A Social Ecological Framework

College can be a difficult transitional time, and researchers have found that about 33% of college students in the United States experience symptoms of depression or anxiety in their college career (Lipson et al., 2019; Velasco, 2017). In a 2016 survey, the National Collegiate Athletic Association (NCAA) found that 30% of student athletes experienced chronic stress and felt intractably overwhelmed in the past month (NCAA, 2016). Given that there are approximately 460,000 NCAA student athletes across the country (Epps, 2020), it can be assumed that approximately 69,000 of those student athletes are struggling with managing their mental/emotional health. Even more alarming, only about 10% of student athletes with mental health concerns actually seek professional psychological help compared with 30% of non‐student athletes (Lipson et al., 2019). Researchers have found that student athletes are more susceptible than their nonathlete peers to certain mental health concerns given the intensive demands associated with being a collegiate athlete (G. T. Brown, 2014; Cosh & Tully, 2015). More specifically, student athletes are at a greater risk than their nonathlete counterparts of experiencing mental health problems such as substance use (particularly alcohol use) and social anxiety (Ryan et al., 2018). For example, Wolanin et al. (2016) found that 19% of their student‐athlete participants (N = 465) had alcohol misuse concerns and 34% struggled with anxiety or depression. The four most prevalent mental health problems student athletes experience are anxiety, depression, eating disorders, and substance use (Ryan et al., 2018).

Risk Factors for Student Athletes

Student athletes are often perceived to be an extremely healthy group of people who are believed to have privileges and resources that would reduce their need for support. Although this may be generally true when it comes to physical health, it is not the case for all student athletes, and not true about their mental health (Etzel et al., 2006; Fletcher et al., 2012). Although participation in organized sports has many documented benefits (Beauchemin, 2012; G. T. Brown, 2014), student athletes face social isolation, identity conflict, career/vocational issues, and fear of failure and success (Ryan et al., 2018). Furthermore, there is evidence to suggest that student athletes' demands increase their risk for experiencing certain mental and physical distress (e.g., eating disorders, anxiety, depression, overtraining, substance use; G. T. Brown, 2014; Gulliver et al., 2012; López & Levy, 2013). Student athletes also experience unique stressors, including increased academic pressures to maintain eligibility, intense physical training and conditioning, injuries, burnout, pressure and expectations from coaches to win, pressure to maintain peak physical condition, frequent critical evaluation about performance, and the commercialization of college athletics (G. T. Brown, 2014).

Student Athletes' Help‐Seeking Behavior

Help‐seeking behavior is generally understood as an adaptive mode of coping with personal concerns or problems (Gulas, 1974). For the purpose of this article, we review student athletes' attitudes toward seeking professional psychological help. Professional psychological help is “assistance provided by individuals who have a recognized role and appropriate training in providing mental health treatment” (Rickwood et al., 2005, p. 221). Previous research has found that individuals who are more willing to seek help likely experience fewer behavioral and emotional problems (Moreland et al., 2018). Student athletes have more negative attitudes toward help‐seeking than do their nonathlete peers (Watson, 2005). López and Levy (2013) noted significant barriers that interfere with student athletes' help seeking from mental health professionals, including time, stigma (self and public), confidentiality, and counselors' failure to understand the specific needs of being an athlete.

Conceptual Framework: Social Ecological Model

Several disciplines, including the social sciences and public health, have developed social ecological frameworks or models that examine how individual, interpersonal, and environmental factors interact in a way that influences a person's beliefs, attitudes, behaviors, and experiences of the world (McLeroy et al., 1988). In this study, we used the social ecological model for health promotion (SEMHP; McLeroy et al., 1988) as a framework to examine the factors that influence student athletes' help‐seeking behaviors and the steps counselors can take to address these barriers as educators, advocates, and therapists. According to the SEMHP, behavior is determined by (a) intrapersonal factors, (b) interpersonal factors, (c) institutional factors, (d) community factors, and (e) public policy (McLeroy et al., 1988).

The first level of the SEMHP, intrapersonal factors, involves exploring characteristics of the individual, such as attitudes, beliefs, behaviors, skills, and knowledge. McLeroy et al. (1988) clarified that these factors should be considered in the developmental context of the person. For example, an athlete may hold beliefs about seeking help that will influence their likelihood of getting help. Interpersonal factors are addressed in the second level of the SEMHP and consist of an individual's formal and informal social networks and support systems, such as family, friends, neighbors, and work colleagues. For instance, an athlete's family may heavily influence their attitudes about seeking help. The third level of the SEMHP, institutional factors, includes social institutions with organizational characteristics and formal and informal rules and regulations for operation. For example, the sports team the athlete is a part of may influence their perception of seeking help. The fourth level of the SEMHP, community factors, includes relationships between institutions and organizations, such as the collaboration of athletic departments from different universities to support athletes' mental health. Finally, the fifth level of the SEMHP involves public policy at the local, state, and national levels, such as the NCAA's rules and regulations regarding athletes' mental health (McLeroy et al., 1988). Whereas other researchers have used the social ecological model as a framework to examine various behaviors and health outcomes among college students and student athletes (Essiet et al., 2017; Fetherman & Bachman, 2016; Kerr et al., 2014; Tallant, 2011; Williams et al., 2006), to our knowledge, it has never been used to conceptualize student athletes' mental health help‐seeking behaviors. However, it appears to be a useful lens to gain better insight into student athletes' help‐seeking behaviors, which in turn may inform practice. Therefore, we used the SEMHP model as a framework to examine the factors known to influence student athletes' help‐seeking behaviors, as well as discuss solutions and recommendations for counselors to help bridge the gap.

Call to Action: Sports Counselor Roles

It is crucial that sports counselors in college settings be equipped with knowledge, awareness, and competence regarding the student‐athlete population, including athlete identity, risk factors, unique strengths, and barriers to them seeking help. Being competent in these areas will aid in informing the roles counselors should assume to comprehensively support student athletes' mental health and wellness. Nevertheless, counseling professionals are often trained from an intrapersonal lens with a narrow focus on how to help a person or athlete, which can limit their perspective on how to most effectively improve the mental health of athletes. To address this gap in counselor training, we used the social ecological model as a framework to conceptualize and clarify the varying roles that are essential for counselors to adopt (i.e., educator, advocate, and therapist) to best support the mental health needs of athletes and work toward redefining sports culture norms.

Counselors as Educators

The role of a counselor educating athletes and athletic personnel is becoming more recognized, especially as athletic departments and college counseling centers are increasingly aware of the mental health concerns and crises that exist among their athletes (Lipson et al., 2019). Now, more than ever, it is imperative that counselors, using their specialized mental health training to identify problematic signs and symptoms, educate athletes, coaches, parents, and other athletic personnel. Before discussing the specifics about the role of counselors as educators, we explore the current sources that can often negatively inform athletes and reduce their likelihood of seeking professional psychological help.

One source that influences athletes' perceptions of mental health and seeking professional help is themselves. Athletes' personal attitudes and beliefs, composed of their personal schemata, norms, self‐concept, and skills, are heavily influenced by their level of knowledge about mental health. Mental health literacy, by definition, encompasses the ability to differentiate a mental health condition from general stress, attributions of mental disorders, and knowledge and beliefs about risk factors and available professional help (Ackerman, 2011; Gulliver et al., 2012). Poor mental health literacy has been identified as a significant barrier to help seeking among student athletes (Gulliver et al., 2012; Weatherhead, 2015). As noted by Gulliver et al. (2012), the top three factors that influence athletes' attitudes about seeking professional help are (a) not knowing about mental disorders or symptoms, (b) not knowing when to seek help, and (c) experiencing stigma associated with getting help. Low mental health literacy among athletes leads to minimization of symptoms that could warrant seeking help, misperceptions (or expectations based on stereotypes) about professional psychological help, beliefs informed by inadequate knowledge about mental health and counseling professionals, and beliefs that there are no positive outcomes from getting help (Ackerman, 2011; Gulliver et al., 2012; Watson, 2005).

On an intrapersonal level, athlete identity (i.e., the degree to which one identifies with the athlete role) and, on a community level, sport ethic have both been found to influence athletes' attitudes and openness to seeking professional help (Brewer et al., 1993; Hughes & Coakley, 1991). Sport ethic refers to the criteria for defining what it means to be a “real athlete.” Sport ethic often perpetuates messages, ideologies, and norms regarding seeking help that are unfavorable and can deter athletes from violating those “rules” (Diamond et al., 2016; Hughes & Coakley, 1991). Researchers have shown that athletes tend to overconform to social and sport norms to maintain status and loyalty to the team, which can lead to harmful behaviors, including binge drinking, hazing, and not seeking professional psychological help (Diamond et al., 2016; Marx et al., 2008; Williams et al., 2006). A study of African American football players found that the more a student athlete identified with their athlete identity, the more stigmatized their perception of seeking help was and the less likely they were to seek help (Steinfeldt et al., 2009). Furthermore, researchers have found that student athletes are hesitant to seek help out of fear of being stigmatized by teammates, coaches, student peers, and fans (Steinfeldt et al., 2009; Watson, 2005).

Sports teams also have considerable influence on student athletes' behaviors and norms on interpersonal and institutional levels (D. J. Brown et al., 2015; Williams et al., 2006). Team rules are a significant factor that influences student athletes' professional psychological help‐seeking behaviors. For example, the way a coach (being the leader of the team) sets precedents for what behaviors are followed by their athletes (Williams et al., 2006) can affect professional psychological help‐seeking behaviors of their athletes.

Steinfeldt et al. (2011) conducted a study on coaches' influence on football players' perception of masculinity and found that the coaches affected the players' views of emotions both positively and negatively. Wrisberg et al. (2010) examined coaches' willingness to encourage their college athletes to see a sports counselor or consultant. They discovered that coaches were more likely to encourage their athletes to seek help from a sports counselor or consultant if it was related to performance and mental training issues and less likely to encourage their athletes to seek help for mental health concerns that warrant counseling services (Wrisberg et al., 2010). Furthermore, although coaches generally supported making sports counselors or consultants available for athletes, fewer were supportive of hiring one full‐time within their athletic department (Wrisberg et al., 2010). Additionally, most coaches supported adding more mental health trainings available for athletes, coaches, and athletic personnel, but the majority of the coaches surveyed did not want the trainers to be present at practice or competitions. Many coaches display stigmatized mental health beliefs as evidenced by their self‐reported concern that having a sports counselor or consultant more involved might suggest that many of their college athletes experience psychological problems (Wrisberg et al., 2010). Thus, as mentioned above, the sports team (with coaches being the leader) becomes its own culture that influences athletes' attitudes and behaviors regarding help seeking.

These research findings substantiate the need for counselors as educators, given the lack of mental health education and the negative influence that sport ethic, athlete identity, teammates, coaches, and sport governing bodies can have on athletes' perceptions of seeking professional psychological help (Kroshus, 2016; Reich, 2019; Sudano et al., 2017). Counselors as educators have the opportunity to inform athletes, parents, and athletic personnel about mental health and can work toward destigmatizing help seeking and redefine what it means to be an athlete. For example, recalibrating norms so that athletes perceive being “mentally strong” as someone who gets help when they need it instead of pushing through the pain. On an intrapersonal level, researchers have found psychoeducational workshops and seminars aimed at improving student athletes' mental health literacy to be effective in improving athletes' perceptions of seeking help (Ackerman, 2011; G. T. Brown, 2014). Psychoeducation was found to improve athletes' competency in coping with mental health symptoms. Counselors who educate athletes by conducting workshops and seminars about mental health are helping reduce self‐stigma and reshape attitudes, beliefs, and behaviors toward mental health and seeking professional help.

Psychoeducational content should address the main factors that influence athletes' attitudes toward seeking help, namely, not knowing about mental disorders or symptoms, not knowing when to seek help, and experiencing stigma associated with getting help. To address these barriers, counselors should provide specific education on basic mental health concepts, such as unique risk factors among athletes; signs, symptoms, or indicators; treatment options; coping strategies; and resources available. When educating athletes on mental health, counselors should provide basic and foundational information regarding mental health concepts to equip the athletes with a frame of reference. Second, counselors should spend time explaining risk factors and symptoms that make athletes susceptible to mental health concerns, how to distinguish between a mental health condition and general stress, and when one should seek professional help. Finally, counselors should present the research and prevalence of athletes who struggle with mental health concerns at youth, collegiate, and professional levels to help reduce stigma toward mental health difficulties and help seeking.

In conjunction with counselors educating athletes, it is essential that coaches, parents, and other athletic personnel receive training on mental health matters as well. Mental health training for athletic personnel and staff will likely have an impact on intrapersonal, interpersonal, institutional, and community levels. As with education for the athletes, the training would help improve athletic personnel's attitudes and beliefs about mental health and seeking help, which would affect athletes on an interpersonal level, given their likeliness to adhere to norms and beliefs the coach establishes for the team. Because coaches set the precedent for “rules” and “ideals” the team operates under, educating coaches to have more open and positive attitudes about integrating mental health into their team cultures could foster a pro‐mental health atmosphere. Trainings provided by sports counselors could target variables empirically associated with the creation of a pro‐mental health culture. For example, training may increase coaches' mental health knowledge, empathy and understanding of student athletes' mental health concerns, and awareness of how to identify alarming mental health signs and symptoms in athletes (Moreland et al., 2018). It is evident that sport ethic and sports culture have a significant impact on student athletes (G. T. Brown, 2014; López & Levy, 2013; Watson, 2006); therefore, requiring mental health training could help increase athletic personnel's mental health literacy and foster more positive perceptions of athletes' help seeking within the sports community.

Given the strong influence that parents have on athletes' perceptions of seeking help, it is equally important to improve their attitudes as those of the student athletes (Cranmer & Myers, 2017; Rice et al., 2016; Starcher, 2015). Counselors educating the parents of athletes is necessary given how involved parents are throughout their children's careers. Educating athletes' parents would have a positive impact on an interpersonal level by helping improve athletes' family/social networks' attitudes and beliefs about mental health and help seeking. For example, counselors could educate athletes' parents by holding a separate parent orientation the same day their freshman athletes have orientation. This parent orientation could be held within the athletic department and include an introduction to all of the athletic personnel who will be supporting the athletes throughout college, including the coach, academic counselor, athletic trainer, and sports counselor. Each professional could introduce themselves and talk about their specific role in working with the athletes. This could provide an opportunity for the sports counselor to provide some brief psychoeducation about the unique stressors student athletes frequently encounter, signs or symptoms the athlete is struggling with a mental health concern, the importance of the wellness model and self‐care in stress management, and resources for the parents to support their children's mental/emotional health. Educating athletes' parents may also influence others' beliefs on institutional and community levels. For example, parents having more pro‐mental health discussions with people in their social circles (e.g., neighbors, fellow sport parents, friends, religious/spiritual organizations, workplaces) may have a ripple effect on these institutions' and communities' beliefs and attitudes toward seeking counseling.

The counselor's role as educator for athletes, athletic personnel, and parents is critical in working toward improving the negative beliefs, ideals, and norms that sports culture has historically perpetuated among athletes about mental health concerns and professional help seeking. Educating the sources that are embedded within sports culture is key in producing systemic change across intrapersonal, interpersonal, institutional, community, and policy levels in regard to mental health.

Counselors as Advocates

The second role that is important for counselors to take on to support athletes' mental health needs is being an advocate. Although all counselors are tasked with assuming this role in some capacity, it is arguably even more necessary when working with an at‐risk population, such as student athletes.

As previously discussed, some of the most influential people in student athletes' lives include family, friends, coaches, and teammates (Cranmer & Myers, 2017; Nazione et al., 2011; Reich, 2019; Starcher, 2015). Sources that communicate messages that can encourage or discourage certain behavior may influence student athletes' help‐seeking behaviors on an interpersonal level (Etzel et al., 2006; Sinden, 2013; Steinfeldt et al., 2011). Researchers have examined the salient messages athletes received about sports from their parents while growing up and prior to attending a Division I school (Cranmer & Myers, 2017; Starcher, 2015). The findings from one study revealed that one of the most common messages athletes received from their fathers about sports was “Winning is everything. Second place is the first loser” (Starcher, 2015). Cranmer and Myers (2017) examined messages that Division I student athletes received prior to entering collegiate sports and uncovered similar findings, including an emphasis on physical skills/performance and messages such as “Winning is everything.” The findings of both studies suggest that the messages athletes received from parents and coaches emphasize that performance is valued over everything else. Although there is a paucity of research on specific messages athletes have received that influence their perceptions of seeking professional psychological help, it is reasonable to assume that these messages, which encourage a mentality that values performance over everything else, can influence attitudes and behaviors toward seeking professional psychological help. Student athletes' social networks can reinforce harmful guidelines and norms that encourage them to be self‐sufficient and can lead to underutilization of counseling services, thus fostering a culture of risk for this population (Cranmer & Meyers, 2017; Reich, 2019).

As previously stated, on an intrapersonal level, self‐stigma is a significant barrier for student athletes' help seeking. Similarly, on an interpersonal level, public stigma is one of the leading barriers that interferes with student athletes and college students seeking professional psychological help (Vogel et al., 2007; Watson, 2005). Public stigma refers to society's negative beliefs, attitudes, and behavioral consequences about mental illness, which in turn lead to stereotyping, prejudice, and discrimination against people with mental health disorders (Vogel et al., 2007).

For example, some potentially harmful messages or guidelines athletes receive from coaches, parents, teammates, media, fans, and sports culture that may influence their perception of seeking psychological help include “No pain, no gain”; “Shake it off”; “Be mentally and physically tough”; and “Never quit” (Cranmer & Myers, 2017; Reich, 2019). At the interpersonal level, it is vital to consider how teammates, coaches, and other athletic personnel reinforce these messages that likely reduce the chances of addressing mental health concerns. One study examined the effect that the social network called “sportsnets” had on athletes (Nixon, 1992). In the sportsnet, athletes exist in a subculture with implicit and explicit messages about risk, pain, help seeking, and injury that sway what attitudes and behaviors are considered acceptable as an athlete (Coakley, 2004; Hughes & Coakley, 1991; Nixon, 1990; Parham, 1993). The structural location of athletes in sportsnets (i.e., at the bottom of the hierarchy), as receivers rather than sources of these messages, makes it difficult (if not impossible) for them to challenge the messages regarding seeking help because it may make them appear “compromised” or “weak” (Coakley, 2004; Hughes & Coakley, 1991; Parham, 1993). It is important to consider the way messages in sportsnets, which often have unfavorable attitudes toward seeking help, can be confounded by other social networks and relationships outside of sports, including an athlete's culture, family, coworkers, and other friendships, that do not endorse getting help when needed (Cranmer & Meyers, 2017; Nazione et al., 2011; Starcher, 2015).

For collegiate student athletes, the NCAA is the governing body that sets formal rules and guidelines that are designed to support, protect, and promote the holistic health and development of student athletes (G. T. Brown, 2014; Fletcher et al., 2012; Sudano et al., 2017). Because these guidelines must be followed by athletic departments and personnel as well as the student athletes, it is important to evaluate how this organization can influence student athletes' help‐seeking behavior. Sudano et al. (2017) stated that the NCAA has endorsed an integrated care model that provides medical and mental health support for athletes, has established best practices for athletes' mental health, and offers programs to better support athletes' holistic development. However, there still appear to be gaps in terms of regulation, implementation, and utilization that have unfortunate implications on student athletes' mental health (Born, 2017; Kroshus, 2016).

Although the NCAA has outlined best practice considerations and recommendations for mental health concerns for student athletes, uniform state or federal mental health policies have not been developed and enforced at colleges that help protect and safeguard this population (Born, 2017; Kroshus, 2016). Nevertheless, legislation passed at the 2019 NCAA convention now requires that all universities in the Power 5 conferences make professional psychological help and resources available to student athletes (Adelson, 2019). Although the passing of this legislation is encouraging, it primarily benefits only Division I athletes, leaving the rest of college athletes at Division II and III schools at a disadvantage in terms of the provision of mental health support. Another concern under this new legislation is the potential disparity in how much universities are spending on mental health services and support resources for their athletes. Although this new policy is a step in the right direction, it is vital to clarify more specifically how much universities are required to spend to ensure that athletes are receiving equal resources and opportunities for support. The lack of definitive policies surrounding professional psychological help across all universities, prevention, and awareness for college athletes is problematic and can send a message to student athletes that needing professional psychological help is not necessary unless you are an elite Division I athlete. Additionally, a study found that the majority of female student athletes were unaware of any mental health resources provided or endorsed by the NCAA (Born, 2017), further reinforcing how lack of policy implementation influences help‐seeking behaviors (Born, 2017; Kroshus, 2016). These factors contribute to stigma, norms, beliefs, motivation, expectations, and unfavorable or ambivalent feelings student athletes hold about mental health professionals that could be perpetuating low rates of help seeking.

Therefore, it is vital to consider how sports counselors can work toward advocating for athletes' mental health needs that will improve athletes' and athletic personnel's attitudes, sports culture norms, funding for mental health support, and uniform policies providing equal access/opportunity for athletes to receive mental health care. On institutional and community levels, one of the first steps counselors should take in an advocacy capacity is collaborating with other professionals inside and outside the mental health field. This first includes fostering professional relationships with people inside the athletic department at their institution to determine how colleagues can work together to better support athletes' holistic health and determine gaps in the current care. Sports counselors working at a university could advocate to the athletic director about having a monthly meeting with all athletic personnel present to set aside intentional time assessing services and support that could be improved for athletes' overall wellness. On a community level, counselors should also collaborate or network with sports counselors at other colleges to stay abreast of resources, programs, and services they are utilizing with their athletes to provide ideas about how to enhance their department. Discoveries of innovative ideas used by counseling professionals at other schools could also be presented to the rest of the athletic department at a monthly meeting. The sharing of resources, events, programs, practices, and services related to mental health promotion is critical in the creation of a culture of care across collegiate sports (Neal et al., 2015; Williams et al., 2006). These collaborative and multidisciplinary efforts have been adopted at certain universities across the country and have been found to help foster mental health access and awareness among college students, increase network and referral sources on and off campus between multidisciplinary professionals, and help begin the process of destigmatizing seeking professional psychological help (Abidi et al., 2016; Ackerman, 2011; Beauchemin, 2012; G. T. Brown, 2014). Collaborative efforts can have direct and indirect effects on student athletes' perceived stigma (self and public), access, motivation, and belief in positive outcomes, as well as increase mental health literacy (Abidi et al., 2016; Ackerman, 2011; Beauchemin, 2012; Moreland et al., 2018; Shor, 2009; Wrisberg et al., 2009).

On a policy level, counselors should advocate to sport governing bodies, such as the NCAA, about the importance of creating uniform mental health policies to ensure that there are adequate resources to support the mental health concerns of athletes at all Division I, II, and III schools. Although some coaches support mental health care for their athletes, the hiring of mental health professionals is still underprioritized. Counselors should advocate for a policy that requires every athletic department to have a full‐time counselor available to athletes to guarantee equal access and mental health support for all college athletes (Wrisberg et al., 2010). If the sport governing bodies are resistant to putting this type of policy in place, it would likely be necessary for university and mental health professionals to advocate for state or federal regulation mandating a mental health policy at their universities.

Counselors as Therapists

In the role of therapist, counselors can provide support and assist student athletes with their mental health needs. It is important to consider the specific ways counselors can most effectively help athletes in a clinical capacity, because this will increase the effectiveness of treatments and help improve attitudes toward seeking counseling.

Previous help‐seeking experiences (both positive and negative) have been found to influence college students' and student athletes' current beliefs about seeking professional psychological help (Anderson et al., 2004; Bohon et al., 2016; Vogel et al., 2007). For example, positive associations of seeking help were informed by increased knowledge and openness that resulted from previous experiences of getting help (Kim & Zane, 2016). Additionally, Kim and Zane (2016) found that college students who received professional psychological help in the past were more aware of symptoms indicative of potential depression and anxiety problems, as well as more likely to recommend seeking professional help for those symptoms to others. Watson (2005) found evidence supporting that expectations student athletes have regarding counseling services significantly influenced their attitudes toward seeking help. Having a sports liaison working with the athletic department and university has been found to provide emotional support for student athletes, and studies have shown that most college athletes endorse the importance of having a sports counselor or consultant working with them on performance and mental health concerns (Wrisberg et al., 2009). Nevertheless, only 39.7% of athletic departments have access to these professionals, let alone have one full‐time on their staff for student athletes (Connole et al., 2014). Researchers have noted the importance of having a “campus intervention team” at universities that includes a sports counselor or consultant who can represent the needs of the student‐athlete population (G. T. Brown, 2014; Shor, 2009).

Together, these research findings support the value of having a trained mental health professional as a full‐time staff member in athletic departments. Counselors' rigorous training in helping skills, conceptualization skills, human development, diagnosis, and evidence‐based treatments, in addition to their clinical understanding of the unique stressors athletes encounter, qualifies them to effectively aid in improving athletes' mental health concerns. One recommendation for counselors working with athletes is to administer mental health screenings annually. On an intrapersonal level, counselors' use of screenings with athletes helps in the identification of signs or symptoms of potential mental health conditions (Kroshus, 2016), but on an interpersonal level, it could also help destigmatize student athletes' and athletic personnel's perceptions of seeking help. On an institutional level, requiring student athletes to complete a mental health screening indicates that athletes' mental health is prioritized by their university and athletic department, just like their physical health. Screenings can also create a space to help normalize conversations about mental health between athletes and athletic staff, increase mental health literacy, and positively reshape personal and sport norms toward seeking professional psychological help. Another recommendation would be for athletic departments to hire sports counselors who are former athletes. Research has found that athletes are more open to seeking counseling if their therapist was a former athlete because of their increased understanding and knowledge of the stressors associated with being an athlete (Moreland et al., 2018). Student athletes attending counseling would likely promote change on intrapersonal, interpersonal, and institutional levels, because it would improve their individual attitudes toward seeking help, reduce stigma among athletes, model pro‐mental health support in their sports community, and produce positive changes in their performance and mental/emotional health. See Table 1 for a summary of sports counselor roles.

Table 1

Summary of Sports Counselor Roles

Conclusion

In this study, we used the SEMHP as a framework to explore important factors that influence student athletes' help‐seeking behaviors and provided recommendations for how counselors can support student athletes' mental health. More specifically, we sought to provide insight into ways counselors can address barriers that interfere with student athletes seeking professional psychological help from an educator, advocate, and therapist role. The main barriers discussed at the varying social ecological levels include athlete identity, previous experiences seeking professional psychological help, mental health literacy, expectations surrounding outcomes of seeking help, stigma (self and public), social norms, access to a sports counselor or consultant on the athletic staff, and lack of policies surrounding student athletes' mental health. To address these barriers, we recommended that counselors educate athletes, parents, and athletic personnel through trainings and workshops; hire a full‐time sports counselor on staff (ideally a former athlete); collaborate with other professionals and universities; conduct mental health screenings for student athletes; and advocate for universal mental health policies for this population. Using the SEMHP model to examine barriers and solutions regarding student athletes' help‐seeking behaviors provides a systemic framework for counselors to utilize, ensuring that they are addressing the mental health needs of student athletes on intrapersonal, interpersonal, institutional, community, and policy levels.