Story by Blake Richardson
As UNC-Chapel Hill freshman Maggie Berra lay on the couch, barely able to walk after hip surgery, her mind was locked in an internal debate: Should she tough out her second semester on the UNC rowing team, or should she walk away?
Berra was depressed. Her parents could tell by her grades, but her teachers, her coaches and friends couldn’t tell at all. And that was the worst part. Isolated from her team because of her injury, Berra didn’t know anyone at UNC well enough to share what she was going through. She felt miserable and invisible.
Berra had known she couldn’t row her first month of college, because she was injured in a car crash three weeks before she was set to start her freshman year. But while meeting with doctors at UNC Sports Medicine, Berra learned she needed surgery. For her first year of college, she couldn’t row.
“I had lost my identity as a rower,” Berra said. “I came in injured and I didn’t know it. I couldn’t do what I came to do, and I felt like I was disappointing myself, my coaches, my parents.”
Berra’s struggle isn’t uncommon. Mental illness is on the rise in the United States, and college athletes are not immune. In fact, they face more barriers when seeking help. The expectations that athletes be mentally tough and play through pain creates a culture of silence. And too often, college athletic departments lack mental health resources.
The pain remains in the shadows.
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When she was battling depression and anxiety as a sophomore on the University of Southern California’s volleyball team, Victoria Garrick turned to Google. She remembers searching “athletes and depression.”
“I didn’t find anything,” she said.
Like many athletes, Garrick said in an interview that she found it hard to seek help as she struggled with anxiety and depression because of the emphasis on mental toughness in athletes.
“If I’m feeling really depressed, and I can’t go to practice without crying, I think that I should probably take the day off, because you’ll probably make it worse, just like playing on an injury,” Garrick said. “But it’s just not viewed the same for me to tell my trainer or tell my teammates, ‘I’m feeling depressed, I can’t come.’ … When someone can’t see it, it’s much harder to assure them it’s there, it’s happening, it’s real.”
So when she got the chance to give a TED Talk on her experience, Garrick jumped at the chance. Since she spoke in June, 2017, her talk has been viewed almost 20,000 times.
Though Garrick couldn’t find other athletes opening up, she wasn’t alone in her mental health battle. A study by researchers at Drexel University and Kean University found that athletes suffer from mental health disorders at the same rate as the general population, at 25 percent.
In fact, a 2014 survey by the American College Health Association found that among student-athletes, 28 percent of women and 21 percent of men were depressed, while 48 percent of women and 31 percent of men were anxious, according to. And 30 percent of athletes reported feeling “intractably overwhelmed” in the past month in a study by the NCAA that was released in January, 2016.
The stress of athletes’ time demands contribute to the problem. The NCAA’s study found the median time athletes spent on sports was 34 hours per week in 2015 for Division I, an increase from 32 hours in 2010. One in three athletes struggled to find energy for things outside their sport because of physical demands — one in four from the mental demands. And athletes slept six hours and 16 minutes per night on average when their sport was in season. Eight hours is recommended.
Campus mental health services are available to athletes but can be daunting to use. Because athletes are more recognizable than other students, seeking help from campus services — walking to the building, scheduling an appointment and sitting in a waiting room — feels too public.
And while some athletes can benefit from seeking help from someone outside the sports world, many of them struggle to connect with someone who is not specially trained.
“I really think of athletics as a culture,” said Dr. Jeni Shannon, UNC’s sports psychologist. “And there are some really unique aspects to this culture that folks who don’t have the specific background and training in working with athletes may not understand fully. The athletes just may not feel like their world, their culture is as understood going to somebody who isn’t trained in that way.”
But the majority of athletes don’t have access to that resource. A study by Dr. Laura Sudano from the Wake Forest Baptist Medical Center found that 20.5 percent of Division One schools offer those services.
Sudano said the school’s discrepancy stems from three concerns: deficits in finances, the risk of harming an athlete’s confidentiality by providing mental healthcare that’s too integrated, and a lack of guidance from the NCAA.
The NCAA released 40-page writing on guidelines in 2016 of how to address mental health for athletes, but no set standard is required of schools. Sudano said the NCAA would ideally require schools to house a mental health provider trained to help athletes, because integrating mental and physical health care can help de-stigmatize seeking help.
“When you come to the training room, yeah, you’re going to get treated for your aches and your pains and whatever chronic injury you have, but you also have the opportunity to speak with somebody if you are struggling,” Sudano said. “And it helps just to normalize that culture.”
The stigma of mental illness cannot be eradicated from athletic culture overnight, but Sudano said providing integrated resources is an effective way to start. UNC has begun to see the benefit of this since hiring Shannon as a full-time sports psychologist at the start of 2017.
Shannon meets with about 25 student-athletes per week during individual appointments. She helps them work through anything from on-the-field issues or injuries, to relationship problems, body image issues and mental health disorders — most commonly depression and anxiety. She’s found wellbeing and athletic performance are frequently intertwined.
“A lot of times people will come in for performance issues because that’s kind of an easier entryway to the services,” Shannon said. “The idea of working on your mental game, for most people, is less threatening than working on your mental health.”
Shannon has worked part-time at UNC since 2014, but was hired full-time this year as the University noticed the need to expand the sports psychology program. Taylor Leath, a redshirt-junior UNC volleyball player who is chair of the wellness committee for the Student Athlete Advisory Council (SAAC), said the organization advocated for the full-time position during monthly meetings with administrators last year.
Leath first realized the scope of mental illness in a meeting with Spectrum, a social justice group for UNC athletes. In the club’s safe space, athletes spoke about issues with mental health they and their teammates were experiencing. She said because SAAC is made up of team leaders, many athletes were opening up to them as well.
“Those relationships within teams have kind of opened peoples’ eyes up to see that there was something that needed to be addressed,” Leath said. “And there was a resource that we could tap into, and we knew that we were able to get that resource as well.”
In the full-time role, Shannon has integrated herself in the athletic community. On top of individual appointments, she meets with three to five teams per week to work on mental game, works with SAAC and Spectrum to spread awareness, runs a support group for injured athletes (a service she wants to expand to athletes in medical retirement and with body image issues), and she regularly communicates with coaches.
Shannon’s prominence makes her more accessible. Athletic trainers, academic advisors and others in the department have been trained to spot warning signs that an athlete is struggling and make referrals. In fact, Shannon said the majority of her referrals come from the athletic trainers. But because athletes are more willing seek help, Shannon doesn’t have the time to serve them all, even with help from part-time mental health providers. Athletes who want see her have to schedule an appointment two or three weeks in advance.
The program is moving away from stigma. Leath has noticed a heightened mental health awareness compared with her first two years at UNC. Shannon has seen improvement in the stigma through a new source of referral: The athletes who meet with her.
“I can’t tell you how many times I’ll get an email saying, ‘Hey, I know you see my teammate, and he really encouraged me to reach out to you,’” Shannon said. “… That’s a huge source of referral that I’ve really seen increase, and honestly the most powerful one.
“It’s one thing for a coach or a Sports Med. staff to say, ‘Oh, I think you should talk to someone.’ It’s a different thing for a friend to not only say, ‘I think you should,’ but ‘I’ve done it, too.’”
In that spring semester of her freshman year, Berra ultimately decided on her own to return to UNC for another semester. She had something to prove — to her teammates, her coaches and herself. She dreamed of rowing competitively, and she was determined to make that happen.
Support from her parents helped, but the biggest improvement was in her mindset. Surgery was behind her, her grades improved drastically, and she and could feel the progress in her recovery. After a painful semester of rehabilitation, Berra competed as a sophomore, even rowing in the ACC Championship.
But as the season’s end approached, Berra began to feel a throb in her left hip.
“I knew the pain,” she said. “It was a very familiar pain.”
An MRI her junior year confirmed her suspicions: She had cringe impingement and a torn labrum again, this time in her left hip. Berra stood in front of her team and started bawling as she shared the news: She had to retire.
Berra lost her identity again. But this time, she didn’t cope with it alone. Her coaches, Sarah Haney and Anthony Brock, and a friend recommended that she meet with Shannon, so Berra did. She opened up about her struggles, and with her help, Berra found herself in other interests. This time, her injury was painful — but not debilitating.
“I feel like I would be a completely different person if I had had someone like her my freshman year,” Berra said. “It would’ve been a completely different situation.”
