This Article is written by Anna Elizabeth Mithun, University of Turin, Italy, an intern under Legal Vidhiya
ABSTRACT
Athletes face immense mental pressures that are often overlooked in favour of physical performance. This essay examines the mental health rights of athletes, highlighting how psychological well-being remains undervalued in competitive sports. It explores the historical stigma surrounding mental health, the unique challenges athletes encounter; such as anxiety, burnout, and media scrutiny, and the insufficient legal and institutional safeguards currently in place. Through analysis of recent cases and organizational policies, the essay argues for recognizing mental health as a fundamental right. It concludes with recommendations for legal reform, improved support systems, and cultural change to ensure that athletes receive comprehensive care both on and off the field.
KEYWORDS
Mental health, Athletes, Human rights, Sports law, Performance pressure, Stigma, Institutional support, Well-being, Law, Sports
INTRODUCTION
In the world of sports, athletes are often celebrated for their physical strength, endurance, and resilience. Yet, behind the medals and records lies a less visible struggle – mental health. While physical injuries are treated with urgency and care, psychological challenges such as anxiety, depression, and burnout are frequently ignored, downplayed, or even stigmatized. For decades, a “tough it out” culture has dominated athletics, discouraging open discussions about mental well-being. However, in recent years, high-profile athletes have begun to speak out, drawing global attention to the urgent need for mental health support in sports.
Despite this growing awareness, mental health rights for athletes remain underdeveloped in both legal frameworks and institutional policies. Many athletes still lack access to adequate mental health resources, face pressure to remain silent, or risk career consequences for seeking help. This essay explores the mental health challenges faced by athletes, the legal and ethical dimensions of their rights, and the responsibility of sports institutions to provide meaningful support. By examining current shortcomings and proposing necessary reforms, the aim is to reframe mental health not as a personal weakness but as a fundamental right in the world of competitive sport.
HISTORICAL CONTEXT & CURRENT LANDSCAPE
Historically, the perception of athlete well-being, including mental health, has been heavily influenced by a “sports exemption,” where issues concerning athletes’ employment are largely governed by sports federations rather than traditional labour law. This approach has placed athletes in a vulnerable, dependent, unstable, and precarious position. The systemic lack of protective frameworks for overall well-being implicitly fosters an environment that prioritizes performance despite intensifying physical and psychosocial loads. The increasing physical demands and resulting injuries, averaging 8.6 million annually, point to a culture that, until recently, did not adequately safeguard holistic athlete health. This historical context contributes to negative trends in athlete health, including mental well-being.[1]
High-profile athletes have increasingly spoken out about their mental health struggles, challenging long-standing stigmas in the sports world. In 2021, gymnast Simone Biles withdrew from several Olympic events, citing mental health concerns and prioritizing her well-being over competition. Naomi Osaka, a top tennis player, made headlines after pulling out of the French Open to protect her mental health, sparking global conversations about the emotional pressures athletes face. Michael Phelps, the most decorated Olympian in history, has openly discussed his battles with depression and anxiety, becoming a vocal advocate for mental health awareness in sports. These examples highlight the urgent need for better support systems and recognition of mental health as a core component of athlete welfare.[2]
Scientists have also observed a recent increase in sudden deaths among athletes. Crucially, over 50% of surveyed athletes experience financial difficulties within five years of ending their careers, which leads to mental health problems. Additionally, incidents like the US Gymnastics team physician facing hundreds of sexual abuse allegations underscore the profound psychological trauma experienced by athletes due to exploitation.
Athletes themselves are increasingly challenging the “sports exemption” and advocating for labour law application. The widespread recognition of psychosocial factors influencing injuries and recovery further emphasizes this growing understanding. There are various precarious practices that are still widespread and constitute a threat to athletes’ health and working capacity. These include informal and unstable contracts, with many athletes lacking written agreements or facing very short durations, violations of labour mobility rights, treating athletes as assets in “transfer” systems, unfavourable working conditions, such as wage manipulation, late payments, and irregular hours that often exceed 40 per week with insufficient rest or vacation, pervasive discrimination and violence, including significant gender pay gaps, racial discrimination, and high levels of sexual abuse affecting young athletes and restrictions on the right to protection, with many sports disputes handled by internal arbitration bodies rather than general courts.
While the Professional Footballers’ Association organized a social media boycott to protest racist abuse, the international community and national states still must reduce the “sports exemption” and implement legal mechanisms to bring athlete labour under labour law to genuinely safeguard their physical and mental health.[3]
MENTAL HEALTH CHALLENGES SPECIFIC TO ATHLETES
Athletes, despite often appearing as symbols of strength, face significant mental health challenges, frequently deterred from seeking help by a prevalent “win at all costs” culture in sports. These issues impact elite athletes, student-athletes, and para-athletes across various levels of competition.
Anxiety and Depression is one of the mental health challenges specific to athletes. Over 30% of student-athletes report experiencing overwhelming anxiety, with approximately one in four U.S. college athletes suffering from depression. Elite athletes also report high rates of generalized anxiety disorders, with the COVID-19 pandemic significantly exacerbating mental health concerns among student-athletes.[4] High risks of eating disorders are also observed in weight-sensitive sports, with 10-25% of collegiate athletes reporting depression and eating disorders, often due to an intense focus on body physicality. Substance abuse and addiction are often seen to be prevalent among athletes. This encompasses issues like opioid addiction (e.g., in the NFL), alcohol abuse (e.g., in MLB), and sport or exercise addiction, where athletes might ignore injuries or overtrain, leading to physical and psychological harm. The expansion of sports gambling and the rise of esports also pose significant addiction risks, particularly for young male teenagers, potentially leading to neglect of personal life. Another notable challenge many athletes face is the loss of identity after a career ends. A poll found that 50% of retired players felt a loss of control, identity, and struggled to find new purpose within two years of retirement, contributing to severe anxiety and depression.[5]
All of these struggles are intensified by several multifaceted factors. Physical risks and injuries, particularly concussions, are linked to serious psychiatric symptoms including depression, aggression, and suicidal behaviour (e.g., in former NFL players). Athletes often hide injuries due to fear of being perceived as weak or replaceable. Trauma from sexual abuse and misconduct within sport (e.g., as seen in gymnastics cases) can cause lasting mental health trauma. “Hard coaching” that devolves into verbal abuse and bullying (e.g., fat-shaming, name-calling) also negatively impacts athletes, who often find it challenging to speak out against authority figures. Social media scrutiny, public pressure, and sponsorship demands create immense stress. The demanding training and competition schedules, constant travel, and lack of personal life further impair mental well-being. High-profile cases, such as Naomi Osaka’s anxiety over press conferences and Simone Biles’ withdrawal from Olympic competitions due to mental health concerns, powerfully illustrate these pressures.[6]
Despite the pervasive stigma often associated with mental illness in sports, prominent athletes like Kevin Love, Michael Phelps, and LeBron James have openly discussed their struggles, helping to destigmatize these issues and advocate for greater awareness and institutional support. In response, major sports organizations including the NCAA, NBA, NFL, MLB, NHL, IOC, and USOPC are increasingly implementing programs to support athlete mental health, emphasizing a “culture of care” and providing access to mental health experts and post-play transition support.
LEGAL AND ETHICAL DIMENSIONS OF MENTAL HEALTH RIGHTS
Mental health rights include the right to confidential and accessible mental health services. This means athletes should have access to treatment, and the details of their mental health care should be protected from unauthorized disclosure. Some relevant guidelines and acts such as The Health Insurance Portability and Accountability Act of 1996 (HIPAA), The U.S. Center for SafeSport, guidelines from the American Psychiatric and Psychological Associations that help guide clinical practice conversations are available in the U.S. International frameworks like the UN Convention on the Rights of Persons with Disabilities (UNCRPD) and WHO guidelines emphasize the right to mental health care and non-discrimination. As a signatory to the UNCRPD, India is obligated to uphold these protections, including for athletes facing psychological challenges. However, the implementation remains limited, and specific mental health rights for athletes are not clearly outlined within Indian sports law or policy frameworks. There is a need for specific protocols and considerations, such as discussing prohibited/banned substance lists that vary by sport; a specialized attention beyond general law is also required to ensure these rights are upheld in the athletic environment.[7]
Maintaining high standards of ethics and professionalism is paramount in sports and performance mental healthcare. For coaches, teams, and governing bodies, along with other stakeholders like athletic trainers, agents, and medical personnel, the ethical obligations include many. Careful consideration of information sharing, communication with all involved parties, developing clear protocols for collaboration to assist with care[8] integration and role clarity, explicitly identifying what information is protected versus what can be shared are all of utmost importance.
Identifying all relevant stakeholders to prevent incidental or unintended disclosures of sensitive information, establishing emergency action plans for mental health emergencies, mirroring medical emergency plans, honest communication with athletes regarding any potential conflicts of interest, especially if a provider serves a dual role (e.g., performance evaluations alongside therapeutic services), to build and maintain trust are all non-negotiable. It is important to include athletes in discussions when appropriate, particularly concerning decisions related to removal from play and plans to return to play, balancing safety with the athlete’s autonomy and privacy. For medical prescribers, discussing the benefits and risks of medication use including potential impacts on an athlete’s health and safety in play, and informing athletes about prohibited/banned substance lists relevant to their sport is key.[9]
INSTITUTIONAL RESPONSIBILITIES AND SHORTCOMINGS
The immense pressure causing athletes burnout often stems from global stages like the Olympics and the overall competitive environment of high-level sport and professional sport. This implies that such organizations, which oversee these environments, contribute to the conditions athletes face. For employed athletes, there are indications of employer responsibilities for their well-being. Under Swiss law, an employer (such as a sports team) has a legal obligation to protect and respect the personality of the worker and give due regard for his or her health. This provision could justify the implementation of psychological follow-up measures for salaried athletes. Moreover, an employee who is unable to work because of an illness, including any impairment of physical, mental or psychological health like stress or depression, according to Swiss jurisprudence, may be entitled to salary maintenance and temporary protection against the termination of his employment contract.
There are also significant shortcomings and a lack of clear mental health policies or access to professionals for many athletes, particularly those who are not salaried. Non-salaried athlete such as those who are self-employed or act as service providers are not covered by the protections of labour law. Consequently, if they are unable to compete because of burnout, they effectively lose a portion of their income.[10] A number of cases vividly demonstrate the career consequences of burnout and mental health challenges. For example, American gymnast Simone Biles withdrew from key events at the Tokyo Olympics, citing “twisties” that were brought on by the “pressure of winning.” Similarly, Japanese tennis star Naomi Osaka refused to attend a press conference and later left the Roland Garros 2021 tournament because of “excessive pressure,” and she later broke down in tears after facing insults from the crowd. After feeling “exhausted” and having “lost the physical drive, the desire,” former Australian tennis player Ashleigh Barty retired at the age of 25. The psychological recovery of Slovenian footballer Josip Iličić was described as “very complicated” after he disappeared from the field for long stretches due to alleged depression. After a long injury layoff, English footballer Luke O’Nien experienced profound uncertainty about his future and a sense of isolation, which raised questions about his identity outside of the sport.[11]
Non-salaried athletes facing long-term mental health issues like depression or burnout may see a drop in their income from sponsorship or endorsement deals, or even have these contracts terminated entirely. This highlights a critical vulnerability where athletes’ financial stability is directly tied to their performance, with limited safety nets for mental health breaks. While Iličić’s alleged depression was never confirmed by the person concerned and information came from voices of his coach and teammates, whether there were instances of confidentiality breaches concerning mental health issues are not clear.
One of the very few instances of an institution taking a positive step was when the Los Angeles Dodgers renewed the contract of their young baseball talent, Alvin Andrew Toles, who suffered from serious psychological issues including bipolar disorder and schizophrenia. Even though it was understood he would likely not return to play, this renewal provided him access to the health insurance and mental health services he needs to continue fighting his demons. This demonstrates a commitment from a team to support an athlete’s long-term well-being beyond their immediate playing capacity.
Given that athletes are generally advised to take out insurance for lost income and to pay close attention to the terms of their contracts with suppliers and sponsors, it is clear that comprehensive institutional support is not always guaranteed. As a result, athletes are left to protect themselves from the financial and career repercussions of burnout.[12]
PATH FORWARD: RECOMMENDATIONS AND REFORMS
Some recommendations and reforms for mental health support in sports include mandatory access to mental health professionals in sports teams. To ensure athletes’ well-being, sports organizations must create interdisciplinary mental health support systems with access to professionals and counselling. International Federations (IFs) should integrate mental health expertise into their Medical Committees, while IFs, National Olympic Committees (NOCs), and National Federations (NFs) should appoint a designated mental health contact point for all event support teams. Local Organising Committees (LOCs) are responsible for ensuring that mental health expertise is part of medical services planning and for providing information on local resources. During events, sport-specific mental health professionals should be accessible, either on-site at Medical Centres or on-call. Where possible, NOCs and NFs should offer continuous support, from athlete support staff to clinical psychologists or confidential counseling. Health professionals are obligated to provide early and effective mental health interventions. New legal protections are needed to safeguard mental health on par with physical health, recognizing that athletes have a human right to the highest possible standard of well-being and a safe environment for both training and competition. This right is enshrined in various international human rights treaties, with the IOC committed to upholding it through frameworks like the Olympic Charter and Framework on Human Rights. The duty of care for health professionals is mandated by various normative frameworks, including the Olympic Movement Medical Code. All mental health information must be safeguarded with proper health data protection and confidentiality protocols.
Robust prevention and education programmes on common mental health issues, crisis intervention, and cultural sensitivity are strongly recommended for medical support teams, athletes, their entourages, and all sports officials. The IOC offers resources like the Mental Health in Elite Athletes Toolkit and educational programs such as the IOC Diploma (for physicians/licensed practitioners) and IOC Certificate (for athletes, coaches, and entourage) to enhance understanding and well-being. Mental health literacy education aids staff in early recognition of concerns. For media, sensitivity, empathy, and implicit bias training are suggested, along with clear guidelines for respecting athlete mental health.
Athletes should also be offered psychological support following their return from events to help manage feelings of loss, negative emotions, and identity challenges characteristic of the post-Olympic period. The IOC’s Athlete365 platform provides resources for athletes’ mental health during and after their careers, including specific transition support for retired athletes.[13] Fostering a culture of openness and acceptance around mental health is crucial to reduce stigma and encourage help-seeking. Peer-to-peer learning programmes and communities of practice are encouraged to facilitate this. Creating mental fitness areas at events, designed as calm spaces with educational elements, aims to promote destigmatization of help-seeking and normalize conversations around mental health. Confidentiality agreements and clear communication about privacy also support a trusting environment.
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CONCLUSION
Mental health is just as vital as physical health, yet athletes continue to face stigma, neglect, and inadequate support when it comes to psychological well-being. While awareness is growing, much work remains to ensure that mental health rights are clearly defined, legally protected, and institutionally supported in the sports world. Recognizing and addressing the unique pressures athletes face is not only an ethical responsibility, it’s essential for their long-term performance and overall well-being. To truly support athletes, we must move beyond awareness and commit to lasting reforms that treat mental health care as a fundamental right, not a luxury.
REFERENCES
- Burnout in sport and its legal consequences – Elite Law, https://www.elitelaw.ch/burnout-in-sport-and-its-legal-consequences/.
- https://stillmed.olympics.com/media/Documents/Athletes/Safeguarding/Mental-Health-Guidelines-for-Events-EN.pdf.
- Olena V. Moskalenko et al., ENSURING PHYSICAL AND MENTAL HEALTH OF ATHLETES BY THE LABOR LAW, 74 Wiadomości Lekarskie 3025, XXXX (2021), https://doi.org/10.36740/wlek202111228.
- Protecting Athletes’ Right to Mental Health Treatment, Psychology Today (Dec. 1, 2023), https://www.psychologytoday.com/us/blog/sports-and-performance-psychiatry/202312/protecting-athlete-rights-to-mental-health-treatment/amp.
- Salim Yaacoub, Legal recommendations and psychological advice sports administrators can implement in the next pandemic, The International Sports Law Journal (Apr. 20, 2023), https://link.springer.com/article/10.1007/s40318-023-00240-x.
- The Anxious Athlete: Mental Health and Sports’ Duty and Advantage to Protect (Apr. 4, 2022),https://journals.law.harvard.edu/jsel/wp-content/uploads/sites/78/2022/04/13-1-Weston.pdf.
[1] Olena V. Moskalenko et al., ENSURING PHYSICAL AND MENTAL HEALTH OF ATHLETES BY THE LABOR LAW, 74 Wiadomości Lekarskie 3025, XXXX (2021), https://doi.org/10.36740/wlek202111228.
[2] Burnout in sport and its legal consequences – Elite Law, https://www.elitelaw.ch/burnout-in-sport-and-its-legal-consequences/.
[3] Olena V. Moskalenko et al., ENSURING PHYSICAL AND MENTAL HEALTH OF ATHLETES BY THE LABOR LAW, 74 Wiadomości Lekarskie 3025, XXXX (2021), https://doi.org/10.36740/wlek202111228.
[4] Salim Yaacoub, Legal recommendations and psychological advice sports administrators can implement in the next pandemic, The International Sports Law Journal (Apr. 20, 2023), https://link.springer.com/article/10.1007/s40318-023-00240-x.
[5] The Anxious Athlete: Mental Health and Sports’ Duty and Advantage to Protect (Apr. 4, 2022), https://journals.law.harvard.edu/jsel/wp-content/uploads/sites/78/2022/04/13-1-Weston.pdf.
[6] Ibid
[7] Protecting Athletes’ Right to Mental Health Treatment, Psychology Today (Dec. 1, 2023), https://www.psychologytoday.com/us/blog/sports-and-performance-psychiatry/202312/protecting-athlete-rights-to-mental-health-treatment/amp.
[8] Salim Yaacoub, Legal recommendations and psychological advice sports administrators can implement in the next pandemic, The International Sports Law Journal (Apr. 20, 2023), https://link.springer.com/article/10.1007/s40318-023-00240-x.
[9] Protecting Athletes’ Right to Mental Health Treatment, Psychology Today (Dec. 1, 2023), https://www.psychologytoday.com/us/blog/sports-and-performance-psychiatry/202312/protecting-athlete-rights-to-mental-health-treatment/amp.
[10] Burnout in sport and its legal consequences – Elite Law, https://www.elitelaw.ch/burnout-in-sport-and-its-legal-consequences/.
[11] Ibid.
[12] Ibid
[13] https://stillmed.olympics.com/media/Documents/Athletes/Safeguarding/Mental-Health-Guidelines-for-Events-EN.pdf.
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