What did we learn about elite student-athlete mental health systems from the COVID-19 pandemic?

Elite student-athletes (SAs) in higher education (HE) have distinct mental health (MH) risks. The COVID-19 pandemic put pressure on systems and increased elite SA vulnerability to adverse MH outcomes.The aim of this study was to explore the provision and management of MH in elite HE sports settings during the time of COVID-19 pandemic stress. The secondary aim was to identify lessons and opportunities to enhance future mental healthcare systems and services for elite SAs.A qualitative study design was used to investigate the views of three groups (athletic directors, coaches and sport healthcare providers). Ten key leaders were purposively recruited from HE institutions in Canada, the USA and the United Kingdom. They represented various universities from the National College Athletic Association, U SPORTS Canada and British Universities and Colleges Sport. Semistructured interviews were conducted, recorded, transcribed and thematically analysed.Five key themes were identified: (1) The pandemic disruption had salient impacts on motivation and how elite SAs engaged with sport (2) when student sport systems are under pressure, support staff perceive a change in duties and experience their own MH challenges, (3) the pandemic increased awareness about MH care provision and exposed systemic challenges, (4) digital transformation in MH is complex and has additional challenges for SAs and (5) there were some positive outcomes of the pandemic, lessons learnt and a resulting motivation for systems change. Participants highlighted future opportunities for MH provision in elite university sport settings. Four recommendations were generated from the results.