Simone Biles, Michael Phelps, Naomi Osaka, Serena Williams – in recent years, several elite athletes have publicly shared the mental health challenges that led them to step away from major competitions. Their actions mark a culture shift toward greater acknowledgment of psychological well-being in sport but despite this increased awareness, student-athletes in Canadian universities continue to lack necessary emotional support.
In essence, student-athletes are often conditioned into thinking they are living the dream; if something goes awry, the problem must be the athlete.
“You’re very much made to drink the Kool-Aid in athletic programs … like it is bigger than you and you are a part of something, and this is our history,” says Santana Ferreira, a graduate student and member of the University of Toronto women’s soccer team. “You get so indoctrinated into how phenomenal everything is … but it’s not for everybody, and the people that it’s not for have a rough go.”
Student-athletes enter their post-secondary years dedicated to representing their university and furthering their athletic careers. This school-sport regimen imposes time demands equivalent to a full-time job. During the busiest times of their athletic seasons, they may be training or competing up to seven days a week. Travel eats up yet more time.
Beyond navigating the same stressors faced by their non-athlete peers, the student-athlete encounters challenges balancing school and sport, pressure to perform in the public arena, and team/coach dynamics. Injury is another stressor as athletes grapple with the psychological effects of being unable to compete, isolation from their teammates, and whether they will be able to return to sport. These can compound into tremendous emotional stress.
“Student-athletes, in general, can experience a high burden of mental health symptoms,” says Carla Edwards, pre-eminent Canadian sports psychiatrist. “The challenge is that there are very few … mental health resources dedicated to student-athletes in most Canadian institutions.”
In 2020, she and others at U Sports – Canada’s national governing body for university sports – published mental health best practices to guide institutional management of student-athlete mental health, which were largely informed by the National Collegiate Athletic Association (NCAA) mental health guidelines. Intentionally non-prescriptive, the best practices were intended to serve as a menu of options for improving mental health services while taking into account institution-level differences in resources and structure.
Despite recommendations from athletes and sport governing bodies, evidence suggests that schools have barriers to accessing care and uphold environments that stigmatize mental health.
The most widely recognized explanation for this gap in care is financial constraints. Canadian universities do not have the financial infrastructure or athletic budgets of their American counterparts. Those budgets also vary considerably across universities and across teams within Canada.
That said, it remains unclear whether the funds available are being allocated to prioritize improvements in mental health services. Though Edwards has offered several low-barrier solutions that would not impact the budgets of universities, she says she has seen resistance to their implementation.
The issue of gaps in mental health services primarily lies in whether institutional leadership believes in and prioritizes mental health, explains Edwards, who adds that schools may be worried about legal liabilities since they may not have the resources to meet the need, she says.
The issue of gaps in mental health services primarily lies in whether institutional leadership believes in and prioritizes mental health.
For student-athletes, gaps in mental health services become glaringly obvious when they are in need. During her undergraduate education, Ferreira experienced mental health challenges while recovering from a concussion and navigating the pandemic. She says there was one athletic counsellor for all varsity teams at the University of Guelph; issues with access and fear of repercussion led her to pursue external care.
There is an understanding among student-athletes that mental health is rarely discussed and that services are generally inaccessible at Canadian institutions. And this appears consistent across Canada. Hilary Evans and Philip Thorne, former student-athletes from Mount Allison University and University of Calgary, respectively, cited a lack of targeted mental health care. Athletes remain perplexed by the gap in resources given the demonstrated importance of mental health.
“You’ll have a team doctor or you’ll have a physiotherapist … how do we not have an advocate for mental health on the staff so that person becomes seen and is easy to approach for the student-athletes?” asks Thorne, a former football player.
For many, the looming impact of stigmatization remains.
“I can’t see why we don’t resource better, especially if the research shows that athletes with access to mental health care perform better, have more longevity in sport,” says Ferreira. “I can’t see why, if not for stigma, we don’t allocate funds that way.”
Supporting the mental health of student-athletes goes beyond more investment. It means leveraging existing resources and technology and offering an integrated pipeline for services – from identification to support. According to Edwards, the University of British Columbia and Carleton University are schools that demonstrate the gold standard through their robust mental health services.
Echoing her work on the U Sports mental health best practices, Edwards points to simple things all universities can implement. For example, integrating a mental health screener into pre-season health assessments athletes must complete is an opportunity to determine those in need or at risk. Digital assessments that can flag concerning scores streamline the process, reducing the time needed to review documentation and lowering pressure on staff.
Though many universities do not have sport-specific care, they have wellness centres with mental health professionals – psychotherapists, psychologists and social workers – that provide a foundation that can be scaled up, Edwards suggests. Athletes can also be connected with sports psychiatrists, like herself, who are covered by provincial health care.
Schools with the financial capacity can expand their existing care team with the inclusion of mental health professionals who offer sport-specific support. For instance, some Canadian universities or individual teams have integrated mental performance consultants (MPCs) who focus on helping athletes develop tools for improved performance and overall well-being. Though they cannot diagnose or treat mental illness, they can serve as a conduit to further care. Some former student-athletes, like Rankyn Campbell of Campbell Health and Evans from Mount Allison, have become mental health practitioners, providing athletes support that is conscious of athlete identity and experience.
While sport offers athletes a plethora of positive outcomes and opportunities, providing suboptimal care to Canadian student-athletes can outweigh the positive impacts, leading some to underperform, suffer in silence or quit their sport altogether. Many athletes, including Ferreira and Evans, say a dedicated mental health professional within the athletic care team would be greatly beneficial.
Canadian post-secondary institutions need to step up to the plate to improve mental health services for student-athletes. Fear about legal liabilities cannot continue to override action to support psychological well-being. As the culture around mental health for elite athletes continues to be acknowledged, there is cautious optimism that future student-athletes will be better supported.