Mental health is an integral dimension of elite athlete well-being and performance that cannot be separated from physical health. More than 1/3^rd of elite athletes suffer from a mental health crisis, manifesting as stress, eating disorders, burnout, or depression and anxiety during their athletic career.  A recent burgeoning is evidenced around mental health in elite sport in the past few years with reported prevalence of mental health symptoms and disorders among male elite athletes from team sports varying from 5% for burnout and adverse alcohol use to nearly 45% for anxiety and depression. Among female elite athletes, eating disorders are also prevalent. Among collegiate athletes, the prevalence ranges from 10% to 25% for depression and eating disorders. Higher prevalence rates of mental disorders in athletes are evident when they are going through periods of transition or adversity through injury, deselection, burnout, or prolonged competition periods spent away from family and friends. Olympic swimmer Michael Phelps, Olympic gymnast Simone Biles also are victims of mental health problems in Sports.

Exercise has anti-depressant effect, hence sports participation should theoretically protect an athlete against mental health symptoms but why athletes are at increased risk for mental health issues? This can be explained with the diathesis – stress model which states that “people have an underlying predisposition for mental health conditions, and these traits lie dormant until exacerbated by stress and the stressors athletes face are much more significant”. During an elite sport career, both generic and sport-specific stressors might increase the risk of mental health symptoms and disorders.

Mental health disorders in athletes are not only associated with an increased injury risk but also portend poorer outcomes subsequently, including prolonged recovery times, increased rates of injury recurrence, decreased rates of return to sport, and reduced performance upon return.

Early identification of at-risk or symptomatic athletes is very much essential and can be achieved partly through routine mental health screening followed by subsequent referral of at-risk athletes to professional mental health support usually a sports physician/ sports psychologist and upskilling sport staff to act as ‘navigators’ to better identify and respond to mental health symptoms.

According to recent research, only 22% of athletes sought professional help for mental health issues. Barriers to help seeking like identification, stigma, and resource availability, do exist but promoting athlete help-seeking behaviour remains necessary to ensure the success of the early intervention framework.  Mental health help-seeking is an adaptive process to cope with mental health concerns through gaining outside assistance.  Athletes need to be educated about various sources of help-seeking commonly include self-help, informal (e.g., friends, family), semi-formal (e.g., help-line, local support group, internet searches) and formal help. Formal help-seeking is from professionals with appropriate training in providing help and advice, such as mental health and health professionals including general practitioners, counselors, psychologists and psychiatrists. IOC expert group also considered the social environment in which elite athletes operate as a risk and insists to create an environment that promotes mental well-being and resilience.

Management approach should be comprehensive, integrative and includes psychotherapy with or without pharmacological therapy, keeping the athlete at the centre and also addressing his/her emotional, mental, physical, social, spiritual and environmental influences that might have affected mental health.