By Rebecca Dell
COLUMBIA, Mo. — Mental illness afflicts 18.6 percent of the U.S. adult population, according to a Substance Abuse and Mental Health Services Administration survey, and college-level athletes and coaches are not immune. Their stories in the media range from hopeful and triumphant to sad and tragic:
Former Michigan defensive lineman Will Heininger was severely depressed at the end of his freshman year, but he felt he had to hide his struggle. An athletic trainer noticed something was wrong and got him help within the athletic department. Later, Heininger told ESPN, he was relieved to find out he wasn’t the only student-athlete taking antidepressants.
Former Syracuse offensive tackle Jonathan Meldrum had battled depression before college. He told the Atlantic he reached another low his sophomore year and got help thanks to a coach noticing something was wrong.
Former Georgetown cross country and track athlete Katie McCafferty had a stress fracture that kept her from practicing with her teammates. McCafferty told the Atlantic she did not have much emotional support from her athletic department.
Former University of Pennsylvania cross country runner Madison Holleran completed suicide in January 2014. Her father told the New York Post that classroom pressures had stressed his daughter, and she had lost academic and athletic confidence.
And, as those familiar with the University of Missouri might know, former MU swimmer Sasha Menu Courey suffered borderline personality disorder. During her time at MU she was allegedly raped by one or more football players. Menu Courey completed suicide in 2011.
These are just five cases. The NCAA alone claims more than 450,000 student-athletes. Statistically speaking, there are tens of thousands of student-athletes suffering from mental illness. But the sports world, with its high achievers and physically strong members, is a particularly tough place to bring up mental illness. To destigmatize the need for help, mental health must be an open discussion. At the same time, athletic departments must fine-tune their support systems and education for students and staff.
Stigma can surround mental illness in sports
In the fall of 2005, Mark Potter coached his team through a normal practice. Afterward, with the door to his office safely closed, he put his head down on his desk and cried.
And he didn’t know why. He had a job as head basketball coach at his alma mater, Newman University, in Wichita, Kansas. He had a wonderful wife and kids. His steadfast Christian faith provided a bedrock for his life. He was a former two-sport collegiate athlete, and like many athletes, he could tell himself to persevere and bootstrap through his days. The uncontrollable emotion seemed inexplicable.
Little did Potter know he was suffering from severe depression.
For him, the first step toward opening the conversation was talking with his wife. “I needed permission from my wife to be sick,” he says. But then he wanted to hide his struggle from others. “When I first started going through it, I didn’t want anybody to know,” Potter says. “Heck, I’m a head coach, you know, I’m a father, I’m a husband. I didn’t want people to know I couldn’t handle my daily business.”
Many athletes face similar concerns. The American Psychiatric Association notes several causes for athletes to feel they shouldn’t struggle mentally: They appear physically healthy. They’re idealized. They fear seeming weak. But they are also at risk for mental illness. Head injuries can increase risk of depression, and other factors such as other injuries, overtraining, stress and pressure can sometimes contribute to anxiety or depression.
The NCAA’s Managing Student-Athletes Mental Health Issues handbook, which offers guidelines for coaches and other non-clinical staff to identify struggling athletes and offer help and referrals, gives further reasons for athletes’ vulnerability. For example, an injured athlete may lose self-esteem and identity as a result of sitting out of competition. That can contribute to depression.
But sports can be key coping mechanisms for students with mental illness. One athlete, a junior at an NCAA Division III school, says that despite a currently undiagnosed mental illness, participation in track has helped her stay in school. “It’s kind of keeping me rooted here,” she says.
Menu Courey, the MU swimmer, was told not to train with the team while she recovered from a back injury and went to counseling. During that time, her parents say, she felt alienated from both the people who had become her Mizzou family and the activity that kept her mind occupied. Swimming, her parents realize now, was one lifelong way she coped with BPD. With that gone — at the same time she experienced upheaval in other areas of her life, such as the end of a relationship, her parents say — she had lost almost all of her coping skills and had to get inpatient care to learn how to cope. Tragically, it was too late for her.
Athletic departments need open dialogue
In January 2014, ESPN’s Outside the Lines published an investigation criticizing the University of Missouri for how it handled the alleged rape of Menu Courey in 2010. The story impelled MU to investigate its own resources and practices related to mental health care and sexual assault reporting.
Department spokesman Chad Moller said in an email that since receiving the Dowd-Bennett law firm’s report about where the University failed in handling the sexual assault allegations related to the Menu Courey case, Mizzou Athletics started an internal review on mental health resources, communication and education within the department. However, Moller declined to make any coaches, athletes, mental health providers or officials available to talk about mental health for this story, despite six requested interviews.
“I think it will be important for us to see what the group comes up [with],” Moller wrote in his email, giving his rationale for not allowing interviews. Moller did not respond to a request for more information on the Mizzou group, although the Maneater, the student newspaper at the University of Missouri, reported the names of the members and that the internal group does not have a timetable.
Colin Livasy, a former MU swimmer and one of Menu Courey’s good friends on the team, calls his two years swimming at Mizzou a “fantastic experience” overall. But a lonely freshman year as a walk-on living in different housing than his teammates, along with the toll of athletic pressure, pushed him into depression.
“We were physically exhausted all the time,” he says. “And because swimming in particular is a sport in which 90 to 95 percent of the time you’re by yourself in your own head, you know, staring at a black line at the bottom of a pool, it’s hard to deal with emotional issues. And I know some people are able to separate themselves from that: When they get in the pool it’s a totally different world, basically. But [. . .] you know, it’s hard to control your emotions whenever you’re stuck with your own thoughts.”
Livasy went to sports medicine personnel, and he got an antidepressant and an anti-anxiety medication in the summer between his freshman and sophomore year. While that alleviated his depression and anxiety, he says the change in coaches between his and Menu Courey’s freshman and sophomore years was particularly challenging. He stopped swimming for Mizzou after his sophomore year and continued the rest of his college career without antidepressants or anti-anxiety medications.
Fortunately, Livasy took action when he realized he needed help. But again, the conversation can be hampered by fear of stigma surrounding mental health. Potter says that while he was secure in his job, others might worry that getting help would affect theirs. And what people see in the media might reinforce ideas of stigma: just think about reports following the Aurora or Sandy Hook shootings linking mental illness to violence. Moe Keller, vice president of public policy and strategic initiatives at Mental Health America of Colorado and a former Colorado legislator, said at the Health Journalism 2014 conference that individuals don’t want to be associated with violent acts perpetrated by a tiny percentage of those with mental illness. And Susan Lewis, a policy and systems advocate and CEO of Mental Health America of the Heartland, says: “Part of the problem is we use the term ‘crazy’ in America to explain anything we don’t understand,” and then we also use it to describe someone with a biological mental health disorder.
The NCAA and others work toward solutions
The mental health field in athletics is developing through a variety of initiatives. In September 2013, the National Athletic Trainers’ Association released recommendations for developing plans for student-athlete mental health. In November 2013, the NCAA’s Sport Science Institute hosted its own Mental Health Task Force. Experts from the task force are writing a handbook for clinicians about factors that affect student-athlete wellbeing, and the plan is to publish the by the summer of 2014, says Sport Science Institute Associate Director Mary Wilfert. In March, two student-athletes in Canada founded the Student Athlete Mental Health Initiative to provide a support network for student-athletes. In April, the NCAA announced on its website that a $50,000 Innovations in Research and Practice grant will help a team at the University of Michigan develop a model program to tailor mental health resources to student athletes.
Individual NCAA member schools are responsible for implementing and administering their own athletic programs, Wilfert says. In September 2013, licensed psychologist Debbie Wright, the former director of mental health at the MU Student Health Center, moved into a full-time position with Mizzou Athletics. She has about 10 years of experience working with athletes and coaches, she said in an email. But not every athletic department has the luxury of having a full-time licensed psychologist on staff.
Licensed psychologist Chris Carr, sport and performance psychologist at St. Vincent Sports Performance in Indianapolis, says the field of sport psychology needs to clarify the difference between kinesiology or physical education and psychology. Carr helped create the Big Sky Sport Psychology Conference, an invitation-only event that provides a collaborative environment for licensed mental health providers who work in athletics. This year’s conference hosted over 80 providers, but Carr says at this point, that’s still not enough to supply the demand.
“If every NCAA Division I athletics department said, ‘OK, we are going to commit the resources to have a full-time, in-house [. . .] sport psychology service for our student-athletes,’ the reality is you probably would be very limited in having the best-trained folks take those positions,” he says.
Washington State University models one approach
Jerry Pastore is a licensed mental health counselor and a Big Sky Conference invitee. Pastore works in the Washington State University athletic department, coaching students through many aspects of wellbeing, and he builds rapport with athletes as soon as they arrive at college. “Effective counseling is all about personal relationships,” he says. He speaks to teams and freshman classes. He shows up to practices. He educates coaches and all athletic department staff members about signs of mental health distress. Athletes are referred to him through sports medicine, but some come to him on their own.
Livasy, the former MU swimmer and one of Menu Courey’s friends, believes coaches and staff in athletic departments should continually remind every athlete of mental health resources. “I think that it should be expressed on a very personal level,” Livasy says, “like ‘If you guys are having any problems, you can come to us for literally anything; you can talk to us about anything, and we’re not going to ignore it.’”
In addition to working with students himself, Pastore can also refer athletes to a psychologist at the student health center who has 20 hours a week devoted to athletes. Having a psychologist outside of the athletic building gives athletes a chance to breathe between a counseling appointment and the rest of their day, Pastore says.
To normalize mental health care, Pastore emphasizes the natural cycle of emotional highs and lows. “We all have problems, whether you want to label it as mental health or not,” he says. “I often say to student-athletes, ‘We all hit speedbumps in life. You don’t get through life without speedbumps, that I know of.’”
The administration and coaches are on board with the all-around wellbeing program, something Pastore says is crucial. “I’ve never had a coach say to me, ‘Hey, you need to fix this kid, this kid’s our starting whatever,’” Pastore says. “Some student-athletes have left the university, but every time they leave, they left connected with parents. We provided them a plan to get help. It was their choice to leave, or the parents wanted to bring them closer to home until they got better. We’ve always said the door’s open if you want to come back.”
This May, Pastore says, the PAC-12 Health Conference will integrate more wellness and mental health. “I think athletics in general is probably going to move in this direction,” Pastore says of Washington State’s model. “I think conferences are going to take it by the horns too and start taking a more active role.”
Expectations for mental health needs should be emphasized
Since their daughter died, Mike Menu and Lynn Courey have become voices for mental health awareness. They speak to high school students, and the Sashbear foundation they help run is about to sponsor its second annual Borderline Walk to raise awareness of borderline personality disorder.
The Washington State model aligns closely with Menu and Courey’s hopes for mental health care for athletes.
For one thing, Menu and Courey suggest a bridging strategy to help athletes when they transition out of sports. Especially for athletes like Sasha who use sports as a coping skill, it’s important to look for a new hobby or activity to keep them stable during emotional transitions.
Also, Menu and Courey say, a perfect world would include four doors on the pool deck: one for sport-specific help, one for physical help, one for mental help and one for academic help. Student-athletes would expect that they might need to enter and exit any of those doors at any time. They would feel free to do so in front of their friends and peers. Courey compares a mental health tune-up to a car tune-up: “I would recommend that every person go for a mental health checkup at least twice in their life,” she says. “All the baggage we carry builds up and becomes a big weight we need to carry.”
Finally, Menu and Courey advocate for a personal level of mental health support.
When Menu Courey was about 13, her father says, she reached one of the plateaus common in a timed sport such as swimming. Still the fastest swimmer in her age group, she was winning her races but not improving her times. So she cried. Her father recognized the need to acknowledge both the wins and the emotions and then work toward a solution.
“Always start with the validation,” Menu says. “Validate their emotions.” Validation builds trust, Menu and Courey say; once you’ve affirmed that what someone is feeling is real, he or she may be more open to listening to advice or referrals to professional help.
On a bad day you also don’t need a lot of advice. You just need a little empathy and affirmation. You need to feel once again that other people have confidence in you. — Anne Lamott, author
Potter received medication and spread the word
When Potter, the basketball coach, finally went to a doctor, he was diagnosed with severe depression. When he heard he would get medication, he realized that perhaps there was something real causing his state. He missed eight games while he waited for the medicine to take effect. “I was just sick,” he says. “I was just mentally ill.”
Now he tells his story to his team and anyone else who asks. He says people sometimes seem hesitant to call him, thinking he’s too busy to talk. “No I’m not,” he says. “Not when it comes to life and death.” Although his status as a head coach initially made him hesitant to admit he needed help, he realized that many others felt the same, so he decided to speak up for their sake. And for some athlete, or anyone really, that transparency and education just might make the difference.
Resources at MU
College campuses have some of the best mental health resources in the country, says David Wallace, the director of MU’s Counseling Center. At MU, he says the general budget and student activity fee pay for student access, and the Center stays busy with the high demand for appointments. The Center also offers training in mental health prevention, early intervention and suicide prevention, and any student, faculty or staff member can call 573-882-6601 from 8-5 p.m. on weekdays to ask what to do if they’re worried about someone.
For more mental health resources, see http://counseling.missouri.edu and the list of resources at http://mizzouweekly.missouri.edu/archive/2014/35-27/suicide/index.php.
Rebecca Dell can be reached at email@example.com.