When the first college athlete died by suicide this year, Kate Intile thought of the time her own sport had left her in months of darkness. After she was cut from a storied college running program, "I wasn't able to find any worth in myself," she said. "I've never felt like less of a human."
As an elite college cross-country runner, Intile said she had been body-shamed, pushed through injuries and made to feel worthless when her times did not measure up. When she learned in March of the suicide of Katie Meyer, a charismatic goalkeeper who had helped Stanford to a national championship in soccer, Intile feared for her former teammates and other college athletes.
"It felt like it was only a matter of time," Intile said.
At least four more NCAA athletes have died by suicide in the two months since Meyer's death, three of them young women. Intile, who now runs for Oregon State, said the fear has only grown.
"It's a constant worry you have in your life, on top of everything else," Intile said. "This could happen to me; this could happen to my teammates. My parents are worrying about me. It's this vicious, anxious spiral of 'Where is everyone at?' and 'If someone's not okay, what do I even do?' "
Intile, other current and former college athletes and advocates told The Washington Post they see the moment as a mental health crisis for college athletes. The factors that have exacerbated it - the pandemic, social media, the rising pressures on young people - are shared by many college students, experts say.
But the deaths of Meyer and the other athletes have shaken the close-knit community of elite college sports, sparking fear and anxiety, according to athletes and others working in college sports.
"Nervous is a good word for it," said Christopher Bader, the assistant athletic director of mental health and performance at the University of Arkansas. "One of the scariest parts of our job as psychologists, in general, is the not knowing. I can see somebody every week for an hour a week, and that's only 1/168th of their week. There's 167 other hours that I don't see them; that's the scary part when you hear of things like this."
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For some athletes, including Intile, the concern has sharpened into anger at a system they say is inherently harmful to college athletes' mental health. As athletes have traded news of the deaths, they've been strategizing how to keep one another safe and brainstorming ways to reform what they view as broken systems at their colleges. Meanwhile, Intile said, "Not once have I seen the NCAA even make a statement."
In a statement to The Post, the NCAA said it required schools to provide mental health services to athletes and that it consulted extensively with experts to create best practices for care.
"The mental health crisis in this country touches every aspect of society, and the NCAA acknowledges the urgency and magnitude of this issue," said an NCAA spokesman, Christopher Radford. "We also understand that the mental health crisis has been exacerbated - for student-athletes and others - by the isolation and other impacts of COVID-19."
But athletes and advocates have pushed back against the idea that the deaths by suicide are simply a reflection of the wider, and well-documented, mental health crisis among all young people. The challenges faced by athletes are sharply distinct from those of other college students, they argue: relentless hours, physical injury, limits on social circles that are confined to teams and can disappear with injury or poor performance.
The family of one athlete who died by suicide in recent months, Wisconsin runner Sarah Shulze, said in a statement that they believed the stress of college sports had contributed significantly to her death. "Balancing athletics, academics and the demands of everyday life overwhelmed her in a single, desperate moment," they wrote in April.
Scholarships and spots on teams can hang on individual games and meets; coaches and athletic departments, paid and funded based in part on how athletes perform, lean heavily on the young people they are tasked with overseeing.
And unlike with most students, advocates said, there is a billion-dollar oversight body charged with guiding and protecting college athletes. The NCAA last convened a formal task force on mental health in 2017, and though it updated its best practices in 2020, critics said the organization has not done enough to prioritize athletes' mental health when it comes into conflict with issues such as practice time, coaching and compensation.
Athlete safety and the NCAA's business model are "fundamentally opposed to one another," said Andrew Cooper, a former college runner and activist who has called for dismantling the NCAA. "The more money pumped into the system, the more pressure on coaches, the more pressure gets put on athletes."
For some, the NCAA's silence in the face of athletes' deaths this year, and the worries of their teammates and competitors, has been conspicuous.
"Saying something would be better than nothing," said Morgan Ferrara, a former Division I soccer player who is now a PhD student at the University of Houston, of the NCAA. "I want to see them acknowledging these things are going on, putting in place some sort of steps that you're going to force institutions to follow."
Chad Asplund, a sports medicine doctor who worked in several Division I athletic departments, compared the NCAA's focus on how college athletes should be allowed to profit off their personal brands with what the organization has done in the face of the recent deaths of athletes.
"All this [name, image and likeness] talk," Asplund said, "and there's been zero talk of the epidemic of suicide."
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Mackenzie Fitzpatrick's dark moments came after a string of injuries kept her off the softball field for much of her career at the University of Connecticut.
"I was really struggling - I just felt completely isolated from my team, really alone," she said. "I felt like a burden to everyone around me, [to] our trainers and doctors, being in the training room every day."
For a while, she hid all of it from coaches and teammates. Like many people struggling with mental health in and out of sports, Fitzpatrick feared being seen as weak, she said. But the reasons behind it were, she thought, particular to college sports.
"It's the culture of college athletics - we talk about the grind, no days off, no time off, the idea that the people that are successful are the ones that never turn off their switch," Fitzpatrick said.
When she finally sought therapy on the advice of the team doctor, her coaches were supportive. But she found that between classes and sports, she didn't have a single hour in her schedule for therapy. Fitzpatrick had to ask her coach if she could come late to practice once a week, she said, an accommodation she knows some coaches would never allow.
Pietro Sasso, an assistant professor at Stephen F. Austin State University in Texas who has studied mental health in college sports, calls it an "athletic tax." College sports "have such compressed schedules," Sasso said. "Their demands don't let them get access in the same way other students have the privilege of."
College athletes experience mental health struggles at the same or higher rates than typical college students, studies have shown. Many college students, especially part-time students and those with families, face time pressures, and mental health stigmas persist in virtually every corner of society.
A 2015 study found that college athletes had a lower rate of suicide than the general college population. In the midst of a broader crisis in mental health on college campuses, there is no data yet to show how the suicides of college athletes in 2022 compare with the rate of young people as a whole.
But the number of NCAA athlete suicides in the first four months of 2022 alone appears to be substantially higher than the rate in the past. That 2015 study found 35 college athlete suicides between 2003 and 2012, less than four per year. The vast majority of those deaths - 29 - were men, another significant difference from this year.
Dan Romer, the research director at the Annenberg Public Policy Center at the University of Pennsylvania, pushed back against the idea that there was a particular crisis among athletes, arguing that the system of mental health care is broken across colleges as a whole. Romer researches mental health in young people, including the effects of social media and suicide.
"It's not just athletes - the real crisis is in the university and colleges themselves," Romer said. When students approach colleges with mental health struggles, Romer said, particularly in the midst of a crisis, they often push to remove the student from campus. And Romer said that he has seen colleges effectively cover up student suicides, fearing contagion with other students - but also fearing bad publicity.
"If students feel like they aren't going to get help, then they aren't going to seek it," Romer said.
But even as young people everywhere experience mental health problems at unprecedented rates, young athletes' particular struggles are often deeply ingrained in the culture of college sports.
Jayden Hill, a Division II track runner at Northern Michigan University, was "always the first person" to reach out to someone struggling with their mental health, said her mother, Christine Hill. She saw herself as an advocate, Hill said, and would support friends and even strangers by text and over social media.
When it came to Jayden's own lifelong struggle with mental health, though, she was hesitant to speak up publicly, Christine Hill said. "She never wanted to be seen as weak. She was so terrified that somebody would think that she wasn't strong."
Hill was one of several college athletes who died by suicide in April.
Her identity had been wrapped up in her sport since she was small, Hill's family said. She dreamed of running in the Olympics, keeping a framed USA sprinter's uniform outside her room. But when she started running in college, Hill's times dropped, her mother said. "She put so much pressure on herself to do well," Christine Hill said.
Hill's coaches were supportive, her mother said. But she worried about disappointing them anyway, worrying they had expected more when they brought her to the university. "I think she started to feel like she was a burden, like to her coaches she was a burden," Christine Hill said. "She didn't want to be a burden."
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An increasing focus on mental health in sports has led more colleges, especially at larger Division I schools, to add mental health professionals who work exclusively with athletes, increasingly from inside locker and training rooms.
The NCAA's best-practices guidelines, released in 2016, call for campuses to create "interdisciplinary teams" focused on mental health, including trained practitioners who are not simply performance coaches focused on on-field showings. The organization recommends screening students for mental well-being along with physical health.
At Arkansas, Bader heads a team of three mental health professionals who are focused on outreach to athletes. He has seen "huge growth" in the past 15 years, he said, as awareness grows.
Bader said he's happy with the NCAA's best-practices guidelines. Anything more rigid, he said, such as requirements for every school, could impose unnecessary standards in a field where flexibility and adaptability are necessary. "We need to put continued attention on it," Bader said. "Advocacy and education are huge for us."
For activists such as Intile and Cooper, more significant systemic changes are necessary. The pressures and stressors faced by young athletes, they argue, are linked directly to the massive college sports industry, and especially to the NCAA.
Especially at the top divisions, NCAA sports, they say, incentivize winning above all else, tying pay and bonuses for coaches and athletic departments whose athletes notch victories. That is true in nonrevenue sports, such as running, and even moreso in sports like football and basketball, where winning teams can rake in millions for colleges.
"It was drilled into our head, the goal is to compete for and win national championships, and that implies 'at any cost,' " Intile said of her time running cross-country at the University of Colorado Boulder. "It's a sink-or-swim program, and if you sink, you sink hard."
Intile described practices she said were damaging to her mental health and that of her teammates, including pushing her to run through injuries that later became more serious. She underwent a "body composition test" monthly, she said, where a clinician would pinch their bodies as they stood clad in a sports bra and running shorts. The exam room's large windows looked out on the weight room, where other athletes were often present.
"We would fight for the early morning appointment so you wouldn't have to eat breakfast, and football [players] wouldn't be there [in the weight room]," Intile said. "You walk out with Sharpie marks all over your body. Everyone knows you got body comped this morning - it was like a physical representation of the fact that you had to go through trauma."
In a statement, the University of Colorado said it recently made body composition tests voluntary as a result of athlete concerns, consulting with a Student Athlete Advisory Council in recent months about the policy, and that it offers "extensive resources" to athletes in mental health.
The university "is committed to the physical and mental well-being of our athletes, and that commitment serves as the cultural foundation of not just our cross-country team, but of all our programs," said Steve Hurlbert, the university's director of communications.
Many college athletes "are viewed as wins and losses, not as people," said Asplund, the sports medicine doctor. Asplund is now the executive director of the U.S. Council for Athletes' Health, a consulting firm that specializes in college sports.
"They're disposable commodities where coaches and universities chew them up and spit them out," Asplund said. "There's not a focus on the individual athlete; it's all on the outcome."
On the other side of the coin from coaches paid to win games, Cooper notes, are college athletes who are not paid a cent - but who put what is often the equivalent of a full-time job into their sport, despite an NCAA rule that technically caps the time they spend on athletics at 20 hours per week of official practices and training. That number excludes many mandatory activities for athletes, like travel and physical therapy.
"People don't understand the demands that are placed on athletes," Cooper said. "You're going constantly from 6 a.m. to 9 p.m. every day, month in and month out."
Cooper argues that the only way to deal with the conflict he sees between the NCAA's incentives and athletes' mental health is to dismantle the organization, or at least dramatically reform the structure of college sports. Allowing athletes to unionize and be paid for their labor, he said, gives them control over their working conditions.
"The NCAA has created an environment where athletes are treated like cattle," Cooper said.
Other dramatic reforms include pushing to incentivize athlete development and health in coach pay and evaluations at competitive programs; substantially cutting back hours, offseason training and travel; and cracking down on abusive coaching practices.
New rules that give college athletes control over their own name, image and likeness have finally given athletes a chance to make money off their sport. But that, too, has come with a mental health cost, something the NCAA acknowledged as part of a review of how the new rules have affected athletes.
Young female athletes, especially, have found that the main way they can earn income through college sports is with their social media presence.
Sedona Prince, an Oregon basketball player who is among the most famous college athletes on TikTok - and whose viral video ignited an uproar over the NCAA's unequal treatment of men and women at its basketball tournaments - posted a tearful video last month saying she was taking a break from the platform. She described how her growing fame among her classmates had led them to treat her like an object.
"I'm not any different because I'm on TikTok. I'm still a person," Prince said in the video. "My mental health has really been declining for a long time, to the point where I'm really at my lowest right now."
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In their frustration with the NCAA, some college athletes have taken it upon themselves to act.
Weeks after Katie Meyer died, Fitzpatrick remembers being shaken. "That's when I recognized this is a crisis," Fitzpatrick said. "I was like, 'This needs to be bigger.' " She went on a "rant" on Instagram, she said, demanding change from the broader athletics community.
"It's not about 'checking in' anymore. It's not enough," Fitzpatrick wrote on her page.
Just a few days after the post, Fitzpatrick's own close-knit sport lost a student to suicide: Lauren Bernett, the starting catcher on the James Madison team that starred at the Women's College World Series last year.
Fitzpatrick met with her team administrator and printed fliers with QR codes that direct athletes to mental health resources. But she wants to see the same urgency from college sports' most powerful forces.
"I don't know what's going on with the NCAA," Fitzpatrick said, "but there needs to be more."
