes, it’s certain that many, like Heininger, are struggling with depression and other diseases.

Eventually, Heininger turned to his athletic trainer, who worked with his coach and team physician to get him help. They connected him with a social worker who helped him turn his life around. The National Athletic Trainers’ Association (NATA), the NCAA and other health and mental-health organizations want more student-athletes who are dealing with psychological issues to follow Heininger’s lead. So today at the NCAA’s Indianapolis headquarters, a 10-member inter-association task force, led by NATA, announced nine guidelines to help athletics trainers, coaches, team physicians and other athletics administrators work with student-athletes who are living with psychological issues.

“Mental health disorders are an under-recognized and undermanaged condition in our country, and college students are particularly vulnerable,” said Dr. Brian Hainline, NCAA chief medical officer. “Student-athletes are not immune to mental health problems, and can suffer from some unique stressors.”

The task force’s recommendations will be published in greater detail in this month’s edition of the Journal of Athletic Training, and are designed to provide a clear road map to address the mental challenges student-athletes face, according to Timothy Neal, assistant director for sport medicine at Syracuse and chair of the task force.

“The probability of encountering one or more student-athletes with psychological concerns within an athletic department is a certainty,” Neal said in a statement released by the NATA. “Our goal is to immediately address and care for the student athlete with the best protocols in place.”

The announcement was hailed as a major step to addressing the issue of student-athlete mental health, which in recent years has prompted athletics programs to devote more resources to psychological support.

The guidelines were presented as developmental steps for athletics programs to institute a plan for recognizing and referring student-athletes with mental health concerns.

“These recommendations are a leap forward in providing a safe and sound environment for student-athletes who may be suffering from a mental health disorder,” Hainline said. “As athletic trainers so often serve as the primary health care provider for student-athletes, this consensus paper provides the foundation for a management plan that is evidence-based, confidential, free of conflict-of-interest and is valuable to everyone who works with the student-athlete.”



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