Working With and Through Athletic Trainers to Meet Student-Athletes’ Mental Performance and Mental Health Needs

In January 2023, the National Collegiate Athletic Association (NCAA) released the Transformational Committee Report that outlined the targeted areas and needs within the organization to improve the health, well-being, and overall experience of student-athletes.¹  One area of emphasis was better engagement with the Holistic Student-Athlete Well-Being Model that is focused on providing NCAA student-athletes with a variety of resources, such as athletic trainers (ATs), strength and conditioning coaches, mental health providers, and nutritionists.^1,2  However, when looking more closely at the Transformational Committee Report, mental performance consultants (MPCs) were not listed as a key departmental resource, which means that student-athletes who may be experiencing a mental performance concern, such as having precompetition anxiety, are likely not having their unique needs met.¹  Oftentimes, MPCs and Licensed Mental Health Professionals (LMHPs) are viewed as having similar training, certifications/licensure, and service delivery, yet, this is not the case.

Since the implementation of the 2016 NCAA mental health initiative, there has been an uptick in the number of LMHPs being hired within NCAA athletic departments, especially at the Division (DI) level.^3,4  However, in some of the sport psychology literature, mental performance and mental health have often been grouped together under the phrase “sport psychology” or using the title “sport psychologist,” causing confusion between the services and the providers.⁵  Although mental performance and mental health services complement one another, they are vastly different in delivery and training requirements for the providers. MPCs hold a master’s or doctoral degree in “sport science, psychology, or a closely related field” and are encouraged to obtain the Certified MPC credential, which illustrates the highest standard of competence in delivering mental skills training programs to assist performers.⁶  For example, these programs can help athletes build confidence, manage pressure, improve focus, and become more cohesive with team members.^4,7  To achieve the Certified MPC certification, individuals are required to complete sport science and psychology course work that meets the “knowledge area” requirements, obtain 400 hours of supervised consulting experiences, and pass the certification exam.⁸  On the other hand, mental health services are focused on assisting individuals in improving their daily functioning and navigating pathologic mental health issues (eg, diagnosed clinical depression).^2,9  There are a variety of individuals trained to address student-athletes’ mental health needs that include licensed psychologists, licensed master social workers, licensed clinical social workers, and licensed professional counselors.⁶ 

Although mental performance and mental health professionals’ educational requirements and scope of practices differ, researchers have found that NCAA DI athletic departments tend to hire a singular LMHP to meet both the mental performance and mental health needs of their department.⁴  Jones and colleagues refer to this professional as a Licensed Sport Psychology Professional who “holds a mental health licensure” but is also delivering mental performance services.⁴  Researchers who conducted an analysis of all Licensed Sport Psychology Professionals employed in NCAA DI athletic departments revealed that the large majority of professionals only have clinical, counseling, and/or social work training, with few having sport science training, and most do not hold the Certified MPC credential.^4,10  In fact, at the 2022 Association for Applied Sport Psychology Conference, researchers revealed that Licensed Sport Psychology Professionals spend most, if not all, of their time delivering mental health services to student-athletes, meaning that it is likely that little, if any, mental performance service delivery is occurring with student-athletes.¹⁰  This leaves student-athletes who may be experiencing a mental performance challenge, such as having reduced confidence or precompetition anxiety, potentially not having their needs met, which may impact their sport performance and over time could lead to the development of a preventable mental health issue.

An important professionals who can help in ensuring that student-athletes’ health-related needs are met are ATs. Given the recognition of ATs as health care professionals and job-related physical presence, ATs have constant contact with student-athletes and address both physical and mental health concerns to improve overall well-being and sport performance. Because of their consistent interactions with student-athletes and prioritizing health and performance, ATs are uniquely positioned to identify student-athlete needs, including both mental health and performance-related issues. Additionally, ATs have foundational training surrounding mental health and psychological responses to injury through education-based competencies (Commission on Accreditation of Athletic Training Education standards) while also understanding the impact of sport culture on student-athletes because they see it in their daily interactions.¹¹  Further, student-athletes often disclose uncomfortable information, such as mental health challenges and/or needs, to ATs because of their physical presence and close bond prioritizing holistic health.^12,13 

Despite the use of ATs as a “one-stop shop,” ATs and student-athletes recognize the need for a multidisciplinary team as it relates to psychological care.¹²  ATs feel confident in their ability to discuss mental health with athletes; however, ATs desire more specific training related to intervening on mental health concerns.⁹  Despite general comfort with discussing mental health, work done by Zakrajsek and colleagues revealed that ATs do not feel it is their responsibility to provide mental performance services; however, they believed an MPC could “complement their efforts” in assisting student-athletes.^14,15 

Psychological care requires collaboration from the entirety of the multidisciplinary team that is focused on improving student-athlete mental health and mental performance. More specifically, being able to understand the role each team member plays as it relates to mental performance and mental health and the reasons why student-athletes experience different psychological challenges is vital so that optimal care, inclusive of the appropriate team, can be provided. In quantitative and qualitative studies done with ATs, researchers found that they are open and supportive of psychological services and believe they are important to have available to student-athletes.^14,15  Furthermore, student-athletes also recognize both the value and limitations of ATs’ training and scope of practice related to psychological services.¹²  Although having supportive ATs is a facilitator to seeking psychological health care, student-athletes realize that they often need more assistance than an AT is trained to provide in the area of mental health and mental performance services. It is encouraged that ATs, MPCs, and LMHPs use a performance team approach where they collaborate to determine which professional is best suited to meet the unique psychological needs of student-athletes; the performance team should be tailored based on available resources and athlete needs.

Because ATs have foundational educational training competencies in both mental performance and mental health, they support and believe in both services and, in most cases, are the first lifeline to recognize student-athletes’ psychological needs in many sport settings; therefore, they are uniquely positioned to advocate for improved referral procedures and institutional resources to improve mental health and performance. Furthermore, ATs have preestablished relationships with sport-related administrators via whom they can advocate for student-athlete health-related needs and resources. Over the last 6 years, we have seen an increase in psychological challenges with athletes, and with the NCAA’s adoption of the Name, Image, and Likeness, athletes are experiencing new pressures and psychological demands.^16–18  With these increasing pressures and psychological challenges, it is nearly impossible for 1 professional to meet the needs of all athletes. Researchers support this sentiment, as they found that 1 professional delivering both mental health and mental performance services often has limited, if any, availability to meet the mental performance needs of athletes.¹⁰  This means that many athletes’ mental performance needs will likely not be met, and, in some cases, these providers will also not be able to meet every athlete’s mental health concerns.

Therefore, we are encouraging ATs to help in disseminating information about MPCs and LMHPs and explaining how their services differ from one another while advocating for the inclusion of more psychological professionals to meet student-athletes’ varying needs. ATs are often the “lifeline” in helping multidisciplinary teams to support student-athletes; therefore, it is recommended that ATs working in an athletic department that employs an MPC and LMHP help in developing more seamless educational resources and referral procedures to ensure that student-athletes experiencing psychological challenges get to the appropriate professional to meet their needs. With ATs being a key resource and often serving on the front lines with student-athletes, they see different psychological challenges and concerns. Because of their training and close proximity to student-athletes, they are in a unique position to advocate to their administration for the hiring of MPCs and/or LMHPs to meet their populations’ needs. This advocacy can also help reduce the ATs’ workload burden by ensuring that student-athletes are receiving individualized appropriate care from highly qualified providers so that ATs can focus on their scope of practice, including the physical health needs of all student-athletes. Financial barriers do exist to hiring multiple MPCs and/or LMHPs as part of the multidisciplinary care team for student-athletes. Ultimately, institutions that have limited resources but are able to hire a professional full-time should verify that provider credentialing matches the job description and what the athletic department needs are at the time of the hire. If there is a financial burden in hiring 1 or multiple professionals, MPCs and/or LMHPs could be hired part time or on a contracted basis where the professional comes in a set number of times per semester to meet with student-athletes. If there are no financial resources available, it is encouraged that the athletic administration advocate for the Counseling and Psychological Service Center on their university campus to dedicate 1 full-time LMHP to see solely student-athletes. In addition to using athletic department or campus resources, ATs can also access mental health resources from the American Psychological Association and mental performance resources from the Association for Applied Sport Psychology. Furthermore, if ATs are wanting information about certified MPCs in their local communities, they are encouraged to visit the Association for Applied Sport Psychology website where they can access a global directory of certified MPCs (see https://appliedsportpsych.org/certification/cmpc-directory/). ATs can use these resources to establish relationships for athlete mental health and mental performance needs in the absence of or in addition to resources available at the school level. In closing, ATs are a critical resource to student-athletes, and, with their foundational training competencies highlighting mental performance and mental health services, they are in a unique position to help improve the referral procedures for student-athletes and/or advocate for the inclusion of MPCs and/or LMHPs to meet student-athletes’ mental performance and mental health needs.