Best Practices for Coaching an Athlete With Mental Health Concerns

Psychological problems in youth including depression, self-harm/suicidality, anxiety, substance use, and eating disorders are a growing concern,^3,4 only exacerbated by the Covid-19 pandemic.^1,2 Elite-level youth and college athletes are not immune from this psychological distress. ⁵ Although engaging in highly competitive sports can be a rewarding and life-enhancing activity, it also is extremely demanding. Challenges in the recruiting process, competitions, training routines, and pressure to consistently perform at the highest level may create distress or exacerbate underlying mental health conditions in elite athletes.

When an athlete shows signs of psychological distress or is experiencing a mental-health-related problem, a coach may feel disappointment in the player’s performance, fear they will lose a player, worry it will impact the team and perhaps negatively affect other players, be concerned it will scare new recruits, and harbor doubts about their own coaching and the possibility they contributed to the distress of the athlete. These are understandable concerns, but they must not interfere with appropriately addressing the needs of the distressed athlete.

A best-practice approach to coaching and mental health includes the following steps:

BE PRO-ACTIVE. Expect that your athletes are going to be under duress at times and normalize this experience for them. Let them know others may be having a difficult time, too. Bring in experts to work with your team in a prophylactic manner – preventing distress is easier than curing it. Cultivating healthful sleeping, eating, and mental health practices and addressing substance use should be an integral part of elite training. Given their influential position, coaches can serve as role models with respect to healthful behaviors for their players and staff.

ENCOURAGE ATHLETES to express their worries and concerns to responsible adults, as well as to seek support from their team mates, other coaching staff, and you. Let them know they do not have to suffer in silence.

THANK the athlete when they do have the courage to come to you and share their distress. Tell them you are glad that they spoke up because now you can help them get the support they need. It is a testimony to the relationship you have developed with players if they trust you enough to share their concerns.

EXPRESS EMPATHY. Say you are sorry they are not feeling well and that you want their sports experience to be positive. Acknowledge elite competition can be challenging, but it should not be overwhelming.

ASK THEM what they need from you, what would be helpful. Even slight variations in training schedules, practice routines, or coaching strategies and communication styles might make a big difference. Would a brief time away from some team responsibilities be useful? Work with the athlete on a plan for return to health and let them know that it is OK to take time away from their sport if needed.

DESTIGMATIZE mental health concerns. If an athlete told you they were experiencing feeling physical pain, you would probably know what to do to find them help and to ensure their proper treatment and healing to be able to return to play. It should be the same with mental health pain. It is no more their fault than is a physical injury. The main difference is that the athlete might experience stigma, feeling ashamed or embarrassed or “weak” because of the emotional distress. Indeed, some coaches may have told them as much. Acknowledge that athletes should not be asked to push through significant mental pain, just as they are not asked to push through physical pain from serious injuries.

MAKE REFERRALS to appropriate experts. You are not responsible for solving the athlete’s problems, but you should be a source of information for how they can get help. If the athlete indicates in any way that they are planning to hurt themselves or that they want to die (and you can ask them directly about this), get professional assistance immediately. Seek advice from university representatives, colleagues, and students themselves about services for additional support.

MAINTAIN CONNECTION. Even if athletes need to take some time off to heal (and this applies to healing from longer-term physical injuries as well), be sure to continue to check in with them and make available to them the positive aspects of team bonding and coaching staff support. They should not be isolated, ostracized, or punished because of their problems. If the player grants permission, you can share with teammates information so that they can support the player. This has the added benefit of showing to other players that they can expect support if and when they need it as well. A player’s eventual return should be celebrated.

These best practices are not difficult to implement, yet many coaches do not follow them. They show anger and disappointment and shame the athlete. They act as if having psychological difficulties is surprising, abnormal, a sign of weakness, a lack of commitment, a willful disregard for the team, or even a personal insult to the coach.

What makes it difficult for some coaches to respond appropriately and effectively? They may have been trained in a system that was not in line with current best practice, and this is the only approach they know. They may feel it has worked with some athletes in the past. In addition, they may be struggling themselves. High-level coaching is a demanding occupation with considerable challenges. When one is feeling stressed, it is difficult to tolerate distress in others and respond with empathy. However, the coach, a professional and the responsible adult in these situations, must find a way to rise above their own concerns at least to the extent that they can be available for the athlete in distress. Coaches deserve the same kind of support that athletes do, and they should seek out such support from experts or other adults outside of the team when needed so their distress does not detract from their coaching. Coaches might benefit from reflecting on their own views about mental health in their athletes and examine their own personal barriers, if any, to implementing the best practices outlined above.

In sum, playing sports at an elite level can be rewarding, but it is challenging. Athletes, like everyone else, are not immune from experiencing psychological distress at times. Coaches have the ability – and the responsibility – to effectively intervene to assist the player in distress. This will not only help the athlete but will contribute to a more positive and satisfying experience for the coach and, ultimately, to the greater success of the whole team.

Jane M. Simoni PhD
University of Washington, Seattle, WA, USA
Address correspondence to Jane M. Simoni PhD, Professor and Director of Clinical Training, Department of Psychology, University of Washington, 3909 Stevens Way NE, Campus Box 351525, Seattle, WA 98195-1525, USA (email: jsimoni@uw.edu).