During the 2012–2013 academic year, 7.7 million secondary school students took part in organized interscholastic sports, compared with just 4 million participants during the 1971–1972 year.1 Many student-athletes define themselves by their identities as athletes.2 Threats to that identity may come in the form of struggling performance; a chronic, career-ending, or time-loss injury; conflicts with coaches and teammates; or simply losing the passion for playing their sport.3–5 These challenges and associated factors may put the student-athlete in a position to experience a psychological concern or to exacerbate an existing mental health concern.2The types, severities, and percentages of mental illnesses are growing in young adults aged 18 to 25 years, an age group a little older than secondary school student-athletes.6 Given that mental illnesses being reported in the 18- to 25-year-old age group may well start before or during adolescence and given the overall numbers of student-athletes at the secondary school level, clinicians are certain to encounter student-athletes with psychological concerns. The goal of this consensus statement is to provide recommendations for developing a plan to address the psychological concerns of student-athletes at the secondary school level. The recommendations will discuss education on mental disorders in young adults, stressors unique to being a student-athlete at the secondary school level, recognition of behaviors to monitor, special circumstances faced by student-athletes that may affect their psychological health, collaborating with secondary school professionals to assist student-athletes with psychological concerns, and legal considerations. Also addressed are educational efforts for student-athletes, coaches, and parents, as well as practical steps to consider when proposing a psychological-concerns plan to administration. The interassociation work group that developed these recommendations included representatives from 8 national organizations and an attorney experienced in sports medicine and health-related litigation; all members had a special interest in and experience with psychological concerns in student-athletes. This multidisciplinary group of professionals included experts in athletic training, general medicine, psychology, psychiatry, pediatrics, secondary school counseling, sport psychology, critical-incident stress management, and law.Recommendations of the consensus statement are directed at the athletic health care team, athletic department administration and staff, and secondary school administration. This includes athletic trainers (ATs); team physicians; coaches; athletic department administrators; administrators such as principals and superintendents; secondary school nurses; and secondary school counselors. It is imperative to remember that the student-athlete is first and foremost a student of the school district and in most cases a minor child; therefore, collaboration with secondary school departments is a must.Two points about this consensus statement are critical. First, the terms psychological concern and mental disorder are used instead of mental illness because only credentialed mental health care professionals have the legal authority to diagnose a mental illness. Suspecting a mental illness in a student-athlete that affects the student-athlete's psychological health is a concern that noncredentialed mental health care professionals have. Thus, we selected psychological concerns for the title, although that term and mental disorder are interchangeable within the statement. Second, only credentialed, licensed mental health care professionals are to legally evaluate, diagnose, treat, and classify a student-athlete with a mental illness. The credentialed mental health care professional should perform that medical-legal duty and not a noncredentialed individual, no matter how caring that person may be. This consensus statement was produced to inform ATs about developing a plan to recognize potential psychological concerns in secondary school student-athletes and to establish an effective mechanism for referring the student-athlete into the mental health care system for assessment and treatment by a credentialed mental health care professional. This consensus statement does not make recommendations regarding mental illness evaluation or care. Rather, our intent was to assist the AT, in collaboration with the athletic department and secondary school administration, in facilitating the evaluation and care of the student-athlete suspected of a psychological concern by credentialed mental health care professionals. Throughout this statement, the terms psychological and mental are used; various authors in both the text and in literature citations chose to use one or the other. Although the terms are synonymous, the focus of the statement is recognition and referral, not treatment; treatment is left to the credentialed mental health care professional. Additionally, in this statement, the term secondary school is interchangeable with high school as found in the literature.This statement mirrors the 2013 document “Interassociation Recommendations for Developing a Plan to Recognize and Refer Student-Athletes With Psychological Concerns at the Collegiate Level: An Executive Summary of a Consensus Statement.”2 That statement was designed for use by the AT practicing at the intercollegiate level. The current statement is designed for use by ATs practicing at the secondary school level, or in the absence of an AT at a particular secondary school, administrators may use this statement to develop a plan to address their student-athletes' psychological concerns. Ideally, a certified AT will help to develop and implement the recommendations of this consensus statement. The information contained in the collegiate and high school statements is similar but is targeted for each audience, and each statement is to be regarded as a stand-alone document for the indicated setting.The purpose of this consensus statement is for the reader to take the information provided and develop an appropriate plan for his or her institution to address the psychological concerns of student-athletes as part of a comprehensive sports medicine health care program. Specific goals of the statement are toThis consensus statement is organized as follows:The recommendations in this consensus statement use the Strength of Recommendation Taxonomy (SORT) criterion scale proposed by the American Academy of Family Physicians,7 which are based on the highest quality of evidence available. Each letter designation characterizes the quality, quantity, and consistency of evidence in the available literature to support a recommendation.Although this consensus statement uses SORT level C evidence for best practices, the educational component of mental illness in young adults is based on SORT level A evidence.Category: ACategory: ACategories: B, CCategories: A, BCategories: B, CCategory: CSimilar to physical injuries, psychological concerns can range from mild to severe, with varying effects on the life of the adolescent. In addition, some of these conditions can be lifelong, whereas others may be short-lived. Normal adolescence is a period of great change and maturation, during which emotional and behavioral difficulties are commonplace; however, the incidence of diagnosed mental health conditions remains consistent across studies, and psychological concerns must be appropriately and the mental health as of mental in with and the to to change and to with in 4 to in this during his or her as a of a mental health The of emotional and behavioral disorders in and is than that of some physical such as and American and of that mental disorder is a by in an emotional or that a in the or mental The that mental disorders are associated with or in or It is to that a mental disorder only the mental disorder an does not the Thus, a student-athlete as a or a with mental The of a mental disorder should have should assist clinicians in the treatment plan and for the the of a mental disorder is not to disorders have a of and the disorders are into of mental The is to an current not to a It is imperative that the not be by with appropriate and may diagnose an with a mental The in the as a for the mental health care professional to form a and are not a to a in the for by behavioral experienced and had The of of mental disorders the experienced of their disorder by age of their behavioral disorder by age of their disorder by age and of their disorder by age of have reported at and a mental disorder with or that with age of for and is and of The of treatment for in the and with of being with in and reported in that million American adults aged 18 or of the experienced a mental illness in aged to years, had experienced a in which was as a or of interest in that at and mental disorders found in adults are associated with during or adolescence and have high aged to had experienced or reported at and reported associated with the of The from with disorders to with behavioral A of of all of disorders associated with or was and to the best for The age of disorder was for for for and for that as as of the in the the for a mental than of diagnosed with a mental disorder disorders are with cases in a of with high disorders are reported in and to and on health-related quality of health care professionals are information on various mental health disorder is than The is at age years, with of mental disorders that have of of treatment for their such as disorders and the most of behavioral which affect of at and disorders at is a concern within this age given that of with of disorder the for a of disorder at some in their a by the of the of a range of mental disorders in a of was in the of aged to 18 in had a emotional that with In addition, mental health care. disorders of as as The of these disorders with a age to and age to 18 in the for an from for disorder to for a These disorders are in about mental health are by In a of from the of experienced a mental disorder during the and about across their incidence of with It is to at age to to at age and to are when to the effects of and Although in the of disorder and from to in aged to 18 and from to a as both disorder and disorder are associated with and of all mental disorders have their during and is the of from the and the regarding use for psychological is that and conditions will for of the terms of both and of all in for mental health that can be targeted for can be as training, and of will have a mental health This incidence for each from age to age In addition, with a physical illness are to develop and with an emotional disorder have an of developing physical the of student-athletes within secondary school athletic departments and the on mental disorders in the is a high that most secondary school athletic student-athletes experience or psychological concerns. The AT, in collaboration with the athletic department and secondary school administration, should develop a plan to recognize student-athletes with psychological concerns and an effective system to mental health care professionals for evaluation and a may which affects secondary school coaches, student-athletes, and their Many student-athletes of emotional than and have as incidence for of interest in and and to of these in can be to to to for athletic and the of professional to these a of life for of our young may with and both and each an on work for and can to physical and psychological and sport identity and the this the the psychological can be when and in their of athletic may being from a team, with in with to or and from and stressors on the student-athlete can be physical physical injuries, mental from and in and and and academic and the to on the team, and and a collegiate or academic These stressors on a on a student-athlete is when is no and the The student-athlete is to a of of and or her at for and is to and student-athletes are in of student-athletes, the of and life to at for and emotional health are as than and by stress or concerns of a Although are to these physical and mental a of the student-athlete will have The stressors of being a student-athlete can a psychological exacerbate an existing or a concern to and stressors to be of are in AT, team and others in the athletic department athletic coaches, academic support staff, school are in to and with student-athletes on a In most athletic department and secondary school have the of the and the student-athlete may to for or with a concern or during a student-athletes may or or some student-athletes, will not be of how a is or are will not inform These student-athletes may in a to others that is when a AT, team or a student-athlete's health, the is of a physical and on the student-athlete's mental health may be both physical and mental health are for the student-athlete's that may be of a psychological concern in a student-athlete are provided in although the is not may or in may be in and may range in to a mental health care professional should be as the and of behaviors or the is a change from the student-athlete's of the most mental and are found in and AT, and should consider the student-athlete's psychological to a physical matter how is a of stress to the Each student-athlete is the or by student-athlete may not be the as experienced by with the one that is or may be a of to stress in various with little whereas others or A student-athlete an for the first at the secondary school level will a for the physical and emotional to and which the AT can help the student-athlete During this of psychological and physical stress associated with an the student-athlete's should be of psychological concern is part of the comprehensive care plan for their to The AT should be of this the student-athlete of his or her to and the student-athlete for that a developing psychological of includes the and psychological effects on student-athletes this A student-athlete a should be for in or psychological a student-athlete a the school is to with the In the absence of a school AT, the should work to and psychological in the for disorders is whereas and is and and is With is a to in the of these which to be in collegiate student-athletes experienced psychological concerns, reported high in high A of of high school students indicated that some or use during the school and of to that of with or on to on the use of by student-athletes are to use in high In a collegiate for as well as and reported high of and associated with found reported and and care should be to the of and use their to an mental illness or that student-athletes will use or the and young the of is disorder affects to in a than to and in of or or their a is by of or and the for in both to the the of is by the of as well as the level of in and work is in with in of for that are severe, or as a of the is diagnosed in are minor and in and can be is that all the are conditions are and conditions that can are the and can be by parents, and and are in of are found in disorders affect as as but the incidence in both with is In of adults, the of disorders is to for and to for not for disorders of or into a of disorder not In the to be diagnosed than or some the focus on and behaviors Although of such as or is associated with some may develop a and of disorders are found in is a of and can and academic The by not only affects the but can affect and and the overall health and of and The for and as by or group of are not or current that an or and is or is to be may or on the targeted or educational young person can be a a or can take or of and can in person or In of being the of playing or of or or sports In addition, are to their or coaches have to and to of the on that a student is being the that a student be others the that the AT a student is or being first the and the school The to this is similar to the an AT that an is a mental health The AT is not to address the with the student and in a a to the and school that the AT the steps to that a school professional and will address the concern It is the of the and to take the steps to and the of team members can be as a of on athletic can be as a part of the is as or of a student to to a of his or her to on in American high are and can team are not of used to or within the These can affect both the and the that from and of and in stress and of stress is to have a team in to address the psychological concerns of student-athletes. This team includes the team school school and mental health care professionals and practicing sports medicine encounter psychological concerns in student-athletes. discuss psychological with student-athletes although their and can be an of information for the a student the school to discuss information with the AT, as by the and district the AT can use that information to best the The AT should with the school in the to information that be in with student-athletes. in the of for mental health the AT can the information for the the AT should with the school and school to regarding the of and the school are that a student-athlete a can the student-athlete's to consider academic AT should establish a within the secondary school and school AT must are available on and Many provide school and only on certain of the and at certain of the An the AT and the health team and how to the school and is for the AT to a plan of In addition, the school and can the AT regarding legal and the current plan of will be to mental health within the The AT and school health team can the plan of to the of for for parents, and district regarding as The school health team can the AT regarding in which a may be the of the or a to the to mental health care. Given that age legal have the authority to make on all of their health on the school administration for this of will be on the for the secondary school AT, his or her of may the AT is by the school or district the may be in an than the AT is a or of the administration may to be for as to the AT should or should not in the of a mental health This be to and psychological concerns are included in the of circumstances for which is should be given to a a the AT does not have ATs the most or may to from a psychological concern during a the AT may be to to the focus on the or and may be to care for an an and to the mental health or the for is In a an may be to provide or may be to with and a student-athlete for a reported psychological to student-athletes for mental disorders and the for by a mental health care professional. In the is a student-athlete for a psychological concern on the of the AT, school school or and a student-athlete with a psychological should on their experience but recognize their collaborating with mental health care professionals can develop the plan of and as appropriate for the ATs on student-athlete mental health of the to in student-athlete mental health concerns are provided in This consensus statement that each athletic consider educational in psychology, and to the of ATs to recognize and student-athletes for psychological physical is an to about a of mental health and to for mental health conditions such as and to and mental disorders should be included in the health The physical an to and mental health concerns by mental health as an of overall for mental health during the physical are found in to the mental health of the physical should be to the of the for a with the student-athlete to or is The of secondary school student-athletes are therefore, of and is a student-athlete with a concern about mental can be an the health and of the student-athlete is a with the is to have with to the of The should focus on the student-athlete as a not as an and the student-athlete to about is are A of to consider the student-athlete to of the is in a student-athlete to consider a mental health evaluation can be giv
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