Responsible mental health screening in high-performance sport: fit-for-purpose tools and care pathways.

Comprehensive integration of mental health screening and triage with mental performance services through a sport science hub model in collegiate sport.

Collegiate sport environments often bring mental health (MH) and performance (MP) into close interaction; yet, screening, triage, referral, and MP support often remain operationally fragmented. This fragmentation may weaken follow-through after screening, limit coordination across clinical and performance services, and create uncertainty around privacy, scope boundaries, and accountability. In this Perspective, drawing on implementation science, integrated care, and systems-oriented organizational design, we suggest that a promising direction in athlete MH-MP support is not simply expanding screening availability, but building governed infrastructure that better connects identification to action. We propose a sport science hub model for coordinating two linked but distinct lanes: (1) structured MH screening, triage, and clinician-led referral workflows, and (2) MP profiling and skills-based support delivered within non-clinical scope. The model is organized around explicit guardrails, including role separation, privacy-secured and auditable access, non-punitive use protections, and emergency escalation pathways. We discuss the rationale for using structured screening and referral processes while acknowledging the limitations of current screening tools, including false-negative and false-positive concerns, and the importance of interpreting performance disruption in context rather than medicalizing normal variation. We conclude with governance principles and a forward-looking research agenda focused on implementation, trust, acceptability, screening accuracy, and prospective evaluation of integrated MH-MP systems.

Safe Enough to Thrive: A Dignity of Risk Framework for Older Adult Mental Health Care

Background Older adults with psychiatric disorders and/or neurocognitive impairment are often cared for in restrictive settings such as long-term care facilities and inpatient psychiatric hospitals. Risk-averse institutional cultures can lead to overly restrictive practices that prioritize safety at the expense of autonomy and dignity. Objective To develop a geropsychology-informed dignity of risk framework that helps clinicians and teams balance safety and autonomy in geriatric mental health care. Methods This conceptual paper integrates psychological, gerontological, and philosophical literature, including human rights perspectives, geropsychological work on fluctuating capacity and serious mental illness, and empirical studies of institutional risk cultures, coercion, and ageism. Results The resulting framework comprises five elements: (1) clarifying older adults’ values and goals; (2) assessing and supporting decision-making capacity; (3) distinguishing everyday life risk from high, non-negotiable risk; (4) explicitly weighing psychological benefits alongside physical risks; and (5) documenting “safe enough” risk-sharing plans in partnership with older adults, families, and staff.

Intersectionality in mental health diagnosis: implications for care equity and health services

A systematic review of the impact of Mental Health First Aid on medical, nursing and allied healthcare professional students

Background Healthcare professional (HCP) students are at high risk of mental health problems, but stigma and fear of career repercussions often deter them from seeking help. Mental Health First Aid (MHFA) is a globally disseminated course teaching the public to identify and respond to people experiencing mental health problems. MHFA training may address some of the challenges faced by HCP students, by improving mental health knowledge and by enhancing well-being and peer support. Aims To systematically review the available literature regarding the impact of MHFA training on HCP students’ mental health literacy, confidence and intentions to provide help, stigma, peer support and self-care. Method Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews ID: CRD42024589509), five databases were searched. Primary studies evaluating the above outcome measures in HCP students were included. Two authors independently screened references and extracted data. Quality was assessed using the Modified Medical Education Research Study Quality Instrument and Cochrane Risk of Bias tools. A narrative synthesis was performed. Results Of 2367 records screened, 26 met inclusion criteria. Confidence in supporting others and mental health literacy showed the most consistent improvements following MHFA training, whereas evidence for changes in stigma was mixed. Peer support, self-care and student well-being were infrequently examined, although qualitative data suggested that MHFA had improved openness to help-seeking. Conclusions MHFA shows promise in enhancing mental health literacy, confidence and intentions, and in reducing stigma, particularly when supplemented with experiential learning. HCP students may benefit from tailoring of such courses to their specific needs, fostering a culture of peer support, enhancing well-being and introducing basic concepts in mental health.

Basic Psychological Needs and Mental Health in Primary Care: A Self-Determination Theory Perspective

Highlights Public health relevance—How does this work relate to a public health issue? Mental health concerns are increasingly managed in primary care, yet healthcare systems often remain reactive, fragmented, and focused on symptom management. This study examines how satisfaction and frustration of basic psychological needs relate to resilience, vitality, coping, anxiety, and depression among adult primary care patients. Public health significance—Why is this work of significance to public health? Findings support Self-Determination Theory by demonstrating that psychological need satisfaction is most strongly associated with well-being, whereas need frustration is most strongly associated with psychological distress in primary care. The results identify autonomy, competence, and relatedness as potentially scalable psychological resources that may strengthen prevention, coping, and mental health promotion. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Incorporating psychological need-based perspectives into primary care may complement symptom-focused approaches and promote more holistic mental health care. Future research should examine how healthcare environments and clinical interactions support—or undermine—patients’ experiences of autonomy, competence, and relatedness. Abstract Mental health concerns are increasingly encountered in primary care, yet clinical approaches often focus on symptom management rather than underlying psychological processes. Self-Determination Theory (SDT) proposes that psychological well-being depends on the satisfaction of three basic psychological needs—autonomy, competence, and relatedness—while their chronic frustration contributes to psychological distress. Despite extensive evidence linking these needs to mental health outcomes, their relevance in primary care remains underexplored. This single-center cross-sectional study examined associations between psychological need satisfaction and frustration and indicators of well-being and ill-being among adult primary care patients. A total of 380 patients (Mage = 47.81, SDage = 15.42) completed validated measures of need satisfaction and frustration, resilience, vitality, coping strategies, anxiety, and depression. A dual-process model was examined, with hypotheses informed by SDT: higher need satisfaction associated with greater resilience, vitality, and adaptive coping (well-being), and higher need frustration associated with greater anxiety, depression, and maladaptive coping (ill-being). Although results revealed several significant cross-paths, need satisfaction was most strongly associated with positive outcomes and need frustration was most strongly associated with negative outcomes. The dual-process model did appear clear for coping outcomes, with need satisfaction uniquely predicting adaptive coping and need frustration uniquely predicting maladaptive coping. Findings highlight the potential value of incorporating psychological need-based perspectives into primary care mental health approaches. By recognizing autonomy, competence, and relatedness as foundational psychological resources, healthcare systems may develop more scalable strategies to promote mental well-being and prevent psychological distress in everyday clinical practice.

Maladaptive exercise: the hidden role of physical activity and sport professionals in the early detection of eating disorders

Eating disorders (EDs) are a significant public health concern, particularly among adolescents and young adults. While physical activity (PA) is generally health-promoting, maladaptive exercise, characterized by compulsive and excessive activity linked to weight control, is often a core feature of ED pathology. Despite the high prevalence of these conditions, early identification remains a critical challenge, as most cases are detected only after severe organic or psychiatric complications. PA and sport professionals, such as personal trainers and coaches, are uniquely positioned to observe early warning signs due to their frequent direct contact with at-risk individuals. This Comment, developed within the European ERASMUS+ Sport project “My Fit Friend”, proposes a practical framework for equipping PA and sport professionals with tools for early detection in youths aged 11–18 years, including a structured observational diary and simulation-based training using avatar interactions. These tools allow those professionals to act as “informed sentinels”, identifying fractures in global functioning and facilitating timely referrals while maintaining clear professional boundaries. We argued that integrating standardized educational interventions and observational tools into European sport policy is pivotal to bridge the gap between the gym floor and clinical intervention, transforming recreational settings into protective environments for youth mental health. Maladaptive exercise may serve as an early indicator of emerging eating disorders within physical activity (PA) contexts. PA and sport professionals can act as informed sentinels, identifying early behavioral and functional changes associated with ED risk. Integrating structured training and digital tools into PA training policies could turn recreational settings into protective environments for youth mental health. Maladaptive exercise may serve as an early indicator of emerging eating disorders within physical activity (PA) contexts. PA and sport professionals can act as informed sentinels, identifying early behavioral and functional changes associated with ED risk. Integrating structured training and digital tools into PA training policies could turn recreational settings into protective environments for youth mental health.