College athletics is under extreme stress. Athletic administrators are weary, but their hearts are steady. They care about their student-athletes. That part has never changed. I saw this in full-force at last weeks NACDA Convention in Orlando.
But after the House v. NCAA settlement, departments across the country are facing hard choices. Budgets are moving. Programs are being restructured. Leaders are trying to decide what is mission-critical and what can wait.
Mental health support too often ends up in the second category.
That choice may feel like a financial necessity. But it comes with real consequences. It increases liability. It leaves young people alone in moments of quiet crisis. It risks lives. Mental health is not a side issue. It is tied directly to athlete safety, performance, and the future of college sports.
Schools that overlook it are stepping into risk, both human and legal.
The Risk Has a History
In 2018, Tyler Hilinski, a quarterback at Washington State University, died by suicide. He was 21. His family filed a wrongful death lawsuit, claiming the school missed clear signs of depression and neurological decline. Teammates had raised concerns. The case settled in 2021.
The legal outcome was private. The message was not.
When a student is clearly struggling, and the school’s system fails to respond, the responsibility does not disappear. It lands on someone.
This is not an isolated event. Suicide remains the leading medical cause of death among college athletes. Many schools acknowledge the problem, but few have built systems that meet the needs of athletes today.
The NCAA has offered strong mental health guidance. Many campuses have not yet adopted it. General counseling centers are overloaded. Appointments can take weeks. And most athletes say they do not feel comfortable getting care inside their department.The result is a quiet breakdown. Students are struggling. Staff know there is a problem. But the system still does not respond fast enough or well enough.
The courts are beginning to notice.
The Pressure on Athletes Has Changed
College athletes today are carrying more weight than ever. They are expected to succeed in the classroom, on the field, and in the public eye. Their scholarships are often insecure. Injuries come with fear of being replaced. NIL deals add pressure. Social media never turns off. The transfer portal can upend entire teams overnight.
About one in four college athletes is experiencing symptoms that warrant mental health care. And half do not feel safe asking for help.
So they wait. They wait for a scheduled appointment. They wait for someone to notice. They wait until the cracks start to show with missed classes, skipped lifts, short tempers, or long silences.
Too often, we do not act until it is too late. Then everyone asks the same question. Why didn’t we do more?
I Have Sat in Every Seat
I have seen this from all sides. I am a psychiatrist. I am the CEO of a national athlete mental health company. And I am a mother of a collegiate athlete.
I have gotten the call. I have watched one of my own children suffer a torn ACL and feel terrified, not of the rehab, but of being forgotten. I have gotten the call from the ice bath, tears filling his eyes. The same week that roster limits caused several of his friends to be cut. He was scared he would be replaced, and that his spot, his value, his identity could all vanish while he was sidelined. That fear never made it back to the athletic department or his coaches. Thankfully he was willing to tell me, but it is still a long road.
The problem is real. That quiet fear plays out in families across the country. It’s not visible in a stat sheet, and it often never gets written in a training report. But it takes a toll on the athlete, on the family, and on the team. The athletic trainers only have time to attend to the immediate injuries and need support.
When these worries go unseen, they grow. When they go unsupported, they spiral. And when something goes wrong, no one wants to realize they had no system to respond.
What Happens When Help Comes Too Late
Mental health concerns do not always look dramatic. Coaches may see changes but not know what to do. Staff may want to help but lack the structure to act. The handoff becomes guesswork.
If the only option is a flyer, or a two-week wait, the moment can slip away. And that may be the last time the student was willing to ask.
Saying “we care” is not enough anymore. Students are asking what care actually looks like. Parents are asking what protection is in place. The public and the legal system are starting to ask how schools justify the risks.
What support did you offer? Did it meet the student’s needs? Was it available fast enough? Could it be trusted?
If the answers fall short, the impact is no longer just emotional. It can be legal. It can be public. And it can cost a life.
Some Schools Are Building, Others Are Partnering
Some athletic departments are building internal teams to handle mental health. Others are relying on trusted partners. Both are necessary, because every athlete has a different story, especially today.
At Onrise, we work quietly with schools and professional organizations across the country. We offer therapy, psychiatry, peer support from former athletes, 24/7 crisis response, and virtual nutrition services. Everything we do is private, built for athletes, and aligned with clinical best practices.
We do not replace on-campus teams. We back them up. We step in when athletes want to talk to someone outside the program. We support students who are away for training or travel. We give schools a clear record that care was available and used.
Many athletes now have access to this model. What they tell us is simple. They want to feel safe. They want help that works. And they want to be treated as people, not just performers.
Most importantly, this kind of care does not require a large budget. What we offer costs roughly one-third of what it would take to hire one full-time in-house mental health professional. It is a simple solution that helps avoid an unnecessary risk.
This Is Not About Blame
Most coaches and administrators care deeply. But caring is not the same as preparation. If a student shows signs of mental health distress and there is no clear system in place, the next step becomes unclear. That is when risk grows.
No one wants to get the call that a student is gone. No one wants to see their program in the news, or to face questions they cannot answer. No one wants to face a parent asking why there was nothing in place to help.
Mental health care does not need to be perfect. But it needs to be present. It needs to be structured in a way that students can access, trust, and use. It needs to exist before the crisis.
Waiting Is the Risk
Schools are under financial stress. There are no easy choices. But removing or delaying mental health support is not a neutral decision. It is a step closer to a crisis that no one can undo. This does not require unlimited funding or a full in-house clinical team. It requires naming the risk and doing something about it.
We are no longer in a time where mental health care is optional in athletics. It is not extra. It is part of a serious program. It protects students. It protects staff. And it protects the institution from consequences that can follow for years.
It is time we stop treating it like it is something we will get to later.
Let’s get to it now.
By Kimberly Quigley, MD | Founder and CEO of Onrise | Psychiatrist | Mother of a Collegiate Athlete