College Athletes Push for More Mental-Health Care, Fighting ‘Tough It Out’ Culture

Olivia Lubarsky had always dreamed of becoming a Division I college gymnast. So when she committed to Towson University in her junior year of high school, she began a countdown on her phone right away.

“It was going to be the best four years of my life,” Lubarsky, now a senior, said.

But the transition from her California high school to an East Coast college was harder than Lubarsky had imagined. A perfectionist in a sport that demands perfection, she set unrealistic goals for her performance and became anxious and depressed when she fell short of them. By the middle of her first semester, she was struggling and unwilling to admit it, even to herself.

“The NCAA conditions you to withhold weakness,” she said. “I told myself, ‘I’m not like that. I’m tougher.’”

The start of college is a difficult time for many students, bringing homesickness, roommate conflicts, and uneasy freedoms. But for college athletes like Lubarsky, it comes with additional challenges: intense demands on their time, the pressure to perform, and the stress of being in the spotlight, their every move scrutinized.

While athletes are physically healthier than many of their peers, surveys have found that they’re just as likely to suffer from mental illnesses — and less likely to seek help. The reluctance stems, in part, from the culture of athletics. From a young age, athletes are trained to push through the pain and be “mentally tough.”

Those attitudes are starting to shift, as professional athletes open up about their own struggles with mental illness, and the NCAA shines a light on the issue. More colleges are screening students for mental-health problems, and some are adding sports psychologists to their athletics staff.

But the biggest driver of change may prove to be students like Lubarsky, who is part of a growing movement of athletes who are challenging the culture of college sports and pressuring their athletics departments to treat mental illness with the same urgency as musculoskeletal injury. During her sophomore year, Lubarsky started a public-awareness campaign at Towson called “Own Your Roar”; this year, she persuaded campus administrators to create a mentoring program that matches freshman and sophomore athletes with upperclassmen on other teams.

Her goal, she said, is to ensure that future students won’t suffer in silence as she did.

“I knew I had my teammates, but I didn’t want to be a burden,” she said. “Maybe if I had a mentor whose job it was to check in on me, I wouldn’t have isolated so much.”

A Disconnect

Division I colleges devote tremendous resources to the physical health of their athletes. Athletics departments brim with trainers, strength coaches, orthopedists, and dietitians. Yet only a fifth of those colleges have a mental-health provider who works in the athletic-training room, according to research published in 2016.

Lubarsky experienced this disparity firsthand. When she sought help, midway through her first semester, the campus counseling center referred her to a list of outside providers. With no car and a packed schedule, Lubarsky chose the most convenient provider, even though it wasn’t a great fit.

During sophomore year, Lubarsky returned to the gymnastics team but ruptured her Achilles tendon before the first meet. A week later, she was in surgery.

“Both of my setbacks were equally valid. Both set me back a year,” she said. “What we don’t have is support for the struggles we face internally.”

Lubarsky said she’s “so grateful” for the support administrators have given to her campaign, and she’s sympathetic to the budget constraints colleges face. She has suggested solutions, like the mentoring program, that don’t cost a lot of money. Still, she thinks colleges as a whole need to commit more resources to athletes’ mental health.

Brian Hainline has heard that often from athletes during his six-year tenure as chief medical officer for the NCAA. A common complaint, he said, is that campus counseling centers don’t understand college sports.

Students tell him, “I go in to talk about anxiety, and the counselor says, ‘Take a couple weeks off your sport,’” said Hainline, who has made mental health a priority of the NCAA.

To remedy that, some colleges are hiring counselors to work with athletes on their home turf: the training room. The counselors, who tend to have backgrounds in sports psychology or be former athletes themselves, “understand the culture of athletics and the demands on student athletes,” said Emily Klueh, a clinical athletic counselor at the University of Michigan at Ann Arbor and a onetime swimmer for the college.

Embedding counselors in the training room carries other benefits too, said Christopher Miles, a medical director of athletics at Wake Forest University who has studied the practice. Busy athletes can get treatment without trekking across a campus, and colleges can more easily coordinate athletes’ physical and emotional care. Putting the psychologist in the same room as the physical therapist can also “normalize” help-seeking, reducing the stigma surrounding mental illness, Miles said.

In a 2016 survey co-conducted by Miles, close to half of the Division I athletic trainers on campuses without embedded counselors said they would be able to provide better care to athletes if mental-health treatment occurred on-site.

But most colleges can’t afford to hire a full-time sports psychologist, and the NCAA’s “best practices” document doesn’t recommend it anyway. Hainline said there’s no evidence that embedding is more effective than off-site counseling and added that some students might prefer the anonymity of a campus counseling center over the familiarity of the athletics department.

‘It’s OK to Not Be OK’

Athletes are pushing back against the “tough it out” mind-set through public-service announcements, social-media campaigns, and sporting events dedicated to mental health.

Anna Glenn, a gymnast at the University of California at Los Angeles, started a mental-health campaign, Bruin Brave, after a season-ending injury led to depression. Justin McKenzie, a former Division II hockey player, cofounded a group called Hope Happens Here at Saint Michael’s College in 2015, after an athlete friend at another college died by suicide.

In men’s sports, especially, “there’s a fear of being deemed weak or unreliable,” he said. “If you’re showing weakness mentally, how can a coach trust you?”

By speaking honestly about their struggles, and getting other students to do the same, they hope to show both athletes and coaches that “it’s ok to not be ok,” as McKenzie likes to say. That this message is coming from peers makes it even more powerful, said Daniel Eisenberg, a professor of health management and policy at the University of Michigan School of Public Health; research shows that peers are one of the most trusted sources of information.

It’s impossible to say how many athlete-run campaigns and groups exist on college campuses, but by all accounts, the number is growing. Hope Happens Here, one of the oldest groups, is up to 11 chapters, on campuses from Maine to North Carolina. Students in Oregon State University’s group, Dam Worth It, recently got a grant from the Pacific-12 Conference to spread its model across the West Coast.

Measuring the effect of the programs and campaigns is tricky — how do you put a number on stigma reduction or quantify cultural change? But Taylor Ricci, a co-founder of Dam Worth It, believes athlete-run groups like hers have already succeeded by creating a space where students and coaches can talk candidly about mental health. The next step, she said, is to match that talk with resources.

That will be harder. Colleges are already struggling to meet the rising demand for student mental-health services. Still, colleges can help athletes in ways that don’t require a ton of money, said Laura Horne, chief program officer for Active Minds. For example, they can create an athlete-wellness committee, as St. John’s University, in New York, has done, or offer walk-in counseling in the athletics department during certain hours, as the University at Albany does.

McKenzie would like to see all colleges screen their athletes for mental illness during the annual preseason physical; right now, only about 40 percent of Division I colleges do, according to Miles’s survey.

Lubarsky, meanwhile, hopes her mentoring program will become a model for other colleges. A psychology minor, she plans to study the program’s effect on student well-being and feelings of self-efficacy, then pitch it to the NCAA.

“This is one area where there is no need for competition at all,” she said. “Take my ideas. We need to unite in this fight.”

Kelly Field covers student success, equity, and federal higher-education policy. Contact her at kelly.field@chronicle.com. Or follow her on Twitter @kfieldCHE.