Sport Psychiatry: Why Coaches Could Play a Crucial Role in Protecting Young Athletes’ Mental Health

Psychiatrist Dr Bonginkosi Mafuze says equipping coaches and other members of athletes’ support teams with basic mental health screening skills could help identify problems earlier, particularly where access to specialist care remains limited.

Young athletes are often expected to train, compete and perform under pressure, yet access to the mental health support available to elite sportspeople may be beyond their reach. Bringing basic mental health awareness and early screening closer to grassroots sport could help address this gap.

Dr Bonginkosi Mafuze, a psychiatrist with a special interest in sport psychiatry, believes coaches, physiotherapists, psychologists and other people working closely with athletes could play an important role in identifying psychological difficulties before they become more complicated to treat.

Speaking during a webinar hosted by the South African Sports Confederation and Olympic Committee (SASCOC) High-Performance Psychology Working Group on Thursday, 22 October, Mafuze called for greater investment in mental health skills among the people who form part of an athlete’s support network.

The webinar, titled Cyberbullying, Mental Health and the Psychological Realities of Elite Sport, examined the psychological pressures athletes face and the support systems needed to protect their well-being.

Mafuze’s contribution highlighted a particular concern for South African sport: how young and developing athletes can receive timely support when specialist psychiatric services are not always readily accessible.

Young athletes need support, not just expectations

Mafuze argued that young athletes should not be expected to perform at the level demanded of them without receiving appropriate support for their psychological well-being.

“If we want teenagers to perform the same way as adults, we must offer the same support teenagers,” he said.

He added that teenagers should have access to sports psychiatrists and sports psychologists similar to the professionals available to elite athletes.

The issue is especially relevant in grassroots sport, where young people may be developing their athletic abilities while also navigating school, family responsibilities, social pressures and the demands of competitive sport.

Although mental health difficulties can affect athletes at any level, identifying those who need help may be challenging when teams lack dedicated psychological support or the resources to refer athletes to specialists quickly.

Mafuze’s argument is that mental health support should form part of athlete development from the teenage years onwards, rather than being considered only when a problem becomes serious.

Why early identification matters

A central part of Mafuze’s proposal is the idea of task shifting and task sharing – approaches that involve appropriately equipping people who are already working within a community or service to help identify needs and provide suitable initial support, with referral pathways to specialists when necessary.

In sport, this could mean training coaches and other members of an athlete’s support team to recognise potential warning signs and use appropriate basic screening tools.

“There is a lot of talk of task shifting and task sharing,” Mafuze said. “What is important is that we need to educate the frontline persons to the athlete so that we pick up signs quite early.”

He warned that delays in accessing specialist psychiatric care could make treatment more difficult.

His proposal does not mean that coaches should be expected to act as psychiatrists or diagnose mental health conditions. Instead, it points to the value of helping people who interact with athletes regularly recognise when someone may be struggling and understand the appropriate steps to take.

Coaches, for example, often have regular contact with athletes and may notice changes in behaviour, engagement or performance. Physiotherapists and other support personnel may also interact with athletes during periods of injury, rehabilitation and recovery.

With appropriate training, clear boundaries and referral procedures, these frontline professionals could help connect athletes to suitable support sooner.

Mafuze said equipping coaches, physiotherapists, mental health coaches, psychologists and other members of an athlete’s entourage with basic mental health screening tools could make a meaningful difference.

He also suggested that early intervention could help ensure that some athletes receive appropriate support at a less specialised level, rather than being referred to a psychiatrist when specialist intervention may not be necessary.

The distinction is important: screening can help identify concerns, but it does not replace professional assessment, diagnosis or treatment.

What South Africa can learn from Zimbabwe’s Friendship Bench

To illustrate how support can be extended in settings where specialist resources are limited, Mafuze pointed to Zimbabwe’s Friendship Bench initiative.

The programme is known for using trained lay health workers to provide structured psychological support in community settings, helping people experiencing common mental health difficulties access care and further assistance when needed.

Mafuze highlighted the value of having people available to listen, identify potential concerns and help individuals reach the appropriate level of care.

He explained that Zimbabwe’s experience offers lessons for settings where psychiatrists are not readily available to everyone who needs assistance.

The principle, as outlined by Mafuze, is to make initial support more accessible while ensuring that people who require specialist care can be referred appropriately.

He illustrated the consequences of delays by referring to the waiting period for an appointment with a specialist.

“If you gonna wait to see Dr. Mafuze my waiting list can be two months and by that time it could be too late,” he said.

The comment underlines the importance of timely access to care, particularly when someone’s condition may deteriorate while waiting for a specialist appointment.

For sport, the broader question is whether clubs, schools, academies and sporting organisations can establish support systems that help identify difficulties earlier, rather than leaving athletes to navigate the process alone.

Any such approach would need to include clear referral pathways, confidentiality safeguards and access to qualified professionals for athletes whose needs go beyond basic screening or initial support.

For grassroots athletes in particular, earlier recognition and clearer pathways to care could make an important difference between struggling in silence and getting the help they need.