For Coaches and Staff

Coaches and support staff are often considered to be on the front lines of mental health. With near daily relationships with our student-athletes, there is a chance that a student athlete may feel comfortable enough to come to you with an issues. Your job is to assist that individual in making sure that they understand what resources are available and to get them to the right treatment professional.

Emergency Action Plan

The following are some guidelines for when a student-athlete should be referred for mental health reasons:

Stated Need for Help.
The need for help with a problem may be stated directly or indirectly. For this reason, it is important to attend to both the content of what a student-athlete is saying and the possible feelings and intentions accompanying his or her message. Listening involves hearing the way things accompanying his or her message. Listening involves hearing the way things are being said, noticing the tone used, and observing the expressions and gestures employed. Special notice is to be taken of incongruities of expression or muted or extreme emotions.

Student-athletes may communicate personal problems to you via email rather than face-to-face. Others may get your attention in written form by references to emotional, physical, or sexual abuse, depression and thoughts of suicide, or death.

Changes in Mood or Behavior.
Actions that are inconsistent with an individual's normal behavior may indicate that he or she is experiencing psychological distress. An individual who withdraws from usual social interaction demonstrates an unwillingness to communicate, commits antisocial acts, has spells of unexplained crying or outbursts of anger, or demonstrates unusual irritability may be manifesting symptoms associated with a psychological problem.

Anxiety and Depression.
Anxiety and depression are two of the more common psychological disturbances that can present significant problems for student-athletes. When these common emotional states become prolonged or severe, they can impair an individual’s normal functioning. If this occurs, some kind of psychological assistance may be useful and should be recommended.

References to Suicide.
While some references to suicidal thoughts or plans are more serious than others, all should be taken seriously. Of particular concern are situations when an individual alludes to specific detail of where, when or how he or she may attempt suicide. In such cases, professional help must be sought immediately. Never assume that references to suicidal ideas or plans are attempts at gaining attention. It is always best to err on the side of caution.

Judgment about the seriousness of a suicidal reference or threat should be made in consultation with a mental health professional.

Physical Complaints.
Physical distress or complaints, which seem to have no apparent cause, may be indicative of emotional problems. Such symptoms may include a loss of appetite or excessive eating, insomnia or excessive sleeping, gastrointestinal distress, headache or general malaise.

Traumatic Changes in Personal Relationships.
Personal problems often result when an individual experiences traumatic changes in personal relationships. The death of a family member or close friend, difficulties in a relationship or family relationships, break-up, changes in family responsibilities, and difficulties in other significant relationships can all result in increased stress and psychological difficulties.

Drug and Alcohol Abuse.
Student-athletes may attend practice or competition under the influence of a drug or exhibit signs of being "hung over." Excessive drinking, drug abuse, or drug dependence are almost always indicative of underlying psychological problems. At the same time, they, in turn, cause problems of their own. Both the substance abuse and the emotional issues may warrant referral for professional attention.

Academic Problems.
Many students find the demands of college-level academic work to be greater than anticipated. While it is expected that all student-athletes will go through some adjustment period, those who demonstrate a consistent discrepancy between their performance and their potential may be in need of assistance. Frequent absences, failure to complete assignments, and inattentiveness in class are problems that might have a psychological basis and thus could be appropriate for consultation with a Mental Health Provider. Many of our student- athletes indicate that personal problems have an effect on their academic performance and have experienced improvements in academic performance as emotional concerns are addressed.

Delphi criteria for an urgent referral to a community mental health service:

1. Reason to believe that there is a risk of significant harm (immediate and serious risk to self and/or others) occurring as a result of a mental disorder, or suspected mental disorder.

2. Level of cognitive functioning that places a student-athlete at immediate risk of harm to self or others (e.g. due to wandering, self-neglect, abuse).

3. Patient will have been ill enough to have seen by the ‘referrer’ who has knowledge of the patient and considers the risk for urgency to be linked with a perceived mental health problem.

4. Support network not coping or sudden loss of social support network resulting in risk to patient.

5. Patient is at risk of abuse/vulnerable and is in a location that is not safe.

6. Delirium where no cause is found in order to rule out an acute mental illness.

7. Not eating or drinking. Level of urgency may depend on duration and what attempts have been made to address this before.

References

A Guide to Making A Referral - Vassar College Counseling:
https://counselingservice.vassar.edu/assets/pdfs/referral-guide.pdf

What should prompt an urgent referral to a community:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777582
Mental Health Fam Med. 2008 Dec; 5(4): 197–201.