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Mental health finally a focus in college athletics, but advocates call for more

News & Observer - 8/13/2019

Aug. 13--In the 17 months since the death of his son, Mark Hilinski has visited enough college athletic departments to see the same things over and over, a pattern repeated: the renovated facilities, the expansive weight rooms, the well-accoutered players' lounges. Shiny perks, all, of a major college athletics enterprise that continues to generate ever-increasing revenue.

And yet, Hilinski said not long ago, referencing the athletes at the center of it all, "We can't fund a staff for their mental health?"

It was a May Tuesday at a Durham hotel, and he and his wife, Kym, had delivered the keynote address at the ACC's inaugural mental-health summit. For more than a year, the Hilinskis had been giving these kinds of talks, sharing the story of their son, Tyler, the former Washington State quarterback.

And so they stood on a stage in front of a crowded ballroom and brought Tyler to life again through their stories. He loved movies, they said. And his teammates. And even the trainers who taped him up before practices and games. And then one day in January 2018, he was gone. A self-inflicted gunshot.

On stage, Mark tried to collect himself when he described accessing Tyler's locked phone. Investigators finally found a way in. The password relayed an ominous message, a kind of last word from Tyler: "Sorry."

After a speech that has grown so routine that the Hilinskis have come to call them "Tyler talks," Mark detailed one of the most important parts of their mission: Persuading college athletic departments to provide "the proper resources," as he said, toward mental health.

Compared to other athletic department endeavors that have long taken priority, dedicating resources to mental health of athletes remains in its infancy. In January, one year after Tyler Hilinski died, the college athletics conferences that comprise the Power Five -- the ACC, Big Ten, Big 12, Pac-12 and SEC -- passed legislation mandating that their schools provide "mental health services and resources" to athletes.

The rule, which took effect on Aug. 1, is broad. It does not necessarily define what "proper resources" are, as Mark Hilinski put it. There are, for instance, no official guidelines about how many mental health professionals an athletic department must employ, or what their specific roles should be. And so those decisions are made school by school, with little uniformity from campus to campus.

What took so long?

In a time when major-conference schools continue to spend large amounts of money on facilities, coaches and other personnel, it is fair to wonder what took so long to commit resources to mental healthcare for athletes. Even the schools that were already providing such comprehensive services, beyond sports psychology, started doing so only relatively recently.

"Sometimes I look back and I think maybe this should have come first, instead of later down the food chain, so to speak," John Swofford, the ACC Commissioner, said during the league's mental health summit, comparing the recent focus on mental health to everything else that for so long overshadowed it.

"But I'm glad to see it, and it has to be something that's ongoing." he said, "... This can't be a one-year summit, so to speak, and then things dissipate. It's something that'll have to be followed up on and dealt with day to day, and invested in day to day in our campuses."

A survey of those campuses found that, across the conference, athletic departments have not hired mental health professionals in large numbers, relative to staffing levels in other areas. The News & Observer contacted all 15 athletic departments in the ACC, and requested from each the number of full-time staff members who provide mental health services to athletes.

Eleven schools responded with the information. With the exception of Wake Forest, the rest of the conference's private school contingent of Boston College, Duke, Miami and Notre Dame did not.

Among the 11 schools that provided information, their athletic departments employ 18 full-time staff members, combined, who provide mental health services for athletes. No school said it had more than three such full-time employees and only one, Virginia Tech, claimed that many.

The schools counted the personnel, and defined it, in different ways. Some included sports psychologists in their total. Some, like Virginia Tech, included licensed counselors. Some noted that they rely on part-time contractors to provide mental health services, and nearly all made clear that athletes also have access to the general mental health resources available on campus, which is something that the NCAA's mental health task force has recommended as part of its "best practices."

'We needed more help'

The NCAA's best practices are the closest things to formal rules governing the kind of mental healthcare that college athletes should receive. Those best practices stipulate that athletes should receive treatment from clinically licensed mental health providers; that there should be procedures to identify athletes in need of help, and a process to refer them to "qualified practitioners."

The best practices suggest that athletes should be pre-screened for mental health disorders, and that athletic departments should create "health-promoting environments that support mental well-being and resilience." The best practices are not rules, though, but suggestions.

"We do not know how closely schools are adhering to those guidelines, (or) if schools have made noticeable changes based upon those recommendations," Charlie Cox, a Florida State doctoral student in sports psychology, wrote in an email. He was the lead author of a 2017 study, published in The Journal of Sports Science, that concluded 1 in 3 Division I athletes suffer from depression symptoms.

Cox, whose study also found that 25.7% of athletes did not know where to access mental health services on their campuses, wrote in an email that there has been "some positive movement" related to mental health and college athletics, and that "progress has been made." But, he wrote, "I think there is a definite need to make mental health resources more accessible to athletes, with professionals who understand the culture and pressures surrounding college athletics."

In a major college athletics world of specialized, sport-specific services, the number of mental health specialists stands in contrast to the number of personnel in other areas. The staff directory for the Clemson football program, for instance, lists 42 individuals, according to the school's website.

Among them are 11 coaches; a director and assistant director of video operations, and a director of football coaching video; a director of "recruiting graphic design;" a director of football nutrition and an "executive performance chef." The staff also includes a "director of applied science" and four administrative assistants, not including the two assistants for the head coach, Dabo Swinney.

At Clemson, which won the college football national championship last January, there as many staffers dedicated to nutrition for the football team as there are who work full-time to provide mental health services for athletes in all sports. The athletic department employs two full-time mental health specialists, and shares two others with the general campus, according to a school spokesman.

"It was really important to Clemson in our structuring that we maintain a tether with the university and their health services, processes, and resources," that spokesman, Jeff Kallin, wrote in an email. "... (W)e are constantly looking at managing the demand on our mental health and wellness professionals, and updating our processes to best care for our student-athletes."

Nonetheless, Kallin wrote that the athletic department had no immediate plans to hire additional personnel to provide mental health resources. In addition to current staffing levels, The N&O also asked each athletic department whether it had immediate plans to hire additional staff members to expand the mental health services offered to athletes.

Only two schools, Georgia Tech and UNC-Chapel Hill, identified such plans. Georgia Tech, according to a school spokesman, is in the process of hiring a full-time clinical psychologist. UNC, meanwhile, is hiring an additional clinical psychologist to join Dr. Jeni Shannon, the clinical psychologist that the athletic department hired on a full-time basis in 2017.

When UNC made that hire, "We thought we had it covered," said Dr. Mario Ciocca, the athletic department's director of sports medicine. There was such high demand for mental health services among athletes, though, that Ciocca said he learned quickly that the athletic department needed to expand its staffing.

"We just figured out that we needed more help," said Ciocca, who added that the broader conversation surrounding mental health in college athletics has "expanded rapidly" in recent years.

'I was going to jump'

The ACC's summit reflected that. It was a two-day event with seminars that emanated gravitas: "Reducing the Stigma of Mental Health" and "Suicide Prevention Strategies," among others. The Hilinskis shared their story of grief, and hope, the first day. The second, Chamique Holdsclaw, best remembered for her basketball brilliance, detailed her experiences with depression and bi-polar disorder.

One of the summit's themes, and perhaps its dominant one, was destigmatizing mental health disorders and challenges -- promoting the thought that it's OK not to be OK. And yet that thought, too, runs counter to athletic pursuits, where between the lines perfection is rewarded, and weakness exploited.

The role coaches play in the mental well-being of their athletes is not necessarily quantifiable, yet Charlotte-based mental health advocate Fonda Bryant is passionate about the relationship. Bryant, a survivor of a suicide attempt, encountered Swofford during a chance meeting in July 2018, and she urged him to address mental health in college athletics.

She made such an impression that Swofford mentioned Bryant during his opening remarks at the summit. Bryant, whose son played football at Wake Forest in the early 2000s, attended as an invited guest. Perhaps what she noticed most, she said later, was the relative absence of coaches in attendance.

"The turnout was so one-sided," Bryant said during a phone interview, "because you had all these psychologists, all these therapists, and then you had some students sprinkled in there and a little bit of coaches. But darn it, the coaches, they should have been there."

Last month in Charlotte, the ACC again hosted its annual preseason football kickoff event -- the same one where Bryant approached Swofford a year earlier. Each of the league's head football coaches were there, along with 28 players, two from every school.

Some sound bites were predictable, as always: the opining about familiar storylines and what can be expected on the field this fall. Coaches arrived prepared to discuss (or deflect questions about) everything from their defensive lines to their depth charts.

Bryant wondered whether those coaches could speak with the same kind of authority about some of the most serious challenges their players encounter -- the ones that form, in the most difficult of moments, inside of their own minds.

"We're not asking them to be psychiatrists or psychologists," she said of the coaches, "but we're asking them to get educated and learn about mental health, and learn that it's just not a 'we're feeling sorry for ourselves' or 'we're having a bad day' -- to realize it is a serious issue."

During interviews at the ACC's media day, several coaches insisted they did understand the significance of their players' mental health. And yet the four coaches asked about it also acknowledged that the discussion is a relatively new one -- that in the not-so distant past they might not have given much thought to an athlete's mental well-being.

Now, said Scott Satterfield, the coach at Louisville, there is a "tremendous amount more awareness. Really in the last two to three, four years."

In some ways, their answers illustrated the novelty of the broader discussion. Coaches understand that mental health is something they should know about. Yet they're still figuring out, too, what to do with the information.

"I think it's awareness, for me," said Dave Doeren, the N.C. State football coach. "Whereas before, you might think a guy's soft. And now it's 'These are real things.' I mean, guys get depressed. We talk to their parents about it -- have you seen a change in your son, is this something you're familiar with? It's definitely something you have to be aware of. And we talk about it as a staff."

Dave Clawson, the football coach at Wake Forest, described it another way:

"I don't know if it alters the way you coach," he said. "But I think there's now this other dimension that if a kid isn't doing well, and it's not injury-related or sickness-related, that this is now in that world of things that can be going on in a player's life, that maybe you didn't consider as much 10 years ago."

At UNC, one football player's recent decision to detail his mental health challenges underscored the importance of providing mental health services for athletes. Jake Lawler arrived at UNC in 2017 from South Mecklenburg High as one of the Tar Heels' most heralded incoming freshmen.

In June, he published a 2,300-word essay on his website in which he described his eight-year experience with depression. He described two times he considered suicide, including the moment, earlier this year, when he stood atop a campus parking deck and contemplated the end of his life.

"I was going to jump," Lawler wrote.

A difficult, if not impossible, question to answer is how many college athletes there are like Lawler -- ones who've thought about suicide, or who are suffering from depression or any number of other mental health ailments. A University of Washington study, published in 2015, concluded that 35 college athletes died by suicide between 2003 and 2012.

The study found that while the suicide rate was lower for college athletes compared to the general population, male athletes and football players, in particular, faced the greatest risk among all college athletes. Another study, the one published in 2017 by the Journal of Sports Science, found that within a sample of 950 NCAA Division I athletes, one-third suffered from depression symptoms.

The authors wrote that "depression is a more significant issue in college athletes than previously thought." Mark Hilinski has tried to deliver that message through the story of his son, who was dead before anyone realized that something was wrong.

At one point during his talk in May, Hilinski spoke plainly to those gathered: "There's a kid on your team suffering from mental illness, or is having a bad day, that could use your help."

Less than a month later, Lawler, the UNC linebacker, went public. He received widespread acclaim for sharing his story and, in a subsequent interview with The News & Observer, said others suffering from depression then contacted him with their own experiences.

In some ways, the reaction to Lawler's story illustrated part of the challenge of addressing mental health among college athletes: so few who are suffering share their troubles that, when they do, it's cause for celebration.

Indeed, it's "very rare," said Myles Dorn, also of Charlotte and one of Lawler's teammates at UNC. "Let alone for a football player, because you're trying to be tough. You're trying to be all strong. But like, you get weak at some times. You get down on yourself sometimes. And it's OK, and it's all right to feel that way."

Now the hope, for Hilinski and other advocates, is that college athletic departments devote more money to mental health -- that, especially, counseling staffs become more robust. Hilinski in an interview in May compared treating mental health disorders with physical ones.

"How do we deal with this the same way I've got a nagging ankle injury?" he said. "I've got 12 guys that can fix your ACL. But nobody to talk to?"

Conferences like the ACC's summit represented a starting point, he said. So, too, does the increased awareness among coaches. And yet after focusing for so long on the tangible and physical -- on building stronger bodies -- college athletic departments are only starting to devote resources to athletes' minds.

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