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A MENTAL HEALTH GUIDE FOR RECREATIONAL SPORT
Supporting Mental Health in Youth Sport: Introducing a Toolkit for Coaches, Clubs
and Organisations
Courtney C Walton a, b, †, Serena Carberry a, b, †, Michael Wilson b, Rosemary Purcell a, b,
Lisa Olive a, b, c, Stewart Vella d, Simon Rice a,b
a Elite Sports and Mental Health, Orygen, 35 Poplar Road, Melbourne, Australia
b Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
c Centre for Social and Early Emotional Development, School of Psychology, Deakin
University, Australia
d Global Alliance for Mental Health and Sport, School of Psychology, University of
Wollongong, NSW 2522, Australia
† These authors contributed equally to this work.
Word Count: 3,989 words
Correspondence should be addressed to Associate Professor Simon Rice
Orygen, 35 Poplar Road, Melbourne, Australia; Centre for Youth Mental Health, The
University of Melbourne, Australia; simon.rice@orygen.org.au
Funding: This research was supported by the McCusker Charitable Foundation. CCW is
supported by a McKenzie Postdoctoral Research Fellowship at the University of Melbourne
(MCK2020292). SR is supported by a Career Development Fellowship from the National
Health and Medical Research Council of Australia (GNT1158881), and the Dame Kate
Campbell Fellowship from the Faculty of Medicine, Dentistry and Health Sciences at The
University of Melbourne.
Please check for any bibliographic updates and cite the published version of this manuscript:
Walton CC, Carberry S, Wilson M, Purcell R, Olive L, Vella S, Rice S (2021). Supporting
mental health in youth sport: Introducing a toolkit for coaches, clubs and
organisations. International Sport Coaching Journal.
https://doi.org/10.1123/iscj.2021-0042
1
2
Abstract
The mental health of young people is of increasing concern, and early intervention prevention
strategies are required. Youth sports are potentially effective environments to situate
interventions due to high participation rates, familiarity to young participants, and the typically
positive relationships held with adults within such spaces. However, coaches identify that they
require more knowledge in order to better respond to mental health concerns that may be
present among players. Here, we describe a research translation process, in which an open-
access evidence-informed resource was developed to support coaches and sports clubs to better
respond to athletes in need, as well as to create environments that may protect against mental
ill-health and promote well-being. The resource includes a toolkit – with an associated checklist
– for recreational sport clubs to follow, a guide to responding to young people in need, and a
short educational video. We suggest that these practical and applied resources which can be
immediately implemented, may assist in the provision of targeted and structured guidance for
coaches’ first response intervention with vulnerable young people. Further, these resources can
support future efforts by being specifically tailored for the unique locations and cultures that
vary among youth sport environments.
Keywords: Mental health; Coaching; Early intervention; Young people; Sport
A MENTAL HEALTH GUIDE FOR RECREATIONAL SPORT
Supporting Mental Health in Youth Sport: Introducing a Toolkit for Coaches, Clubs
and Organisations
Mental health disorders are the leading cause of disability among young people
(Erskine et al., 2015) and the concerning prevalence of these disorders among adolescents has
been recognised as a key global health issue (Patel, Flisher, Hetrick, & McGorry, 2007). The
worldwide‐pooled prevalence of mental disorders has been estimated at 13.4% (Polanczyk,
Salum, Sugaya, Caye, & Rohde, 2015). Just under half of all individuals with a mental
disorder experience the initial onset before the age of eighteen (Solmi et al., 2021). This
highlights the need for early identification of concerns in young people. In addition to current
distress and increased risk of death by suicide (Bilsen, 2018), mental health disorders in
youth have been associated with a range of poorer psychosocial and health outcomes in
adulthood (Clayborne, Varin, & Colman, 2019; Wickersham et al., 2021). Thus, early
intervention is crucial to prevent chronic mental health trajectories for adolescents
experiencing problems with their mental health (O’Connor, Sanson, Toumbourou, Norrish, &
Olsson, 2017). School, community, and sports settings may potentially be preferable
environments (Arango et al., 2018).
Mental health is multidimensional, and not simply inclusive of clinically diagnosable
psychological disorders. Good mental health can be considered as a state of well-being that
allows individuals to cope with the normal stresses of life and function productively, in
addition to possessing the skills and resilience to productively manage abnormal and
potentially destructive stressors (Fusar-Poli et al., 2020; Salazar de Pablo et al., 2020). This is
in line with the dual continua model (Keyes, 2002; Keyes, 2005) which conceptualises
mental health and mental illness as two distinct but correlated axes, rather than sitting on
opposite ends of one spectrum. In such a model, an individual could maintain good mental
health even with mental illness, or conversely, poor mental health without mental illness.
2
Empirical support for this approach is strong, with most data in the literature demonstrating
better explanatory power of dual-continua models over single spectrum explanations
(Matthew & Joep van, 2020). This model has also been influential in understanding mental
health and wellbeing in sport (Uphill, Sly, & Swain, 2016). Therefore, interventions in youth
sport settings should be focused on increasing the mental health of participants to a similar
degree as reducing any symptomatology of mental ill-health.
Participation in organised sport is associated with improved mental health for young
participants (Eime, Young, Harvey, Charity, & Payne, 2013; Panza et al., 2020; Vella, 2019).
This is primarily thought to reflect a range of biological (e.g., neurophysiological effects of
physical activity), psychological (e.g., development of competence, self-esteem) and social
(increased social integration) benefits. Further to the potentially protective factors that
engagement with sport may bring, these environments are situated as a valuable space for
intervention, where the mental health of young people can be supported. This is particularly
relevant given the high rates of participation seen around the world (Aubert et al., 2018), with
adolescents in Australia spending approximately seven hours a week participating in sport
(Vella, Cliff, Okely, Scully, & Morley, 2013).
Within such spaces, coaches are often well placed to support the positive psychosocial
development of young people. Despite the generally positive effects of sport and exercise on
mental health, there are many stressors and environmental factors which may contribute to
mental ill-health in youth athletes (Walton et al., 2021). To this end, both young people and
their parents are supportive of intervention in these spaces, and believe that coaches can play a
positive role in supporting player mental health (Brown, Deane, Vella, & Liddle, 2017; Swann
et al., 2018). A number of studies have examined the perceived competence and mental health
literacy of coaches. While it would appear that coaches believe they have a role to play in
supporting the mental health of young participants, they have also raised concerns about their
3
perceived competence to handle situations in which a young person is disclosing psychological
distress (Ferguson, Swann, Liddle, & Vella, 2019; Mazzer & Rickwood, 2015).
Active interventions have been proposed to increase mental health literacy and the
skillset of those engaged in recreational sport, with mixed efficacy (Breslin, Shannon,
Haughey, Donnelly, & Leavey, 2017). The ‘Ahead of the Game’ study (Vella et al., 2020; Vella
et al., 2018) is one recent example of an intervention that was largely successful in targeting
the mental health of adolescent male athletes. However, uptake from coaches in this trial for a
program based on self-determination theory was extremely difficult; requiring a protocol
deviation to shorten the previously planned intervention in order to boost engagement and
participation. This can be seen as evidence that though structured in-person and targeted
interventions are a necessary approach requiring ongoing investigation, programs such as these
can be time-intensive, require significant coordination and planning, and potentially limit the
scale of uptake. Easily accessible information that can be freely consumed by coaches in their
own time is needed to supplement these important interventions.
In the current Practical Advances paper, we describe a practical suite of resources to
assist individuals (primarily coaches) working in recreational and/or development talent
pathways. These resources aim to assist in identifying and supporting young people who may
be experiencing mental ill-health, as well as nurturing positive mental health in such settings.
This guide was developed by researchers at Orygen, an internationally leading translational
research institute in Australia specialising in the area of youth mental health. This four-part
suite of resources (Table 1) can be freely and easily accessed by anyone.
1
When applied in
youth recreational sport settings, these resources provide guidance and tools for coaches in
responding to the mental health needs of young people.
1
Resources available at: https://www.orygen.org.au/Training/Resources/Physical-and-sexual-
health/Toolkits/Supporting-mental-wellbeing-in-community-sport
4
Development of the Guide
The suite of resources was developed by the authorship team using the following
process. Researchers from the team conducted a literature review, integrating guidance from
peer reviewed journal articles on the topic of youth mental health in sport, as well as
resources that have been developed by our own and other leading youth mental health
organisations. Key themes identified from the literature were synthesised and used by
researchers to develop the framework for the written resource. Information in the resources
was also informed by applied clinical experiences and provision of training within the team,
which includes psychologists (from both clinical and sports pathways) who are specialised in
working with young people. The draft document was reviewed and feedback was provided by
leading local researchers in the area of youth mental health in sports for content-specific
input. Further, we actively used co-design principles with a young person with lived
experience of mental ill-health for content queries and input regarding the design and layout
of the resource. In light of feedback provided, the resource was further refined by a
professional editor. Finally, graphic design elements were developed by Orygen in order to
make the resources accessible and visually pleasing for the target user.
Developmental considerations
Our experience working with young people suggests that the approaches provided can
be made relevant across the spectrum of age groups involved in youth sport. However, we
acknowledge that organisations may need to use some aspects of these resources in a way
that is deemed developmentally appropriate, by considering which factors may be more or
less relevant. For example, drug use may be less likely to represent a “warning sign” for
younger players. Further, communication styles are likely to be different when working with
younger or older players. Adults working within these settings are well placed to recognise
the adaptions that may be needed when working with young people.
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Part 1: Toolkit and checklist for sporting organisations to follow
The toolkit and checklist make up the central part of the resource suite. The toolkit
provides the key information while the checklist condenses this information into a clear form
for clubs to keep track of which aspects are being implemented. The toolkit describes eight
key actions (shown in Figure 1) which suggest priorities for recreational and youth sport
organisations to consider in order to promote good mental health within their club. For each
of these actions, the toolkit explains what the issue is, why it is important, and provides some
practical ideas about how this could be effectively implemented. The rationale for including
the eight key priorities are very briefly overviewed below, and interested readers are directed
to the original open access resource for further detail.
Raise awareness
Increasing knowledge as well as reducing potential stigma is vital for allowing young
people and responsible adults to recognise potential warning signs and know when and how
to seek help (Fleary, Joseph, & Pappagianopoulos, 2018; Kelly, Jorm, & Wright, 2007).
Given young people can be susceptible to stigma as a barrier for help-seeking (Clement et al.,
2015), directing awareness and attention to well recognised athletes expressing difficulties
with their mental health has been suggested as a potentially important approach with this
population (Swann et al., 2018; Walton, Purcell, & Rice, 2019).
Build a culture of support
Building supportive cultures within recreational sport is vital to the ongoing mental
well-being of engaged young people. This section emphasises the need for changing
perceptions to show that supporting mental wellbeing promotes, rather than impedes, sporting
excellence (Gucciardi, Hanton, & Fleming, 2017; Henriksen et al., 2019). This section aims
to challenge perceptions that sports settings (particularly more competitive developmental
6
pathways) need to prioritise performance and competitive pressures at the expense of
supportive climates.
Identify champions of mental health
Selection and promotion of individuals within a club by coaches is recommended to
help drive the agenda of mental health within the club. We call these individuals
‘champions’, and they can help to achieve momentum and attention to the area of mental
health promotion, where collective responsibility may lead to oversight. Champions should
come from all areas of the sport community including players, volunteers, coaches, umpires,
executives, and parents, with an emphasis on young people being involved to ensure that they
are heard and respected as key participants and leaders.
Open lines of communication
A significant barrier to effective recognition and action regarding player mental health
relates to the reticence of young people involved in sport to disclose concerns around their
mental health due to fear of potential stigma or repercussions (e.g., reduced playing time)
(Gulliver, Griffiths, & Christensen, 2012; Watson, 2005; Wynters, Liddle, Swann,
Schweickle, & Vella, 2021). Open communication between staff, leadership, players, family,
friends, and other club supports is crucial for breaking down this stigma. This section
describes the ‘art of conversation’, assisting coaches who may be unsure how to have
discussions around mental health by providing clear, direct, and actionable tips for these
conversations.
Encourage participation
When young people experience mental ill-health they often disengage from activities
like sport which in turn contributes to worsened mental health (Graupensperger, Sutcliffe, &
Vella, 2021; Swann et al., 2018). Tips are provided for helping to retain young people in
sports when they are experiencing periods of mental ill-health.
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Embrace diversity
There is increasingly strong evidence that young people who come from marginalised
groups, such as those with diverse sexuality, gender identity, cultural background, and
physical abilities are at increased risk of mental ill-health, likely via experiences of
discrimination (Benner et al., 2018; Guz et al., 2021; Patel et al., 2007). Indeed, young people
from such marginalised communities may experience difficulty engaging with, and feeling
supported by, recreational and school sport settings (Kavoura & Kokkonen, 2020). This
section describes the importance for youth sport settings to create an atmosphere that starts
with inclusion, but also goes beyond it to celebrate differences and diversity.
Foster wellness and resilience
It is important that sports communities promote strengths and positive mental health,
and do not simply function from a deficits-based approach. This is in line with the
aforementioned dual continua model (Keyes, 2002; Keyes, 2005), and upholds the
importance of fostering wellness, resilience, and mastery in young people. Indeed, research
suggests that under the right circumstances and when taking consideration for a young
person’s unique barriers and life circumstances, sport settings are valuable for encouraging
positive life skills and development in participants (Holt et al., 2020). This section of the
toolkit provides tips on how to promote resilience and strengths of participants in youth sport
settings.
Build links to external supports
This item is a crucial aspect of the toolkit. We have tried to emphasise throughout the
resource that these materials in no way intend to place individual responsibility on coaches to
manage the mental health of young people engaged in sport. Rather, the ideal model involves
a broad system of supports that work collaboratively with each other (see Figure 2). The
8
resource provides tangible examples of how to facilitate this support network, particularly in
regards to more formal networks such as local mental health services.
Part 2: Guide for individually responding to young people
The ‘Guide for responding’ resource details a clear and structured step-by-step
approach with tips for how to engage young people in conversations around mental health, as
well as providing advice on appropriate follow-up steps. The guide details a three-step
approach; ‘Notice’, ‘Engage’, and ‘Assess and Act’.
Step one - Notice.
Step one provides guidance on identifying at-risk young people. Information in step
one mirrors information provided by existing resources (Jorm, Kitchener, Sawyer, Scales, &
Cvetkovski, 2010) around important signs to look out for, which might indicate that a young
person is experiencing distress. The intention of this step is to synthesise key information on
warning signs of distress among young people which might be particularly noticeable in the
context of recreational or school sport, as displayed in Figure 3. General tips include looking
out for social withdrawal, which is an important indicator of emerging distress in young people
(Katz, Conway, Hammen, Brennan, & Najman, 2011). This step also introduces the idea of
‘risk’ (Turecki et al., 2019) in a mental health context.
Step two - Engage
Step two addresses how to approach a young person who may be experiencing mental
health problems and provides guidance on structuring an initial conversation around mental
health or signs of distress. This step aims to provide a clear and practical guide for approaching
a conversation with a young person, once warning signs have been noticed and the coach or
responsible adult is sufficiently concerned. Previous work has demonstrated that many coaches
can experience awkwardness and concern around ‘saying the wrong thing’ to a young person
when approaching this conversation (Ferguson et al., 2019). To address this, three phases of
9
response to enact during a conversation are outlined (see Figure 3). Additional important
recommendations in this step include tips for an appropriate style of communication including
active listening, demonstrating respect and empathy, using direct language and not trying to
educate on concepts or knowledge that is beyond the coaches means.
Step three - Assess and Act
The final step provides guidance for determining the urgency of the situation and the
appropriate follow-up response to the conversation. This step outlines three clear response
patterns based on the information gathered from the young person. The suggested response to
Message 1: Everything is OK, encourages coaches and responsible adults to make a future time
with the young person to check in, in order to solidify the supporting and trusting relationship.
Message 2: Some concerns are present should be followed when the coach is not satisfied that
the young person can manage their concerns independently, and necessitates encouragement
to the young person to approach local support services. These may include support options
located at school, including a school wellbeing co-ordinator, psychologist or counsellor, a local
GP, or community-based early intervention mental health service, such as headspace in
Australia (McGorry et al., 2007). Finally, Message 3: Imminent risk should be followed when
the conversation suggests a young person is at risk of harming themselves or someone else,
and where the coach is concerned that harm will occur if immediate intervention does not take
place.
Part 3: Educational video resource
Lastly, a five-minute video is provided, which may be an effective tool for sharing with
young people, their families, and sports organisations at large. The video overviews the role of
sport in supporting mental health, and how those within these settings may be well-placed to
respond. We suggest the video may be well suited as a resource to open the dialogue within
clubs, and be played in group settings to facilitate discussion.
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Discussion and Applied Impact
The concerning prevalence and associated social, economic and personal impact of
mental ill-health among young people has been well-documented (Clayborne et al., 2019; Patel
et al., 2007; Solmi et al., 2021). Sports clubs and those within them are becoming increasingly
recognised as vital agents in connecting mental health services with young people experiencing
difficulty (Breslin, Haughey, Donnelly, Kearney, & Prentice, 2017; Swann et al., 2018). Thus,
it is necessary that coaches and responsible adults within these environments are provided with
the adequate support and information to effectively assume this crucial role in identifying
mental health issues among young people and practicing first-response intervention. However,
while intervention programs exist which may be beneficial (Breslin, Shannon, et al., 2017),
they primarily focus on awareness and more is needed to freely and openly provide clear,
actionable support to coaches. To address this need, our guide has been designed to assist in
supporting the mental health of young people within recreational and youth development sports
settings. We encourage sports clubs and organisations along with coaches to view and act on
these freely available evidence-informed resources in a way that suits their unique
circumstances.1
Whilst coaches should not be expected to assume the role of a mental health
practitioner, there is still a strong rationale for the provision of clear guidance around how to
respond and direct a young person to necessary supports, once signs of distress are noticed.
Bolstering confidence of coaches to not only recognise but intervene when they are concerned
is vital, in order to do justice to their distinctive opportunity to identify concerns that may be
missed in other contexts. It is important that coaches understand how to leverage their position
– often as a role model (Vella, Oades, & Crowe, 2013) - to respond appropriately to young
people who are experiencing distress and who may seek help from them as known, trusted
adults. Research has suggested that merely improving gatekeeper understanding of ‘warning
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signs’ of distress in young people (Jorm et al., 2010; Vella et al., 2018) may not translate to
altering intervening behaviour. Taking the extra step to provide coaches and other responsible
adults in sport with practical tips for first-response intervention, will ideally help to ensure
vulnerable young people are adequately supported.
However, our clinical and research experience suggests that upskilling coaches to
engage with such training is a complex and difficult task. During the previously described
‘Ahead of the Game’ study (Vella et al., 2020; Vella et al., 2018), the research team met
significant barriers to implementation with coaches, with reduced uptake likely reflecting the
time-intensive nature of training. With the exception of elite competitive sport, youth contexts
are commonly volunteer-led, with leaders typically beholden to their ‘main’ role (i.e., parenting
or employment), limiting the ability to engage with additional responsibilities (Wicker, 2017).
Coaches have suggested that while further training and education as to their role is valuable,
many are restricted by multiple barriers, often relating to time and financial constraints placed
on volunteers (Wiersma & Sherman, 2005). Any intervention within these spaces must be
responsive to this fact, and highly structured interventions with required components may not
be most effective for uptake and scaling.
Instead, the materials provided here are designed to be sensitive and adaptable to the
varied and unique settings that may differ among youth sports (Bean, Shaikh, Kramers, &
Forneris, 2021). While we advocate for all suggestions within the resources, the checklist
allows for coaches, clubs, and organisations to selectively apply whichever of the principles
and strategies are most applicable or feasible. For example, school sport environments and elite
settings with full-time employed staff may be better able to coordinate and facilitate many of
the more substantial suggestions within these resources (e.g., awareness raising events, guest
speakers). A smaller volunteer-led community club however, may choose to implement just
those which are most accessible (such as approaches to communication and support). Future
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implementation research will be key to understanding which aspects of the toolkit are
considered most user-friendly when considering the common constraints that typically exist.
As of yet, we have not methodically assessed for efficacy of this toolkit. Therefore, in
terms of the translational stage of this research, the project can be considered currently as
‘designed for implementation’, with efficacy and effectiveness of the tool unknown (Lane-Fall,
Curran, & Beidas, 2019). While we note that feedback from our community relationships have
highlighted uptake and perceived benefit of this work within their organisations, future mixed-
methods research designs will be required to obtain reliable estimates of both perceived and
measurable effectiveness, as well as the feasibility among coaches and youth sports
organisations. While this will indicate the effectiveness of the guidelines as a cohesive unit, we
highlight that the work is well-informed by the research literature and our combined clinical
experience. Sharing this resource was considered necessary given the typically prolonged
delays between controlled and methodical intervention research, and access for the community.
While the resource presented here is one positive step towards providing increased
guidance for coaches and responsible adults in supporting youth mental health, a number of
limitations in its design and application warrant consideration. First and foremost, the efficacy
of this resource has not been demonstrated. Therefore, we do not describe our resource as an
‘intervention’ per se, but rather a translational resource informed by both clinical expertise and
principles stemming from the research evidence base. Second, while a systematic search of the
literature to inform the resource was conducted using Orygen’s ‘Evidence Finder’
(www.orygen.org.au) which is a comprehensive database of all available published controlled
trials and systematic reviews of interventions in the field of youth mental health, a detailed
review is not reported here.
The guide presented in this study aims to contribute towards a necessary broader system
of collaborative supports, such that if a young person experiencing difficulty disengages from
13
one system, they can be effectively supported by another. We wish to repeatedly emphasise
that the material presented in this resource kit in no way suggests that coaches should be
expected to deliver therapeutic interventions, but rather that they may assist young people with
support and referral to the appropriately qualified mental health clinician if needed. Targeted
guidance, such as the resource presented here, may help to bridge the gap in the existing
information available to support their role in this wider system. Ultimately, it is hoped that the
practical application of this resource within the recreational sport setting, may assist in
increasing the number of competent role models equipped to identify and intervene early in a
young person’s concerns in the recreational sport setting.
Acknowledgements: The authors thank Elon Gersh, Caroline Crlenjak, Jay Carmichael,
Shona Francey, and Rebekah Anderson for their expertise and assistance throughout the
design of the resource at Orygen.
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Table 1. Overview of resources available in the ‘Supporting mental wellbeing in community
sport’ toolkit.
Resource
Brief description
Main components
Guide for
responding
A practical guide to identifying and
helping young people with signs of
mental ill-health.
Discussion of following steps:
1. Identifying warning signs
2. Talking with a young person
3. Determining urgency and response
Toolkit
A toolkit to provide sports
organisations with a clear
framework and practical tools to
ensure that they are supporting
young peoples' mental health and
wellbeing.
Discussion of following components:
1. Raise awareness
2. Build a culture of support
3. Identify champions of mental
health
4. Open lines of communication
5. Encourage participation
6. Embrace diversity
7. Foster wellness and resilience
8. Build links to external supports
Checklist
A brief and user-friendly checklist
to track the ways your club can
provide a safe and inclusive
environment for players.
As per Toolkit, in checklist format
Brief
educational
video
Brief educational video providing a
discussion featuring a young
person, coach and research expert
on how to have conversations about
mental health in community sport.
Brief video (4 minutes 29 seconds)
which can be easily shared and played
in club/sports settings
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Figure 1.
Eight actions to be embedded within community clubs. These are discussed in detail within
the toolkit, and listed within the checklist.
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Figure 2.
Representation of the near and far support networks that a young person is involved in
through sport. The ideal model of support for young people’s mental health involves a broad
system of supports that work collaboratively with each other. This ensures that there are
multiple people who can detect mental health issues in young people and also act as sources
of support.
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Figure 3.
Tips are provided on how to notice warning signs of potential ill-health in a young person (a),
as well as how to communicate this through conversational tips (b).
