Although exercise and sport participation enhances aspects of physical and mental health, athletes appear to evidence about the same severity of mental health symptomology as non-athlete peers. In this chapter, factors that influence the development and maintenance of mental health symptomology in athletes, and state-of-the-art programs to address these concerns (e.g. assessment/screening measures, service engagement methods, intervention), are reviewed. Future directions are offered to inform policy and assist sport organisations in the integration of evidence-supported approaches to mental health optimisation in athletes.