Mikaela Brewer essay on athlete mental health
CHICAGO, IL - APRIL 01: Stanford Cardinal guard Mikaela Brewer (14) looks on in game action during the Women's NCAA Division I Championship - Quarterfinals game between the Notre Dame Fighting Irish and the Stanford Cardinal on April 1, 2019 at the Wintrust Arena in Chicago, IL. (Photo by Robin Alam/Icon Sportswire via Getty Images)

What the NCAA and College Athletic Departments Need to Know About Athlete Mental Health

Why this matters

Mental health is rigidly and fatally misunderstood, especially in college athletics. A former Division I college basketball player explains what the NCAA and university athletic programs miss about athlete mental health.

Monthly Issue Mental Health: A New Priority in Sport

Note: This story includes vivid depiction of mental illness and attempted suicide.

A few months ago, someone asked me, “Have you always been this open about your mental health?” I laughed nervously and shook my head. No. Then they asked, “Have you ever felt the fear of being judged or misunderstood?” Great question.

As a college athlete, one of the worst things you can buy into is the noise — the underlying hum of opinions shared in the news and on social media. However, when the word is out that you struggle with mental health, it’s a different story. The noise finds you.

For the better part of my life, I’ve lived alongside depression and obsessive-compulsive disorder. They shadowed me throughout high school, and followed me out West to sunny California, becoming bolder and more palpable. I wasn’t formally diagnosed with both conditions until my freshman year at Stanford, home to one of the strongest women’s basketball programs in the country. I was the first Canadian to ever play for Cardinal, and fresh off of a silver medal with Team Canada at the FIBA Americas Championship.

Then in February 2017, I was hospitalized on a 5150 hold for suicide.

The hospital cleaved my spirit, as my teammates can attest to each time they visited. I had meager energy between lengthy, harsh therapy sessions and bouts of robust suicidal thoughts. In loneliness, I was left mindlessly scrolling through social media, articles, and message boards that only wore me down more.

I came across speculations about where I could have been when I wasn’t on the Stanford bench for a prolonged time. Many were negative: “She wasn’t good enough.” “She was kicked off of the team.” “She got into drugs and alcohol.” “She was pregnant.” Ironically, this ended up being productive scrolling — I recognized a problem that I could address.

I realized that my time away from the court didn’t prompt, “Gosh, I wonder if she’s struggling with her mental health?” from the fans, public, or news outlets. It generated judgment centered around the stereotype that college athletes are unbreakable. The skills and abilities of athletes are undeniably inspiring and motivating, but still, we’re not suited for Mount Olympus — we have the same brains and physiology as everyone else. We are just as human.

College athletes know the value of trying again, maybe better than anyone — a crooked jump shot or loose running form isn’t an indication of failure, but a need to rework something. A growth mindset for training, competition, and physical performance is embedded into the culture of sports.

Related: What's Missing in How We Talk About Athlete Mental Health?

But the fabric of that culture leaves out a critical thread: Mental health is rigidly and fatally misunderstood, especially in college athletics. We often think of it as a fixed, genetic trait. When we talk about mental health, we usually aren’t talking about severe mental illness, which tends to be more genetically traceable.

We’re talking about a pillar of our health that has psychological, biological, and sociological roots. In the case of college athletes, biological and psychological factors contribute, but their environment is what makes their struggles unique.

To address those struggles, more and better resources are needed — well-organized mental healthcare models; access to care; significantly lower ratios of athletes to mental healthcare providers; and diverse, culturally competent, sport-specific staff are vital. We also need to remove the greatest barrier to help-seeking right now: stigma.

When we lost Stanford soccer player Katie Meyer recently, the anger I felt broke my heart. Our stories and experiences are not the same. But I do know what that moment of crisis and panic feels like. All of us in college sports have to prioritize athlete mental health before we reach such a moment. The enterprise needs a cultural and architectural shift.

Rooted in my own experiences, here are four things that must change — four legs that will support a new table for discussion and action:

1. Understand performance pressure and athletic identity foreclosure: Athletes train to perform, compete, and thrive under pressure. This pressure doesn’t go away outside of training and competition. In non-sport environments, the ability to perform under pressure mutates into an internal pressure to perform all the time. Because identity and self worth are so powerfully influenced by performance, what follows is strong athletic identity, and “athletic identity foreclosure” — associating your worth and identity solely with performance in sport and the athlete role, alongside purposeful avoidance of alternative academic, career, life, or philosophical exploration.

With this understanding, we need to inspire a deeper awareness of the different types of pressure. Making your free throws in front of 10,000 people is different from cloaking the fact that you’ve been feeling depressed while you take them. The latter exemplifies the pressure of performing the caricature of the unbreakable athlete. Because performance pressure often leads to identity foreclosure, it creates the need to embody the role of the unbreakable athlete, which is maintained by unrealistic performance standards and the pressure to meet them. This feedback loop becomes an isolating and backbreaking cycle in which the cost can be mental health and an identity crisis. When performance — in life and sport — isn’t where we’d like it to be, we have no other identity to turn to. We get caught confusing not achieving enough with not being enough.

Anyone working alongside college athletes should consider these nuances in the way identity, pressure, performance, and mental health concerns are intertwined. Take a step back and examine the standards, expectations, and procedures that you hold your athletes to. Are there any messages that shape these nuances or make them more complicated? Does your community’s culture value performance above being human? Do you remind athletes, and yourself, that mental health – alongside physical health – should be the primary standard and expectation, above all else? Are you training young humans to be great athletes, or young athletes to not be human?

2. Redefine and expand the shared symbol of mental toughness: Mental toughness is one of the most treasured mindsets in athletics, but we need to be more clear about what we want it to look, feel, and sound like. Right now, it is defined as the ability to get through pain and discomfort at any cost. There needs to be a clear boundary between where we can expect student-athletes to push through, and where we can expect them to ask for help.

When mental toughness is expected to be maintained unconditionally, it can become pathological. An expectation to do that extra chin-up when your arms burn can and should coexist with an expectation to seek help when you’re experiencing depression. Being mentally tough is also not synonymous with being shatterproof. In sports, these terms are often used interchangeably. At the forefront of mental strength and toughness is bravery and courage fueled by vulnerability, which includes acute awareness — noticing and acknowledging the moments when we need help. There are thoughts, feelings, and experiences that nutrition, hydration, and extra foam rolling can’t address.

Athletes recognize this. But they also fear the consequences of not exemplifying mental toughness as it’s currently understood. They fear that their coach and teammates will see them as weak, and lose confidence and trust in them. Athletes react to adverse experiences in the same ways that other people do, yet they are too often penalized for expressing stressful, fearful, and angry emotions. They are expected to be stoic. When they aren’t, they’re seen as out of control, and judged for not having everything together.

At the intersection of being mentally tough and bottling up emotions is burnout. When we halt the path of emotions in our body part of the way through, we experience exhaustion. Emotions have a cycle. Simply walking away from the stressor that triggers them — such as a practice facility, competition arena, or the opposing team — doesn’t itself allow our body to digest the emotion. Burnout results, leading in turn to isolation, loss of confidence, low motivation, performance declines, exhaustion, and more severe mental health concerns. To a coach, burnout may manifest as being out of shape, a lack of discipline, insufficient work ethic, and inadequate mental toughness.

Of course, there is a time and place for tough emotions – and most of the time, expressing them in public or during competition isn’t ideal. But that doesn’t mean they shouldn’t be expressed at all. If our definition of mental toughness is expanded to include prioritizing and allowing space for all emotions to run their course, including the tough ones, we can reduce and reverse burnout among athletes.

3. Eliminate the notion that you have to be in crisis to seek help: Mental health hygiene should be as important as physical hygiene. Mental health, like anything, is a continuum, and it’s not a destination — it constantly ebbs and flows. Athletes should be encouraged to take care of it before the point of crisis.

There is a common notion that those who are in therapy or seeking treatment already are in crisis, which isn’t true. Many people who utilize therapy do not meet the criteria for a mental illness diagnosis, just as many suicides are related to factors outside of mental illness. Mental health is profoundly shaped by the social determinants of health, such as income, employment, food, housing security, social protection, and non-discrimination, and college athletes should be encouraged to seek and engage with resources – perhaps especially when they are feeling mentally well.

With that said, crisis scenarios do occur. Currently, the only crisis options are checking into a hospital or calling 911. Across North America, mental health crisis response teams are being trained and implemented. In the future, sport-specific resources would likely be comforting for athletes to contact. These teams would steer them away from the hospital and the police, and keep them outside of the public eye.

Within sports, a willingness to simply listen to your players, teammates, friends, and colleagues can also go a long way. Speaking through thoughts and experiences is much easier with a trusted individual who is willing to set aside the role of coach or athlete temporarily. I’m not asking anyone to assume the role of a mental health professional, but I believe that in any instance you can pause, listen, and be human. Freeing a story from your own brain gives it – and the storyteller – breathing room. Sharing with a professional may then feel like a less scary next step. My teammates did this with me. And truthfully, it saved my life. The hours I spent – and still spend – talking through my pain points often shift my mood enough to focus clearly on my next choice.

4. Change the narrative around continued care: When someone accesses mental health support, or is open about their struggles, we place them in a box. We assume that they’ve made it to the other side of the mental health bridge. We assume that they’re fixed. When we frame healing this way, we reinforce the narrative that they must always appear fixed, and that they don’t have a valid reason to struggle again. This firmly places us back at square one, and is one of the most prominent barriers I’ve faced.

I’m open, honest, and vocal about being a mental health activist and advocate, though a prerequisite of this role is a willingness to pick my scabs to share my story and thoughts authentically. This is often painful. I also still experience deep bouts of depression and potent, convincing obsessions and compulsions.

Whenever I speak or write about this concept, I reference a challenging conditioning test I used to run at Stanford. The first time I attempted it, the pain in my legs and lungs was nearly unbearable, mostly because it was unfamiliar. The next few times I ran the test, my body didn’t hurt any less, but I’d grasped and interpreted the landscape. In other words, I haven’t made it through the forest, but I know my way around the trees — where the roots are, where there’s shade, and where it’s safe to spill into a heap and just feel.

When student-athletes choose to be open about their mental health, there cannot be an assumption that it implies that they’re fully healed. Broken bones, for the most part, fully heal, and a return to practice and competition indicates that the break is in the past. Mental health doesn’t fit the same trajectory. College athletes may return to practice and competition while simultaneously working through mental health struggles. One session with a mental healthcare provider isn’t the final puzzle piece. Mental health maintenance is a lifelong process. Struggle often resurfaces, sometimes inopportunely. We have to do a more holistic job of not categorizing athletes who have, do, and will seek mental health support as perfectly healed. Patience and compassion on everyone’s part are required. Just because athletes speak openly about their experiences doesn’t place them on the other side of the bridge.

Looking back, my relationship with basketball dampened because of my struggles. I sat on the bench for most of my career at Stanford, partially because I gave up — I assumed that I wasn’t capable of competing anymore. I’ve since learned not to assume defeat. My career didn’t turn out the way I’d anticipated, not because I wasn’t capable, but because I didn’t want to be alive. I spent so much time trying to believe that I needed to stay because my absence would hurt and devastate people I cared about. The truth is, I did feel needed, valued, and loved, which made me feel more selfish and guilty each time I contemplated suicide.

College athletes are a lot like the stick-figure example passengers on airplane safety cards. They spend considerable time putting on oxygen masks for everyone else in the sports ecosystem by reaching for lofty expectations and standards. They seldom pause to put on their own until there isn’t enough oxygen to breathe. This is no one person’s fault. But we must realize that when we tell someone, “The world is a better place with you in it,” we’re really saying that it’s better for everyone else because they make it better. This is true, but we forget the part where the world has to be a better place for that person, too. This is where our work lies.

Please see our list of Mental Health Resources if you are seeking information or assistance regarding mental health.

Monthly Issue

Mental Health: A New Priority in Sport

Athletes continue to tell us they are not OK with their actions and words. In response, the sports industry has acknowledged it can and should be doing more to support the people who are its lifeblood, from athletes to coaches and beyond.

Sport is both reckoning with its roots, uncovering how history and habit created circumstances that don’t suit everyone who competes, as well as navigating new territory during a time of unprecedented strain on our mental well-being. By making mental health a priority, sport has an opportunity to confer a host of benefits supporting mental wellness and to be more safe, inclusive, and inspiring.