The Role of Athletic Trainers and Mental Health Illnesses in Athletes

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September 18, 2017

By Katie Ostrovecky, MS, ATC

With the rise of individuals suffering from mental health illnesses in the United States today, it is important for us, as Athletic Trainers (ATs), to approach our athletes or patients with a more holistic approach. Mental health can be defined as one’s ability to fulfill relationships and activities as well as cope with adversity due to their mental function (Neal et al., 2015). Stressors from performance, work, academics, and other factors have the potential to cause emotional disturbances that could lead to declined mental health. The athletic population is more likely to experience an increased amount of stressors due to their performance requirements on top of other life changes. Regardless of the setting – secondary, collegiate, professional, military, or clinical – every athlete or patient is at risk to experience stressors that could lead to emotional disturbances. While ATs are not trained to treat mental health illnesses, we are often the first line of defense when it comes to our athletes or patients.

Mental health movements have made strides in the recent years for the general population, but understandings of mental health issues may still be unfamiliar to many. In recent years, the National Collegiate Athletic Association (NCAA) has made it a priority to make mental health “as important as physical health” at the collegiate level by ensuring athletes are provided with access to mental health care (Sudano & Miles, 2017). Unfortunately, it is uncommon for athletes to report mental health issues due to social stigmas and concerns regarding their coaches’ or teammates’ reactions.

So, as ATs, where do we fit into this picture? Current athletic training education programs rarely touch base on the topic of mental health in the athletic population. The lack of knowledge can sometimes make us uncomfortable when it comes to dealing with these issues in our field. However, if our profession as a whole can become more aware and educated on the topic of mental health, then we can hopefully play a part in improving our athletes’ mental health and possibly even saving a life in more extreme cases.

The major issues when dealing with mental health in any setting are the lack of education and the overwhelming amount of social stigmas (Van Raalte et al., 2015). In regards to education, every AT should be aware of the signs and symptoms of mental health illnesses and how to refer an athlete or patient to the appropriate mental healthcare professional. Some signs and symptoms can be show in three different ways: talk, behavior, and mood (American Foundation for Suicide Prevention, 2017). These may include athletes stating that they “feel like a burden” or “feeling trapped.” They may also start to isolate themselves, stop showing interest in activities, abuse substances, experience changes in sleep patterns, or show extreme emotions such as rage and aggression.

Identity in sport plays can play a large role as to why athletes are more susceptible to disturbances in their mental health. Struggling performance, chronic injury, or career-ending injuries can all negatively affect an athlete’s identity which can then lead to psychological responses such as depression, anxiety, or suicidal ideations (Neal et al., 2013). ATs need to be aware of the psychological stress that can accompany the physical changes the athletes undergo.

The three main goals for ATs when dealing with mental health illnesses in the athletic population include the following: gain awareness and recognize the signs and symptoms, incorporate mental health assessments in pre-participation exams, and create a team plan for referral and treatment (Neal et al., 2013). Similar to any other aspect of the medical field, it is our responsibility to stay up-to-date with current research in the mental health field as it pertains to athletic training. Some good resources for mental health can be found at, the National Alliance on Mental Illness, or the American Foundation for Suicide Prevention.

After educating ourselves, the next goal is to educate others while assessing for at-risk athletes or clients. Mental health assessments can be incorporated into pre-participation exams to identify at-risk athletes. This part of the planning may need to be done with team physicians to avoid working outside our scope of practice (Neal et al., 2013). Speaking with team physicians and mental health care providers before the season starts is key for setting up a plan of referral in the case of identifying an athlete with mental health illnesses. Following a referral, the AT should continue to communicate with the mental healthcare provider (with the permission of the athlete or guardian) to help the athlete improve and prevent relapse (Gourlay & Barnum, 2011).

In the case of an emergency or you run into a scenario where you think an athlete or client is suffering from a mental health illness, it is important to approach the athlete in the proper manner (Neal et al., 2015). The following tips can help you when approaching an athlete or client with concerns:

  1. Always make sure to confront the athlete in private (or with guardian in the case of a minor).
  2. Focus on the athlete as a person, NOT from an athletic performance perspective.
  3. Have accurate facts before confronting them and ask open-ended questions (do not use accusations).
  4. Be ready to LISTEN to their story.
  5. Encourage them to consider and treat their mental health the same way they would with their physical health.
  6. Maintain confidentiality.

Hopefully, with current research and the guidelines listed above, ATs can help change the way we look at mental health within both the general and athletic population.


  1. American Foundation for Suicide Prevention (2017). Risk factors and warning signs. Retrieved from
  2. Gourlay, L., & Barnum, M. (2011). Recognizing psychological disorders, part 2: Referral and management. International Journal of Athletic Therapy & Training, 13-18.
  3. Neal, T. L., Diamond, A. B., Goldman, S., Liedtka, K. D., Mathis, K., Morse, E. D., . . . Welzant, V. (2015). Interassociation recommendations for developing a plan to recognize and refer student-athletes with psychological concerns at the secondary school level: A consensus statement. Journal of Athletic Training, 50(3), 231-249.
  4. Neal, T. L., Diamond, A. B., Goldman, S., Klossner, D., Morse, E. D., Pajak, D. E., . . . Welzant, V. (2013). Inter-association recommendations for developing a plan to recognize and refer student-athletes with psychological concerns at the collegiate level: An executive summary of a consensus statement. Journal of Athletic Training, 48(5), 716-720.
  5. Sudano, L. E., & Miles, C. M. (2017). Mental health services in NCAA division I athletics: A survey of head ATCs. Sports Health, 9(3), 262-267.
  6. Van Raalte, J. L., Cornelius, A. E., Andrews, S., Diehl, N. S., & Brewer, B. W. (2015). Mental health Referral for student-athletes: Web-based education and training. Journal of Clinical Sport Psychology, 9, 197-212.


About the Author

About the author picture

Katie Ostrovecky, originally from Northern Virginia, graduated with her Bachelor of Science in Athletic Training in 2014 from Nova Southeastern University. She then went on to receive her Master of Science in Kinesiology with a concentration in Exercise and Sports Psychology from A.T. Still University. She currently works as an Athletic Trainer with the youth population in Southern California. Katie is also a recent self-published author and an advocate for suicide prevention awareness.

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