By Dan Moberger
Medill Reports

At 5:30 p.m. on a muggy Tuesday in mid-July, parents dropped off their teenage daughters at Fleet Fields, a parking lot converted to basketball courts in Chicago’s Bucktown neighborhood. Flanked by industrial-looking brick buildings on three sides, the blacktop has afforded an attractive, open-air training grounds for Flow Basketball Academy during the pandemic.

The thermometer read 83 degrees when practice began, and sparse, wispy clouds decorated the otherwise clear blue sky, leaving the sun an unimpeded lane to the young athletes. Not long after coach and co-owner Korie Hlede started running the team through drills, sweat beaded up on the brows and arms of players. None of them wore a mask.

An hour later, most of these players climbed back into the passenger seats of their parents’ cars, their still-heavy breaths circulating near a loved one. They did it and continued to do it throughout the summer because a key part of their lives vanished from March to June, and they were desperate to get it back.

“A lot of my teammates have hoops in their alleys, but I don’t have an alley,” said Charlotte O’Toole, a rising high school senior who plays on the 17U Flow team. “I literally could not shoot for two months, which was really, really hard and so discouraging for my mental health.

“You feel like you’re losing something.”

High school and college athletes already battle a range of stress factors: extreme pressure to succeed, improving but still insufficient mental health awareness, inadequate and underutilized counseling, and sports-centric personalities that don’t allow for an identity without athletics. Now, because of inactivity and infrequent social interaction and separation from the sports they love, the pandemic has exacerbated those mental health issues and exposed flaws in the way they are treated.

The country already wrestles with a mental health crisis. Adolescents are particularly at risk for a major depression episode—characterized by two or more weeks of depressive symptoms. The National Survey on Drug Use and Health found an estimated 3.2 million, or 13.3% of, Americans aged 12 to 17 in the U.S. had at least one major depressive episode in 2017.

Then, throughout May, a team of researchers at the University of Wisconsin School of Medicine and Public Health surveyed 3,243 adolescent athletes to study the effects school closures and sports cancelations had on participants. Compared to historical data, the findings showed an increase in symptoms of depression.

The study also found decreases in physical, psychosocial and overall health. Dr. Tim McGuine and his research team determined the decline in quality of life had to be, in part, due to the lack of sports and sports-related social interactions.

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“Sports is a great way to form an identity, although there are a lot of pitfalls with that,” said Dr. John Mayer, a Chicago-based psychologist and president of the International Sports Professionals Association.

Mayer said athletes are lost without sports. Many develop substance abuse, among other unhealthy coping mechanisms.

“You see that in these adults who are populating the stands,” Mayer said. “They’re 50 years old, and they’re wearing their letterman jacket from when they were in high school. That identity is still in them and sometimes never supplanted by another identity, which is really sad.”

Dr. Jayne Raquepaw, a Houston-based psychologist who specializes in treating athletes, said some patients pay her $175-per-hour fee because they’re not enjoying their sport anymore but are too invested to give it up. The pressure of earning a scholarship adversely affects their enjoyment of the game, and the pandemic only worsened the issue.

“They are still vying for scholarships in spite of play being shut down,” Raquepaw said. “They are still very much concerned about their careers.”

Flow athletes traveled to tournaments throughout the summer. At one in Indianapolis in early July, their first tournament back since reopening, parents and players ignored mask and distancing mandates, according to several Flow players. Despite concern over that lack of adherence to safety protocols, Flow participated in multiple tournaments this summer.

Nicole Mann, mother of Natalie Mann, a rising senior on the Flow 17U team, called the tournaments “nerve-racking.”

“Basketball is a passion for her, so we’re willing to take that risk,” Nicole said. “We’re being pretty careful in most other areas of our life. We’re choosing to take a risk in that one because it’s a high priority.”

Jeff Levin, a Massachusetts-based life coach who works with teams and individual athletes, said “pressure” does not properly describe what many young athletes feel. He uses the phrase “outcome fever.” Counting NCAA and junior college athletes, approximately 6.7% of high school athletes go on to play in college.

“You have tutors by the time you’re 12, and your parents have selected the sport you’re going to be great at,” said Levin, a former clinical social worker and therapist. “It’s very important in the new parenting playbook that you are great at stuff, so gone is the age-old opportunity to find out who you really are and pursue what you really want as a child.”

A parent of one of Raquepaw’s patients, a junior in high school, physically chased down a recruiter during a basketball game last winter. She said the patient was distressed by the pressure, as well as the embarrassment.

“There are certain parents who are just over-the-top overbearing,” Raquepaw said. “There are still parents out there who do put too much pressure on [their children].”

Part of the blame, according to Raquepaw, also falls on coaches, but she acknowledged coaches may not have time to balance individual players’ psyches and putting together a winning squad.

At the beginning of every season, Robert Brost, boys basketball coach at Bolingbrook High School in suburban Chicago, said he tries to ease pressure on his players during a meeting with their families.

“Everyone lost their minds when we lost two in a row,” said Brost, whose squad went 26-6 last season. “I always say, ‘We are going to lose some games that we shouldn’t. We’re going to play bad sometimes. Your kid is going to have games where he scores 25, and he’s going to have games where he scores 0, so you’ve got to be ready for all of those, and then you’ve got to love him just the same.’”

Brost said his coaching style has evolved in recent years. He now schedules one-on-one meetings, with both athletes and parents, that focus on academics and personal issues, not just basketball. During the pandemic, Brost has remained in touch with players, but said Zoom calls do not encourage the same emotional sharing that he elicits in person. He also acknowledged a lack of mental health training for high school coaches.

“We all have to take psychology of sport, but those are more about motivating athletes and getting them to do what you want them to do, rather than dealing with the issues that they have,” he said.

Required training for coaches differs around the country. The National Federation of State High School Associations offers certification programs, but they are not always required, and none of the course topics are specific to mental health, although there is a subsection on “health and well-being.”

Without extensive mental health training for coaches, the burden falls on school psychologists and counselors. According to 2016 research by the University of New Hampshire’s Carson School of Public Policy, less than 20% percent of school districts meet the American School Counselor Association’s recommended student-to-counselor ratio. The recommendation is 250:1, but the nationwide median ratio is 411:1.

John Morrissey, baseball coach at Middlesex School in Concord, Massachusetts, said his son Owen struggled during his freshman season on the team, which resulted in anxiety and depression. Morrissey hired Levin to work with Owen, then later to work with the whole team. Levin piloted one in-person group session before the pandemic forced the consultations online. The team lost its season.

Parents of many Middlesex students hire counselors or psychologists because the school only employs one counselor for 400 students, according to Morrissey. For students who can’t afford a private school like Middlesex, where tuition costs $65,940 a year for boarding students, life coach or psychologist rates may not fit into the budget.

At Evanston (Ill.) Township High School, Joyce Anderson has a unique job title: college-bound student-athlete advisor. She said she has not seen her job description in any other high school in the country. Anderson works with Evanston’s counselors to help ensure student-athletes are eligible for college sports.

“This happens all around the country: a kid works really hard, gets an A and then finds out that [a certain] class didn’t count for NCAA eligibility,” said Anderson, a former Division I tennis player at Columbia. “I think of that as a big mental health problem. You were recruited for athletic ability, but then you were told that you basically weren’t smart enough to be a college athlete, which is horrifying, and it’s not the truth. All kids can achieve academic eligibility. It’s not an insane threshold, it’s just complex.”

She estimated 25 Evanston students each year played college sports before the school created her position six years ago. Since then, that number hovers around 50 or 60.

“Schools at all levels, all the way through college, really do a weak job of attending to the mental health needs of kids,” Mayer said. “Now, you have the stigma of mental health within sports, and you have a double whammy.”

Before the pandemic, that stigma could have meant the difference between an athlete seeking help and trying to tough out their mental health concern. Now, the convenience of walking into a counselor’s office is gone.

“I always feel like if I were to go in there [or set up a remote meeting], I’d be like taking up their time,” O’Toole said. “It’s not worth it when there are so many other people having so many bigger problems.”

Brost, whose program has produced high-level college players and a recent NBA player in Ben Moore, said he sees a reluctance in athletes to seek counseling.

“There’s still a stigma behind athletes being tough,” Brost said. “That stigma is hard to fight, even though you have Kevin Love coming out and being a great ambassador.”

Love, an NBA champion and five-time All-Star forward, wrote a story for The Players’ Tribune in March 2018, detailing his mental health struggles. In June, the Cleveland Cavalier won the Arthur Ashe Courage Award at the ESPYs for raising awareness of mental health issues. Other high-profile athletes, including fellow NBA star DeMar DeRozan, have also publicly shared their struggles.

“By sharing what he shared, DeMar probably helped some people — and maybe a lot more people than we know — feel like they aren’t crazy or weird to be struggling with depression,” Love wrote in that article. “His comments helped take some power away from that stigma, and I think that’s where the hope is.”

A panic attack during a November 2017 game prompted Love to begin seeing a therapist. The American Anxiety and Depression Association of America estimates 6.8 million adults in the U.S. suffer from generalized anxiety disorder, yet less than half of them receive treatment.

“When kids aren’t necessarily presented an opportunity of how to help themselves and talk about it, then they won’t necessarily go out of their way to figure it out or find someone to talk to,” said Patrick Burke, a rising sophomore at St. Lawrence University in Canton, New York.

Burke worked on awareness campaigns while attending Mount Mansfield Union High School in Jericho, Vermont, where he played football, baseball, hockey and a season of lacrosse. In the fall of 2018, a group that included Burke organized games to bring awareness and raise money for mental health initiatives. Just before the games, MMU lost a student to the very thing those games were supposed to prevent. Just after MMU went remote in March, another student committed suicide.

After the first student’s death, MMU intensified its aggressive awareness campaigns, which resulted in more students being open to regular visits with counselors, according to David Marlow, the school’s director of student activities. He said MMU is working to hire two more counselors to handle the caseload.

In his Players’ Tribune article, Love wrote: “Creating a better environment for talking about mental health … that’s where we need to get to.”

Daniel Divis said awareness of mental health has improved in recent years, in part because of athletes like Love. A former hockey player at Saint Michael’s College in Colchester, Vermont, Divis’ own mental health struggles prompted him to cofound the awareness group Hope Happens Here in 2015 with teammate Justin McKenzie, whose friend committed suicide that summer. Divis said the responsibility also falls on athletes who are more relatable to younger demographics, which is why Hope Happens Here connects college players to high schools.

“Professional athletes who have millions of followers are doing really, really good things for mental health awareness,” he said. “Having gone through even what I did and knowing others go through much worse, I think it feels right and is almost a duty to speak up.”

Divis’ sister plays lacrosse at Ursinus College in Pennsylvania. He said she’s nervous about missing her senior season next spring if sports are still on hold.

“She has relationships, friendships,” he said. “It’s something she’s been working toward for a long time. I know that she’s struggling, and I know that I’d be feeling the exact same way.”

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One sector of athletes that the University of Wisconsin study did not focus on was those who benefited from the time off. Just as sports mitigate stress for young athletes, they can also be a cause of anxiety and depression, according to Mayer.

“When you have kids who are nervous and having self-esteem issues with sports,” he said, “some of the kids are relieved because their teams aren’t participating. It’s like, ‘Wow, I don’t have to deal with a lot of this emotional turmoil that comes with playing a sport.”

The existence of this group supports the argument that young athletes need to diversify their identities, according to Dave Landers, a retired professor of psychology and gender studies at Saint Michael’s College. Landers, who helped create Hope Happens Here, said Divis’ and McKenzie’s outside interests—Divis’ interest in law and McKenzie’s in software engineering—were integral to their identities and helped them once they left behind college athletics.

“Once you get out of middle school and in high school, there’s stuff in the newspaper featuring you in athletics—not as a student, not as a son or a daughter or a best friend or someone who does volunteer work,” said Landers, who was also the school’s representative to the NCAA. “It’s all around you as an athlete. If you lose that because of an injury, or you lose that because of graduation, or you lose that because of coronavirus, what do you turn to?”

Although the long-term psychological effects of missing athletic seasons and months of school won’t be known for years, the short-term effects shown in the University of Wisconsin study can be factored in during reopening risk assessments, McGuine said.

Of weighing her own decision to sit and be safer or play and risk COVID-19, O’Toole said: “I don’t want to harm people in any way, but I feel like we’re careful. Sort of. I don’t know.”

This reluctance to stay off the court, diamond or field, even with the added risk, shows sports’ influence on mental health, mistreatment and misunderstanding of which is a pandemic in its own right, especially now in the wake of COVID-19.

“If I go to my friends who aren’t playing basketball, I’m the one who’s bringing that risk,” Glascott said. “(My mother) thought that was kind of disrespectful, but she does understand that basketball is super important to me.”