New Guidelines on Mental Health and Secondary School Athletes

Source: The National Athletic Trainers' Association 

Dallas, March 2, 2015 – At the sixth Youth Sports Safety Summit this morning, the National Athletic Trainers’ Association released an inter-association task force consensus statement, “Recommendations for Developing a Plan to Recognize and Refer Student Athletes with Psychological Concerns at the Secondary School Level.” The event was convened by NATA and the Youth Sport Safety Alliance, comprising more than 200 organizations committed to sports safety. The recommendations are published online today in the Journal of Athletic Training, NATA’s scientific publication: https://natajournals.org/doi/pdf/10.4085/1062-6050-50.3.03.

More than 7.7 million secondary school students take part in organized interscholastic sports each year. Of collegiate students who experienced psychological concerns, particularly depression, 21 percent (one in five) reported high alcohol-abuse rates while in high school, according to the statement. Additionally 58 percent of 13 to 17 year olds report having childhood adversity including parental loss, economic hardship or maltreatment. A total of 86 percent of U.S. high school students indicate that some classmates drink, smoke or use drugs during the school day.

“The purpose of this statement is to raise awareness and provide education for the high school athletic trainer, coach, administrator, guidance counselor and parent on the prevalence of mental health issues in secondary school athletes,” said Tim Neal, MS, ATC, chair of the inter-association task force. “We have created a roadmap on how to better recognize potential mental health issues and develop a referral system to provide the athlete with assistance. This is the first time a cross section of interdisciplinary professions has collaborated on this type of document for the secondary school setting.”

Many student athletes define themselves and their identities as athletes, and when that identity is threatened the athlete may face psychological issues, according to Neal. Triggers can include a struggling performance, a chronic career-ending injury, relationship challenges, academic pressure, an eating disorder or bullying or hazing, among other concerns.

According to the statement, the types, severity and percentages of mental illnesses are growing in young adults aged 18-25. Given that mental illnesses are being reported in this age group, they may well start before or during adolescence. Recognizing the overall numbers of student athletes at the high school level, sports medicine professionals and mental health experts are certain to encounter athletes with these issues.

The task force was spearheaded by NATA and supported by the American Academy of Pediatrics; American Medical Society for Sports Medicine; American Psychological Association, Division 47: Exercise and Sport Psychology; American School Counselor Association; Association of Applied Sports Psychiatry; and International Critical Incident Stress Foundation.

Athletic trainers (ATs) and team physicians are in positions to observe and interact with student athletes on a daily basis. It is imperative to remember that the student in most cases is a minor; therefore collaboration with the secondary school administration is a must.

Consensus Statement Recommendations

To develop a plan that recognizes and refers student athletes with psychological concerns at the high school level, the task force developed the following guidelines:

1.      Be aware of stressors and the importance of education: A critical component is raising the awareness of the prevalence of mental health issues affecting secondary school student athletes.  ATs, coaches, school nurses and others are in positions to observe and interact with students on a daily basis. They should be aware of behaviors to monitor including injury and effects of concussion; substance and alcohol abuse; eating disorders, bullying and hazing; and effects of ADHD, among other considerations. Educating students on stress management strategies and services available to the athlete can help improve his or her ability to function.

2.      Refer the student athlete for psychological evaluation and care: Ensure a team approach. It’s important for the AT, school nurse, school counselor and team physician to collaboratively identify a potential psychological concern, and refer the athlete to the appropriate mental health professional (clinical psychologist, psychiatrist or licensed social worker). The pre-participation physical examination is an optimal time to ask about a history of mental health problems and to screen for related conditions.

3.      Build a plan for recognition and referral of the athlete with psychological concerns: Establish the need for the plan with the secondary school administration and athletic department. Draft and share the plan for feedback and approval by the school district. Once approved, share it accordingly with all those involved including the AT, coach, school nurse, school counselor and team physician. Review annually and update as appropriate.

4.      Approach the student athlete with a potential psychological concern: While approaching the student athlete with a concern may be uncomfortable, remember that the health and wellness of that individual is critical. Be sure to have accurate facts before meeting with the student, and remain empathetic when the meeting occurs. Encourage the student to talk about his or her situation and to have a mental health evaluation.

5.      Discuss confidentiality issues: In approaching student athletes with questions of concern, it is important to notify them of the limits of confidentiality. The AT should emphasize that informing a parent or coach who may be concerned about the athlete is advisable but not mandated unless there is a threat of harm. The AT and school district should check their state laws relevant to confidentiality and minor children.

6.      Schedule a 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 AT should help that individual make the appointment.

7.      Know when emergency mental health referrals are necessary: If a student athlete demonstrates violence or imminent threat to himself or herself, to others or to property; or reports feeling out of control, unable to make sound decisions or incoherent or confused, an emergency mental health referral is recommended.

This includes possible suicide attempts or threats: Approximately 4,700 young people between the ages of 14 and 24 die by suicide each year in the U.S. One in six high school students seriously considers suicide, and one in 13 students attempts it one or more times.

8.      Address emergencies and catastrophic incidents: The authors recommend the development of an Emergency Action Plan that can be implemented in the event of an emergency stemming from a mental health incident and possible attempted harm to the athlete or others. 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 AT providing initial support until the mental health expert is identified.

• Respond with empathy and support
• Enact the school crisis plan
• Notify the school crisis team
• Identify the level of intervention or referral needed
• Ensure safety and err on the side of safety
• Collaborate with colleagues
• Mobilize the student’s support system (including family)
• Connect immediately with the appropriate resources
• Follow up on the referral

9. Determine need for crisis counseling for student athletes: Student athletes may be exposed to a variety of traumatic stressors in the course of their athletic participation and daily life. Traumatic events may include the death of friends or family or exposure to suicide or violence, among other considerations. Providing appropriate care and referral to a mental health expert should be considered on a case by case basis.

10. Consider legal issues: The majority of student athletes at the high school level are below the legal age of 18. The individual must be considered of minor age, and appropriate measures must be practiced to comply with state laws. Secondary school district policies should be adhered to. ATs and others should be apprised of their respective state laws.

“The key factors in helping a student athlete with psychological concerns are education, early recognition, effective mental health referral and addressing potential risks within the secondary school system,” concludes Neal. “These protocols help ensure the best plans are in place for immediate action and care of the student athlete. Putting these steps in place can help the athlete excel at sport, have appropriate support to manage his or her psychological challenges and continue to thrive in life and school.”

In its continued commitment to youth sports safety, NATA released an inter-association consensus statement on “Developing a Plan to Recognize and Refer Student Athletes with Psychological Concerns at the College Level” in 2013: https://www.nata.org/sites/default/files/PsychologicalConcerns.pdf

For more information please visit: www.nata.org

About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport
Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers’ Association represents and supports 39,000 members of the athletic training profession. Visit www.nata.org