ATs Are Expected to Handle Mental Health Crises Without Mental Health Training

Athletic trainers are often the first adults a student-athlete turns to when struggling with anxiety, depression, eating disorders, or suicidal ideation, because ATs spend more daily face time with athletes than coaches, counselors, or parents. Yet athletic training education programs provide minimal mental health training. Research shows that a significant number of ATs report they are not confident in their ability to provide mental health care and feel inadequately prepared to handle psychological distress, particularly when it is not directly related to a physical injury. The gap between expectation and preparation is dangerous. When a collegiate swimmer discloses suicidal thoughts to their AT during a rehab session, that AT must respond effectively in the moment. If the AT freezes, deflects, or says the wrong thing, the athlete may never disclose again. If the AT tries to provide counseling beyond their competence, they may do harm. The AT is trapped between the reality that they are the person the athlete chose to tell and the fact that they are not trained for the conversation. The NCAA updated its Mental Health Best Practices in early 2024 and required Division I schools to attest to compliance beginning August 2024. But these best practices focus on institutional policies and referral pathways, not on equipping the frontline healthcare providers, the ATs, with practical skills for mental health triage. A referral pathway only works if someone recognizes the crisis and initiates the referral. That someone is almost always the AT, and their education did not prepare them for it. This problem exists because athletic training's professional identity has been historically rooted in musculoskeletal medicine. The CAATE accreditation standards include some psychosocial content, but it is a small fraction of the curriculum compared to anatomy, biomechanics, and therapeutic modalities. Adding substantial mental health coursework would require extending an already-demanding master's program, increasing cost and time to degree. The profession is caught between the clinical reality that ATs are de facto mental health first responders and the educational reality that preparing them for that role would require fundamentally restructuring their training.