Via Global Sport Matters, an article on how college athletes are raising the alarm on mental health:

As college campuses across the United States rally around and reckon with athlete mental health, Gen Z college athletes are taking efforts into their own hands.

On the last night of spring break in March 2022, amid her offseason workouts as goalkeeper for the University of North Texas, Sarah Fuller couldn’t shake the thought: She did not want to return to the field.

Fuller started for the Eagles during their 2021-2022 fall season. Before North Texas, she played four years of soccer at Vanderbilt, where, in December 2020, she received national acclaim after becoming the first female student-athlete in history to score in a major conference college football game.

But the media attention and photos of a smiling Fuller belied her secret: Fuller had struggled with her mental health for years. At both North Texas and Vanderbilt, she’d visited the sports psychologists who served the student-athlete population. She’d tried a therapist through Vanderbilt’s Student Health Center. (That therapist, upon hearing Fuller detail her struggles with anxiety and depression, suggested she simply quit the sport she’d played since she was 5.) She appealed to coaches at both schools, who often responded with a “toughen up” or “just work harder” mentality.

Nothing helped. So that Sunday night, she texted her team trainer:

“I can’t come in tomorrow morning. I feel like I will kill myself if I continue doing this.”

Fuller had five missed calls from teammates after missing practice the next day. But they weren’t calling only out of concern for her well-being. Team rules stated that if a team member didn’t show up for practice, the rest of the team had to do “burpees” – exhausting full-body calisthenics – for every minute missed by the absent player.

“That was sad,” Fuller says. “It wasn’t, ‘Hey, are you doing OK?’ It was, ‘We’ll get punished if you don’t show up.’”

The disconnect between Fuller’s need for mental health support and the lackluster response illustrates a problem that has permeated the United States’ college sports landscape.

At least five student-athletes died by suicide in the two-month span of March and April 2022. And recent data has shown that many more college athletes struggle with thoughts of depression, anxiety and, sometimes, taking their own life.

A comprehensive NCAA Student-Athlete Well-Being Study released in May 2022 showed that the rate of reported mental health concerns experienced by student-athletes (surveyed in the fall of 2021) was 1.5 to 2 times higher than historic rates reported before the pandemic. Add in the pressures of name, image, and likeness business opportunities, the expanded transfer portal, and the after-effects of the COVID-19 pandemic, and the mental load on collegiate student athletes has only increased.

That’s why athletes like Fuller have started talking openly about mental health challenges while simultaneously pushing for advocacy, awareness, and systemic improvements. They know there is no panacea and that every state, city, town, league, and school has different systems in place.

But many student-athletes and organizations are taking tangible action, whether that means publishing their personal stories, like that of Vanderbilt lacrosse player Cailin Bracken, or advocating for more support on Capitol Hill, as Fuller and Bracken have done alongside other current and former college athletes.

“The problem is that so many of us don’t feel like we have this landing pad,” Bracken wrote in her “A Letter to College Sports,” in April 2021. “Instead, we feel like we’re a perfectly curated glass ball, and if we come near a hard surface at the wrong angle, we’ll shatter.”

******

Former Louisville swimmer Abdelrahman El-Araby (who also goes by the name Haridi Sameh) arrived at Louisville in 2018 as an Egyptian national champion and a two-time All-Africa champion. El-Araby, now 23, redshirted his first collegiate season before qualifying for the NCAA Championships during the 2019-2020 season (the championships were canceled due to the pandemic).

Following the pandemic, he swam a successful 2020-2021 season, when Louisville won its first Atlantic Coast Conference men’s swimming and diving championship and El-Araby was part of a winning medley relay team at the NCAA Championships.

He spent months trying to qualify for the 2021 Summer Olympics. But he missed qualifying for Team Egypt by margins as small as 0.2 seconds, and he began to experience depression and feelings of self-doubt and worthlessness.

“The voices in my head just kept getting louder and louder,” El-Araby says. “At some point, the only thing I thought about to shut those voices down was to shut the whole brain down.”

During the 2021-2022 season, El-Araby saw himself as a cog in a machine designed to win trophies. He noticed that when his teammates expressed feelings of depression or needing a break from the water, the response was sometimes mixed. “Some people would be like, ‘Hey man, I’m here to talk,’” El-Araby says. “And others would be like, ‘Why are you being such a p***y? We have team goals here.’”

El-Araby qualified to compete in the 50-meter freestyle and again as part of the 200 freestyle relay team for the NCAA Championships, set for late March 2022. But on March 12, as he later revealed on Instagram, El-Araby attempted to take his own life.

As he began to lose vision and hallucinate, he called his best friend, who arrived and found him lying on the floor. His best friend called 911, and El-Araby was rushed to the hospital. His heart stopped en route in the ambulance, and he fell into a coma.

El-Araby awoke in the hospital two days later, a breathing tube in his mouth. Later, one of the team’s athletic trainers, while trying to understand what had happened, told El-Araby that he hadn’t seen any warning signs. El-Araby says that was because he hadn’t felt like he could tell the team and coaches about his mental struggles.

“Mental health professionals are great, but look logically at the time and number of hours you can spend with them,” El-Araby says. “The team needs to be the safe environment. This is a real thing: You can be talking to an athlete about the game plan for next Monday’s competition. But Sunday night, he might take his own life.”

This crisis isn’t limited to student-athletes. Suicide is the second-leading cause of death for college students nationwide. And according to data from Penn State University’s Center for Collegiate Mental Health, the number of students seeking help at campus counseling centers increased almost 40% from 2009 to 2015 and continued to rise until the pandemic began. The U.S. Surgeon General recently released a lengthy public advisory report detailing the “devastating” mental health crisis among young Americans.

And as a KFF Health News story from February 2022 pointed out, many colleges are struggling to recruit and retain enough mental health professionals, noting that more than 129 million Americans live in areas with a documented shortage of mental health care professionals.

“We were already seeing a decline in mental health before the pandemic,” Dr. Amanda Sovik-Johnston, licensed clinical psychologist and founder and CEO of Active and Connected Family Therapy, says. “Then the pandemic fast-forwarded what was an already-existing trend around the mental health of kids and teens.”

The causes, Dr. Sovik-Johnston says, are multifaceted, including a lack of social skills post-pandemic; a failure to launch; anxiety and struggles with eating disorders; and harm to self-worth stemming from social media. A 2020-2021 Healthy Minds Study collecting data from 373 campuses nationwide found that more than 60% of college students had endured at least one mental health problem.

Many of those challenges are faced by student-athletes, who also endure an additional, specialized set of hurdles. They face persistent pressure to perform well, and they are typically required to spend a minimum of 20 hours a week training when in season while also balancing academics and social lives.

The NCAA Student-Athlete Well-Being Study was designed by NCAA research in collaboration with the NCAA Sport Science Institute and the Division I, II and III Student-Athlete Advisory Committees. As noted in the study’s results, “Women’s sports participants and white student-athletes were overrepresented in the sample.”

Given to more than 9,800 student-athletes across Divisions I, II and III, the survey found that 69% of women’s sports participants and 63% of men’s sports participants agreed or strongly agreed that they knew where to go on campus if they were experiencing mental health concerns. But smaller percentages – 48% of women’s sports participants and 46% of men’s sports participants – said they felt comfortable seeking that support.

“So we have more awareness but still this stigma [about speaking to mental health providers],” says Dr. Jason Freeman, Sport Psychologist and Licensed Clinical Psychologist at the University of Virginia Department of Athletics. Freeman also pointed out that student-athletes of color experience a higher level of distress than their caucasian (and/or) European counterparts, as do those who identify as LGBTQ+, particularly trans students.

The number of staff members devoted to working specifically with student-athletes also varies widely based on institutions’ size, location, and resources. But even when there is a sports psychologist – or two or three – on an athletic staff, the needs of student-athletes range widely. Some student-athletes may want more sports performance-based tools and aid, while others may be struggling with body image, relationship woes, or depression and anxiety. Training a sports psychologist to meet that spectrum of demands is a heavy load. As a result, some colleges and universities are trying to train peers, coaches, and staff in mental wellness skills as well.

“There’s no one who has more power with a student-athlete than a coach,” Freeman says. Empowering coaches and staff to better understand their own mental health, as well as how to talk to their athletes about theirs, is an important step.

When asked in the NCAA survey whether their coaches took their mental health concerns seriously, 59% of men’s sports participants agreed or strongly agreed, compared with half of women’s sports participants.

During Fuller’s year at North Texas, she says she cried before almost every off-season practice. Often, as she prepared to drive to practice, she thought to herself, “I hope I get into a car accident on the way.”

One afternoon, one of her coaches was talking to her after she’d bought a new pair of cleats.

“Are you OK?” the coach asked her.

“No, actually, I’m not,” she replied.

The coach looked confused.

“Wait, what did you just say?” Fuller asked.

“I asked how your cleats feel,” he said.

“They’re fine,” Fuller said, before quickly adding, “but I’m not doing OK.”

The coach looked at her. “OK,” he said.

Then he walked away.

“The people who need to be trained the most are coaches and athletic administrators,” Bracken says. “You are 18, 19 years old, and these adults are the people you see the most. They have a responsibility to keep the student-athletes safe and to meet them where they are.”

Institutions have tried various ways to do so. At the University of Virginia, the athletic department partnered with a local mental health and wellness nonprofit to offer a series of training sessions for athletic coaches and staff. The training, Freeman says, was designed to educate coaches about various mental health conditions, warning signs, and ways to have conversations with student-athletes around seeking care and support.

Student-athletes may also fear repercussions if they ask for a day off of practice or mental health breaks away from their sports, particularly during the season. As such, giving student-athletes the time, space, and reassurances that there will still be a place for them when they return, Fuller says, is the next step.

“It’s so scary to balance the reality of, here’s a sport I’ve played my entire life that I clearly love and I want to succeed in, but at the same time, it’s making me miserable,” Fuller says.

The Virginia athletic department has also set up spaces for student-athletes to talk with each other about their own stories and experiences. “There’s a power in peer sharing,” Freeman says. “Student-athletes are talked at all day: in class, with coaches, on the field, etc. We can support them in creating spaces where they can share stories and perspectives with each other.”

“It’s a mistake to think the mental health of our community will be managed solely by professionals,” Freeman continues. “We need to treat this like a village where we’re coming at this from multiple angles.”

*******

On Feb. 28, Fuller and Bracken were part of a group of current and former student-athletes organized by former college and pro football player Colton Underwood to meet with lawmakers in Washington, D.C.

Underwood, who established his Colton Underwood Legacy Foundation in 2015, says he struggled with his mental health while playing college football at Illinois State University.

“I say this out of complete respect for my university: There was no support system [around mental health],” Underwood says. “I can tell you 100 injuries and other ways they supported broken fingers and torn ACLs. But when it came to depression and anxiety, there was no support system or game plan.”

Underwood was on scholarship, and he knew that the coaching staff had access to his private medical records, which further fueled his anxiety. His mental health challenges continued when he signed with the National Football League’s Raiders in 2017. Life in the spotlight as a pro athlete and contestant on ABC’s The Bachelor series added more pressure.

In an April 2021 interview with Robin Roberts, during which Underwood came out as gay, he detailed his mental health spirals in the years during and since his pro football days. He initially founded his nonprofit to focus on advocacy and awareness around cystic fibrosis but shifted focus to college athletes and mental health in 2021.

That’s why Underwood, Bracken, Fuller, and former college football players Henry Miller and Byron Perkins shared their mental health journeys with bipartisan lawmakers on Capitol Hill.

But they weren’t there solely to share their stories; the athletes also advocated for the TEAMS (Targeting Emotional And Mental Stability) Act, proposed legislation that would allow the U.S. Secretary of Education to fund school-based mental health programs in the student-athlete population and offer funding to train coaches and support staff.

(While none of the legislators’ offices were available for comment for this story, Underwood’s publicity team reported afterward that the meetings were favorable and the legislators promised a full review of the act.)

In addition to proposals for change at the national level through legislation, nonprofits nationwide are working to erase mental health stigmas and bring about more initiatives, resources, and support to campuses.

The Hidden Opponent (THO) was founded in 2019 by Victoria Garrick Browne, a former Division I volleyball player at the University of Southern California. Garrick named THO for her 2017 TEDxTalk, where she spoke about her personal struggle with depression and anxiety and the mental health crisis facing athletes around the world.

THO, which COO LeeAnn Passaro says is aiming to become “the forefront organization in leading actionable change,” now has more than 900 student-athlete ambassadors, called “Campus Captains,” on more than 750 campuses worldwide. THO leaders have created substantive local programs and driven legislation since forming just four years ago.

In January 2023, the Division I, II, and III SAAC and NCAA Board of Governors Student-Athlete Engagement Committee issued a joint statement noting the “urgency surrounding mental health support for student-athletes.” The message noted that for the first time in NCAA history, the term “mental health” is included in the NCAA Constitution, indicating a commitment by the NCAA to student-athletes’ health, safety, and well-being. The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports also commissioned a Mental Health Advisory Group and charged it with updating and reviewing the existing Mental Health Best Practices.

As Passarro points out, there’s still no firm, uniform policy in place, particularly regarding the number of support staff per student-athlete or what mental health services must be made available for student-athletes.

“Having a hired professional in the building who’s a dedicated expert in the field is step one,” Passaro says. “Just like we have athletic trainers on the sidelines who travel with every team. I’d love to see a world where an athletic trainer gets on the bus along with a mental health professional traveling with each individual team.”

Other organizations and initiatives such as Morgan’s Message and Katie’s Save, both named for collegiate student-athletes who died by suicide, have been established to better support student-athletes who are struggling mentally while also improving the treatment of mental health for student-athletes through dialogue, trainings, and designated advocates.

Professional athletes are pushing for change as well. In 2020, New York Jets defensive end Solomon Thomas co-founded The Defensive Line with his parents, Martha and Chris, after Solomon’s sister, Ella, died by suicide in 2018. The mission of TDL is “to end the epidemic of youth suicide, especially for young people of color, by transforming the way we communicate and connect about mental health.”

“At the end of the day, one of the best resources you can have is someone you trust and love,” Thomas says. “And having people in the locker room who are educated and can know how to address [mental health] or look for it and listen. And be more empathetic and sympathetic to the stresses we all go through. We go through similar things, but we handle it so differently.”

*******

In late spring of 2022, as Fuller debated whether to return to play for the University of North Texas for her final year of collegiate eligibility, she joined Minnesota Aurora FC, the first women’s pre-professional soccer team in Minnesota and a team that is community-owned.

Playing with that team in the summer of 2022, Fuller says, renewed her love for soccer. She had supportive teammates and coaches. The coaching staff was all-female, which Fuller had never experienced before.

The team offered weekly check-ins with the players. Every week, each player would be sent a private Google form to answer questions: “How are you doing mentally? Should practices be tougher, or easier? How is your body feeling? How is your mind feeling?”

That type of check-in, Fuller says, felt much more personal. Her coaches would ask her out to coffee and talk about her goals, how she was feeling about the season, and what her future might look like. Whereas in college, Fuller says she’d never had a coach ask her out to coffee to have that kind of conversation.

During the summer season, her North Texas coach called to talk about the upcoming fall. Fuller still hadn’t decided whether to return; during the conversation, though, she felt they weren’t seeing eye to eye, and she couldn’t envision herself returning to North Texas.

Aurora FC advanced to the championship game in 2022, where ultimately the team fell short in the only loss of the season. Fuller remembered how, as she stood in the goal, 6,000 fans chanted her name – and not for football, she pointed out, but for the sport she’d played and loved her entire life. “Having gone through all of those struggles, it was so nice to end it on a high note and with that team,” Fuller says.

She loved the experience so much that she is now the sponsorship coordinator for the team. Fuller works remotely (she lives in Nashville, Tennessee) and has raised more than $300,000 in sponsorship dollars. And she is content, “repaying the team that helped me close my soccer chapter in a very healthy and happy way,” Fuller says.

Overall, this past season was up and down for El-Araby. He tried different medications for his depression, and he changed therapists. And one significant change happened: He began talking more openly about his mental health challenges, hoping it might help others who are struggling.

“A lot of what is beautiful about this population and these students is they are looking for therapists or talking out loud about their anxiety,” Dr. Sovik-Johnston says. “It’s an acknowledgement that life is hard and we need people around us to feel better. And to not do it alone.”

In March 2023, a year after his suicide attempt, El-Araby won the ACC championship in the 50m freestyle, setting a new Louisville record. During his post-race interview, he stood on the pool deck, catching his breath. “I’m sorry,” he said, wiping his eyes as he spoke. A reporter asked what the win meant to him.

“It meant a lot of things,” El-Araby says. “It’s crazy to think I’m still here. If it means anything for anybody, it’s OK to fall. It’s OK to fail. It’s OK to lose the battle, just don’t lose the war. I lost the battle last year, and this one’s for everyone who lost the battle.”