When Dr. Brian Hainline learned about the apparent suicide of another college athlete, it hit hard. Again.
No, he didn't know Washington State quarterback Tyler Hilinski. But he's heard such stories far too often.
The NCAA's first chief medical officer has coped with friends, patients and other college students who took their own lives and whenever it happens, the same emotions and questions come racing back. So Hainline has put together recommendations that may help college athletic departments understand how to help players.
"What we're trying to do is get every single campus to operationalize this," Hainline told The Associated Press on Wednesday, the first day of the NCAA's annual convention. "The same problems regular students have with mental health are the same problems student-athletes have. They think they're unique and they're not."
The 21-year-old Hilinski was found in his Pullman, Washington, apartment on Tuesday after he didn't show up for practice, dead from an apparent self-inflicted gunshot wound. Police also found a rifle and a suicide note.
Police Chief Gary Jenkins declined to reveal the contents of the note.
Police were interviewing Hilinski's friends and people who knew him to try to learn why the Cougars' presumptive starting quarterback apparently took his life. "The missing piece here is why," Jenkins said.
Hilinski's family in California issued a statement saying they were in "complete shock and disarray" over his death.
They weren't the only ones grieving.
A makeshift memorial sprouted near the football stadium on the Pullman campus, next to a bronze statue of the team's mascot. Social media were also filled with comments, including one from former Washington State star quarterback Ryan Leaf, who said he couldn't stop crying.
More than 2,000 miles away in Indianapolis, Hilinski's name repeatedly came up during a previously scheduled panel discussion on student well-being. The session on suicide prevention was full of emotion and concern.
"Last night it was 11 p.m. and I was going to work out when my best friend from UCF texted me pictures of the tweets," Student Athlete Advisory Committee representative Enna Selmanovic said, referring to the reaction about Hilinski. "And she said, 'When is this going to end?'"
Numbers show why mental health has become such a serious issue on college campuses.
According to National Data on Campus Suicide and Depression, one out of every 12 college students makes a suicide plan and 7.5 students per 100,000 kill themselves.
Hainline said the stats are similar for athletes, something Selmanovic found in her own research.
The former swimmer and current pre-med student at the University of Cincinnati found 35 college athletes killed themselves from 2009-15, which represents 7.3 percent of all deaths among college athletes during that time. Twenty-nine of the deaths were male athletes and 13 played football.
Selmanovic revised her prepared remarks after hearing about Hilinski. But the solutions remain the same.
"The lack of education that we believe exists right now will make it worse if it's not solved," she said. "Educating staff and coaches is just as important because they are the ones who are going to know when performance is slipping. And confidentiality is key.
"Getting athletes to know the resources are out there, that's the biggest thing," she added.
While some athletes may avoid asking for help because of worries about what coaches and peers think or whether they may lose a scholarship, the bigger problem might be the long-held stigma attached to mental illnesses.
Former Clemson football player Jay Guillermo understands.
The starting center on college football's national runner-up in 2015 and the 2016 national champions stepped away from football during his sophomore year so he could be treated for depression. At his worst, he said he contemplated suicide but never attempted it.
"The struggle, at least I know for myself, was more admitting that I needed to talk to someone," he said in a telephone interview, noting the university and the coaching staff provided the support he needed. "Especially a male athlete, and a football player in such a physical rough sport, you never want to be the guy that's having to admit that something's wrong. You get that mindset of always pushing through. Nothing's wrong. I'm good to go. I think that's the toughest part. At least for me. Not that there wasn't any resources there, but reaching out to those resources."
Hainline said college students are more vulnerable because a range of illnesses peak during the ages of 18 to 22.
The stress of performing in school and on the field only ratchets up the pressure and if a student isn't sleeping well, as often happens in college, studies show the suicide risk can double or triple even without a mental illness.
Hainline believes schools shouldn't just have a plan, they need to practice the plan and be prepared to help players before dealing with tragedy.
"What's it going to take? Is it going to take having a licensed sports psychologist on campus? Maybe," Selmanovic said. "But we have to hit the mark or sadly more (athletes) will end up like Tyler. I'm not sure about you, but I can't take another Tyler."
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AP College Football Writer Ralph Russo in New York and Associated Press Writer Nicholas K. Geranios in Spokane, Washington, also contributed to this report.
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