Where Does Mental Health Belong in Post-Secondary Sport Medicine?

Universities and colleges increasingly recognize that student-athlete mental health matters. Mental health resources are promoted, athletes may be screened for psychological distress, and referrals to campus counselling and wellness services are often available.

But I have been wondering whether availability is enough.

In many post-secondary sport settings, an injured athlete may interact regularly with athletic therapists, physiotherapists, physicians, strength and conditioning professionals, and other members of an interdisciplinary support team. Psychological care, however, may sit somewhere else: a referral to campus health or wellness once a concern has been identified.

There are good reasons for maintaining that connection — consultation, supervision, consistent standards of care, access to crisis resources. But connection does not necessarily require separation. There may be value in situating a mental health professional within the Athletics & Recreation clinical team, alongside the professionals already supporting student-athletes health, while maintaining a meaningful connection to the university’s broader mental health infrastructure.

The distinction may seem administrative. I don’t think it is. Student-athlete health exists within a particular environment shaped by injury and rehabilitation, return-to-sport decisions, performance expectations, selection, athletic identity, relationships with coaches, academic demands, and the power structures of competitive sport. The argument is not that student-athletes deserve more care than other students. It is that appropriate care should account for the context in which health and distress occur.

Screening Can Identify a Concern. What Happens Next?

I started thinking more seriously about this after reading a recent LinkedIn post from Yasutaka Ojio about his and his colleagues’ new paper, Responsible mental health screening in high-performance sport: Fit-for-purpose tools and care pathways.

The paper responds to a critical review by Jolan Kegelaers and colleagues (2026), who questioned some of the assumptions underlying athlete mental health screening, including its predictive validity, feasibility, effectiveness, and potential for unintended harms. Ojio and colleagues (2026) reframe the question: rather than asking only whether sport organizations should screen, they argue that screening should facilitate triage, early contact, and appropriate care.

A screening score can indicate that something deserves attention. It cannot tell us what is happening, why, or what should happen next. An athlete reporting significant anxiety may be experiencing an anxiety disorder while also responding to injury, uncertainty about return to sport, academic pressure, changes in playing time, conflict, identity disruption, or several of these at once.

A screening tool cannot have that conversation. A person is needed to facilitate it.

If sport organizations increasingly identify psychological concerns as part of athlete health, should the professional equipped for that conversation be part of the athlete healthcare team itself?

Return to Sport Makes the Gap Particularly Visible

Injury is one of the clearest examples of why separating physical and psychological care can become artificial. An athlete can make substantial physical progress while still struggling with fear of reinjury, trust in their body, confidence, or uncertainty about returning.

Liu and Noh’s (2025) systematic review of 62 studies found psychological readiness was associated with return-to-sport behaviour and several post-injury outcomes. Physical clearance and psychological readiness are related parts of recovery, but they are not interchangeable.

Kuzma and Jackson Cheadle’s Rebound (2019) approaches this gap from the athlete’s experience, treating psychological recovery as part of injury rehabilitation rather than something that begins once the physical work is finished. That framing is useful because return is not simply about getting an injured body back to the point where participation is medically possible.

Yet sport culture has historically rewarded athletes for overriding the gap between physical and psychological readiness: you’re physically cleared, therefore you’re ready.

And even if sport is becoming more willing to recognize an athlete’s own assessment of readiness, which athletes have enough power to say they are not ready and have that taken seriously?

A high-status athlete who is difficult to replace may have real latitude to question a return-to-sport decision. A less established athlete navigating the same uncertainty may also know that someone else can take their roster spot. The question isn’t just whether athletes have autonomy — it’s whether that autonomy is available to athletes who haven’t first become valuable enough to command it.

This is where a mental health professional could contribute something distinct. Awareness of psychological factors isn’t the same as professional scope. We wouldn’t address a gap in physical rehabilitation by expanding a psychotherapist’s competency until they could provide physiotherapy. Psychological concerns likewise reach a point where mental health expertise is warranted.

There is some precedent for bringing that expertise closer. Sudano and colleagues (2017) explored an integrated-care model that brought behavioural health into an NCAA Division I athletic training-room setting to reduce barriers to mental health care.

Embedding that expertise within the clinical team could make psychological care part of rehabilitation itself, rather than something an athlete is referred toward once distress becomes obvious.

But co-location does not guarantee integration.

Stress-Testing the Model

Consider return to sport again. An athlete meets the physical criteria to return but says they aren’t psychologically ready. Their mental health clinician shares concerns; other members of the clinical team believe they are ready.

Now what?

Adding psychological readiness to an interdisciplinary model does not guarantee it will carry equal weight. Physical measures may still be treated as more objective, while psychological readiness becomes something the athlete is expected to work through. Somehow, physical indicators, clinical judgement, and the athlete’s own assessment have to coexist without one automatically overriding the others.

Embedding a regulated clinician within Athletics also creates tensions. A coach may want information the clinician cannot disclose. An athlete may be deselected, medically retired, or leave a psychologically unsafe environment while still needing to receive care.

These questions make the clinician’s continued relationship with campus Health and Wellness important. But how does that dual relationship actually work? Who employs the clinician? Who evaluates them? Where do they turn for consultation? Lean too far toward Athletics and the clinician risks professional isolation; too far in the other direction and they may lose the relationships and trust needed to be successful as colleague in Athletics & Recreation.

The culture of the clinical team matters too. A mental health professional could sit twenty feet from the physiotherapy tables and still function only as the person athletes get sent to once someone decides they have “a mental health problem.” Integration requires mental health expertise to be understood as relevant to athlete health more broadly while maintaining clear professional roles.

And then there is capacity. A university may have hundreds of student-athletes. One clinician cannot provide ongoing psychotherapy to everyone. Their role might include individual therapy, brief intervention, consultation, screening follow-up, groups, and referral — but institutions would still need to decide how athletes reach the appropriate level of care.

That inevitably becomes an equity question too. Who qualifies for athlete-specific mental health care? If access follows particular varsity or competitive designations, athletes outside those boundaries may experience many of the same pressures without access to the specialized care those pressures are being used to justify.

Embedding mental health care could close one structural gap while creating another.

Integration Is Not as Simple as Proximity

I keep returning to the question that started this.

If psychological health is athlete health, why are the professionals responsible for psychological care so often structurally separated from the teams responsible for athlete healthcare?

Embedding mental health professionals within interdisciplinary athlete health environments is one possible answer worth exploring. It could bring physical and psychological care closer together, create opportunities for earlier intervention, and give other sport medicine professionals a mental health colleague rather than expecting them to continually extend the boundaries of their own roles.

But moving a clinician into Athletics is the easy part.

Whether that person is genuinely integrated depends on how the team understands their role, how different forms of expertise are weighed, who can access care (USPORT athletes only?), and whether the clinician can remain connected to a broader mental health system while genuinely belonging to the athlete health team.

Those complications do not make embedding mental health professionals a bad idea. They mean the model deserves more thought than simply putting another professional in the room.

Universities increasingly recognize that student-athletes need access to mental health care. The next question may be harder:

Where does mental health expertise belong within student-athlete healthcare — and what would it take for it to become a truly integrated part of that care?

Sources Referenced, in order of appearance

Ojio, Y., Rice, S. M., Lima, Y., & Purcell, R. (2026). Responsible mental health screening in high-performance sport: Fit-for-purpose tools and care pathways. Psychology of Sport and Exercise, 87, 103244. https://doi.org/10.1016/j.psychsport.2026.103244

Kegelaers, J., Wylleman, P., Brevers, D., Pankow, K., & Kenttä, G. (2026). To screen or not to screen? Critical reflections on the use of mental health screening in high-performance sport. Psychology of Sport and Exercise, 85, 103146. https://doi.org/10.1016/j.psychsport.2026.103146

Liu, S., & Noh, Y.-E. (2025). The utility of psychological readiness scales in predicting return to sport: A systematic review. BMC Psychology, 13, 1213. https://doi.org/10.1186/s40359-025-03378-5

Kuzma, C., & Jackson Cheadle, C. (2019). Rebound: Train your mind to bounce back stronger from sports injuries. Bloomsbury Sport.

Sudano, L. E., Collins, G., & Miles, C. M. (2017). Reducing barriers to mental health care for student-athletes: An integrated care model. Families, Systems, & Health, 35(1), 77–84. https://doi.org/10.1037/fsh0000242