Responsible mental health screening in high-performance sport: fit-for-purpose tools and care pathways

Kegelaers and colleagues provide a timely critique of mental health screening in high-performance sport, highlighting concerns regarding predictive validity, feasibility, effectiveness, and potential harms. We welcome this debate and agree that screening can become problematic when used uncritically, symbolically, or without sufficient follow-up capacity. At the same time, if such critiques are interpreted as discouraging mental health screening as a practice, they may unintentionally reinforce mental health-related stigma by implying that mental ill-health is uniquely unsuitable for routine assessment, monitoring, or early support in high-performance sport. We argue that the central issue is not screening per se, but the role screening is given within athlete care systems. Screening is best understood as a structured wellbeing check-in and supportive gateway that can inform triage and facilitate clinical conversation, contextual assessment, and care, rather than diagnosis, surveillance, or stand-alone intervention. Concerns about specific instruments also need to be interpreted in relation to their intended constructs and implementation roles. For example, limitations of the Athlete Psychological Strain Questionnaire (APSQ) as a broad triage tool need not negate its value as a measure of athlete psychological distress. Responsible implementation depends on informed consent, confidentiality, clinical governance, mental health literacy, culturally responsive communication, and clear care pathways. This reframing allows the field to take the risks of screening seriously while keeping mental health integrated within routine athlete health care.