There’s a Mental Health Crisis in Women’s Sports. How Do We Solve It?

Steele, along with Dr. Tiffany Brown and Erin Strout, co-wrote the forthcoming book, The Price She Pays (out June 18), about the hidden mental health crisis in women’s sports. Steele, now a licensed marriage and family therapist, was a highly-recruited track and cross-country runner when she signed with the Oregon Ducks in the early aughts. But she suffered as a collegiate athlete, and the people she trusted to have her best interests at heart put her in harm’s way.

In Eugene, Steele entered a program with unspoken rules about food and a harsh culture centered around body measurements and appearance. One coach quit due to the toxic culture, and many years later, the coach told Steele how her boss watched from the grandstands at Hayward Field and told her to “thin the herd of fat pigs” and “fat cows.”

When a new coaching staff arrived in 2005, Alberto Salazar became unofficially involved with the program. He stepped in when Steele’s performance began to suffer—likely due to REDs (relative energy deficiency in sport) she suspects—taking advantage of her vulnerability and referring her to Dr. Jeffrey Brown, a Houston-based endocrinologist who diagnosed her, at age 20, with hypothyroidism, a condition that can lead to weight gain and fatigue.

Through conversations with former coaches and teammates, and tracking down her own medical records, Steele learned years later that she didn’t have hypothyroidism, nor did she require medication. Her own memories are murky, and she’s still making sense of what happened. Even after an outside doctor confirmed at the time that she did not have the condition, and in the years after she’d left the program, she still trusted Salazar and Dr. Brown. Her body is now conditioned to the medication and relies on it, and she’ll have to continue taking it for the rest of her life.

Those experiences are what led Steele to pursue a career in counseling, specifically to help young female athletes, “because that is what I needed at their age,” she writes in the book’s introduction. Across all sports, girls start dealing with mistreatment from a young age. Sometimes it’s the message of winning at all costs, or to get strong (but not be too big), that drives girls to eating disorders and injuries.

Often, sidelined or retired athletes end up battling depression, anxiety, and other mental health crises. Sometimes the mistreatment can be more overt, as was the case with the now disgraced and lifetime-banned Salazar, who physically, verbally, and sexually abused his athletes, according to allegations by Kara Goucher, Mary Cain, and others.

“What’s been amazing is knowing I’m not alone,” Steele said. “But the devastation is that I’m not alone.”

Knowing she’s not by herself is fuel for the fire. Steele is motivated to make systemic shifts to ensure female athlete mental health is prioritized within athletic systems. “We have to make a change. We have to make sure that athletes are protected,” she said. “…There’s too much harm that is being caused to choose comfort over change.”

To be clear, protecting athletes does not mean reducing expectations of them or taking the intensity out of sports. “We don’t want to soften it or dampen any of that down,” Steele reiterated. Instead of offering pat solutions like “go do some yoga,” she said that athletic programs can actually quantify mental health issues like a team’s retention or injury rate.

Though The Price She Pays details devastating stories of female athletes who have dealt with everything from eating disorders, substance abuse, depression, and suicidal thoughts, to enduring abuse from coaches, other authority figures, or peers, Steele said ultimately she feels hopeful about the future. Yes, “the vastness and the magnitude” of the hundreds of stories she and her co-authors uncovered in researching the book was troubling, but as Brown told Steele when they were writing their proposal, “Your story is so impactful, but the fact that your story isn’t unique is the story.”

That’s why Steele has so much hope. “There are so many amazing women and girls and leagues that are changing the landscape and aiming to do it differently [by] paying attention, trusting women, asking women, and designing leagues built for women,” she said. “There’s a lot of momentum behind generating a change, and that is hopeful.”

The book, written for parents, coaches, and really anyone who cares about women and girls in sports, goes beyond the usual playbook, and with heaps of case studies and interviews, highlights how nuanced and complicated mental health issues can be. And yet, the response from those involved in women’s sports can be simple. Offering support just requires curiosity—“asking about their experiences without trying to change the circumstances or solve problems for them,” Steele writes in The Price She Pays.

Steele and her co-authors argue that there should be systems in place for dealing with mental health concerns; the same as there are protocols and checklists for how to handle concussions and other physical injuries.

These kinds of changes at the collegiate level will require new policies through governing bodies like the NCAA, which currently provides universities with mental health care best practices but only requires Division I schools to offer mental health services to athletes and doesn’t account for long wait times or insufficient licensed staffing.

In the meantime, Steele and Brown hope to catch the attention of well-intentioned coaches, parents, and administrators. Together, they founded the Athletes Mental Health Foundation to provide training and resources beyond the book—to meet people where they’re at, accommodate different learning styles, and give them the tools they need to better support their athletes.

“We would not have done this if we did not believe or have so much hope in athletic systems too, and the power of sport,” Steele said. “We wanted to [provide] solutions, not just name a problem.”

Abby Carney is a writer and journalist in New York. A former D1 college runner and current amateur track athlete, she’s written about culture and characters in running and outdoor sports for Runner’s World, Like the Wind Magazine, The New York Times, and other outlets. She also writes about things that have nothing to do with running, and was previously the editor of a food magazine.