Cailin Bracken arrived at Vanderbilt to play lacrosse already well aware of the importance of athlete mental health. She knew of at least two female college athletes, including one from near where she grew up, who had taken their own lives.

Bracken was overwhelmed by college life, especially when she had to isolate upon testing positive for COVID-19 after just a few days on campus. She decided to leave the team.

“I was so self-aware. I was just so trusting of my intuition in a way, and it sounds cliche, but the idea that I’m like, I need to go home even if it doesn’t feel like the right decision to make in terms of my career path or my reputation or whatever else,” she said. “… I felt when I got to college, like my nervous system was deregulated. I couldn’t process anything. I constantly felt overwhelmed. I never felt safe.”

Then came the first death of at least five college athletes — Stanford soccer goalkeeper Katie Meyer — all of whom took their own lives this spring. It sparked concerns that colleges were not doing enough for some of their higher-profile students.

Bracken wrote an open letter to college sports, calling on coaches and administrators to become more cognizant of the challenges athletes face in navigating not only their competitive side, but also their social and academic responsibilities.

It isn’t clear whether U.S. college athletes are taking their lives at a higher rate than others in their age range; the NCAA declined to share with The Associated Press whether it tracks athlete suicides. But universities are starting to pay closer attention to the mental health of their athletes — in varying degrees — and it’s partly because athletes are advocating for themselves and their teammates.

“Mental health support has to be treated just like academic support and injury prevention and injuries,” said Michael Mominey, the athletic director at Nova Southeastern.

For many schools, the focus began before the pandemic. That includes James Madison, where sophomore softball player Lauren Bernett took her life on April 25.

“What we have seen is over the last decade … (is a) significant increase in mental health concerns, lots more students coming to college with mental health concerns,” said Tim Miller, vice president of student affairs at James Madison, which canceled the rest of the softball season after Bernett’s death. “And what we saw really in the last two and a half, three years of the pandemic is exponential increase. So if you imagine it as a graph, it has gone uphill very quickly.”

Suicides in the U.S. among ages 15-24 rose from 4,600 in 2010 to 6,062 in 2020, according to federal data. An analysis published in the journal Sports Health in 2015 found 35 NCAA athletes took their own lives over a nine-year period (2003-04 to 2011-12), and there were several other similar deaths of college athletes reported in the years following.

This year, Meyer, whose two saves in a shootout helped the Cardinal win the 2019 national championship, took her life March 1. A month later, it was Robert Martin, a graduate student goalie on the Binghamton lacrosse team. A day later, Northern Michigan track athlete Jayden Hill died. Sarah Shulze, a junior who ran cross country and track at Wisconsin, died April 13. Then there was Bernett, followed by Southern University freshman cheerleader Ariana Miller on May 4.

Only half of the 9,808 NCAA athletes who took a survey in late 2021 said they believe mental health is a priority to their athletics department. The survey, which included athletes in all three divisions, showed 63% believed their teammates took mental health concerns seriously, and 56% know how to help a teammate experiencing a mental health issue.

Athletes have less faith in their coaches taking mental health concerns seriously, with 53% believing that’s the case.

Division II Nova Southeastern has a program within its athletics department that integrates mental health alongside other important pieces of athletes’ lives. Mominey, who has been at the school for two decades and also coached baseball there, pointed to 2016 as a turning point.

He said there were instances of athletes who were trying to hurt themselves and “acting out in a way that they were looking for help” — things that needed more than just “mental skills training.” As part of the rollout of the Academic, Injury and Mental Health Program, Mominey and his leadership team had candid talks with coaches, getting both immediate buy-in and immediate pushback.

“We think we’re with them all the time, 20-plus hours a week. We’re always in touch. We recruit,” Mominey said. “But you really don’t know them until you know them. You don’t know what’s going on with mom or dad.”

Nova Southeastern didn’t increase its budget when it made mental health a priority, he said, and doesn’t believe the NCAA is doing enough to help member schools with mental health programs, suggesting even grant money would be helpful.

“We find ways to get it done,” he said of DII schools. “It’s a priority, we’ll make it work, whether it’s funding or not funding … and I would hope to think that the NCAA does make it a priority.”

Brian Hainline has been the NCAA chief medical officer since 2013. He said athletes immediately told him mental health was their top priority.

“I had hardly been on the job, and the student-athletes were clearly not just concerned, but that they were speaking in earnest, saying that they saw this as important as anything else,” he said. “I think in that regard, they were in some ways ahead of others because that certainly was not always the sentiment in sports medicine.”

Hainline oversees the NCAA’s Sport Science Institute, which offers resources like mental health best practices, workshop templates and planning tools. He said SSI also talks to the people in athletic departments who ensure recommendations are being followed and that everyone knows who the mental health providers are and what the protocols are for mental health access.

“For every campus to (follow recommendations exactly), we would be way ahead of the game,” Hainline said. “But it’s sometimes challenging, and I think mental health is not in the same vocabulary as ankle sprains and knee/ACL injuries and things like that.”

Erik Price, the Pac-12 associate commissioner for compliance and governance, worked with athletes, the conference’s mental health task force and Hainline on a 2019 proposal to codify mental health as part of the NCAA’s medical expenses bylaws. While mental health services already fell under medical expenses, Price said he thinks the “declarative statement” destigmatized mental health for athletes and “large intercollegiate athletic departments.”

In early May, the AP requested from the 10 Pac-12 Conference public universities itemized budgets for mental health resources or the athletic departments’ mental health programs. Utah and Oregon both said they don’t have such budgets; private schools Southern California and Stanford declined to provide the information to the AP.

At Colorado, the Psychological Health and Performance office within the athletic department increased its budget by about $128,000 between the 2019-20 and 2020-21 school years, and roughly $16,000 more for the school year that just ended. A CU spokesman said the extra money went toward costs for a new 24/7 crisis hotline and software in 2019, as well as hiring new staffers.

The other seven public Pac-12 universities had not provided budgetary information as of June 2.

Price said the current generation of college students deserve a lot of credit for bringing mental health to the forefront.

“I do believe it’s a generational shift going on in college athletics, which, like any generational shift, has caused the older generation some angst,” he said, adding later that Gen Z is “not shy about talking to each other about their emotions — and they’re wondering how and when their coaches and the adults in the room will join them, and join them more.”

Bracken’s coach, Beth Hewitt, supported her decision to leave the team and assured her she would still have a place if she returns. Hewitt believes it’s a “really big mistake” if athletic departments aren’t thinking about the pressures athletes deal with.

“Unfortunately, we’ve had so many athletes take their own life in the last few years … if that’s not your wake-up call, then you really are in the wrong profession because unfortunately, we can’t just worry about the wins and forget about the person,” she said.