Sports medicine specialists are looking more closely at mental health, both at the ways that young athletes can benefit, and at the ways they may sometimes need help.

“Mental health is a part of physical health, a part of sports medicine,” said Dr. Alex B. Diamond, an associate professor of pediatrics and orthopedics and the director of the program for injury prevention in youth sports at Vanderbilt. “In the past we focused on physical health so much, we neglected the mental health and behavioral health aspect of our athletes.”

“These benefits we talk about — learning how to fail and get back up, teamwork, being part of something larger — only happen when the emotional foundation is strong,” Dr. Diamond said. The children and adolescents seen in a sports medicine clinic are subject to all the same mental health issues that affect 8-year-olds and 12-year-olds and 20-year-olds anywhere, Dr. Diamond said, and in addition, sports themselves can bring “a whole host of additional potential stressors which can potentially unmask something or be a trigger for something.”

That means that mental health issues should be freed from stigma, and regularly and matter-of-factly discussed at the pre-participation physical exam, Dr. Diamond said, which may sometimes be the only time that a child or adolescent sees the doctor. “Probably more important than screening for duckwalk ” — used to check for knee injuries — “ is asking the sex, drugs and rock ’n‘ roll questions,” he said.

And the best way to have those conversations is to have the sports physical done by a provider who knows the child, at the practice where the child has always gone, he said, and not in some other venue like a walk-in clinic or at a group screening.

Normalizing these conversations is also important for the medical staff taking care of college athletes, Dr. Diamond said; mental health providers should be engaged all along and not just come in when something is clearly wrong.

The signs of emotional distress in a student athlete can be subtle, Dr. Diamond said, including changes in performance, in concentration and focus, and perhaps a loss of connection with teammates or coaches. Teams should have emergency action plans in place for mental health problems, as they do for concussion or spinal injury, he said, identifying who will respond and how the child will get help.