Depending on how well they cope with the challenges associated with a career in elite sport, elite athletes might report mental health symptoms. The prevalence of mental health symptoms in active and former elite athletes is substantial, reaching up to 39% for distress and anxiety/depression (not differentiated), 29% for sleep disturbance, and 27% for disordered eating. The occurrence of mental health symptoms among elite athletes is likely to be the consequence of psychosocial stressors (e.g., adverse life events), sport-specific stressors (e.g., severe injury, concussions), and/or stressors related to transitioning out of sport (e.g., unemployment). The treatment approach of mental health symptoms among elite athletes relies on physical activity, psychoeducation, psychotherapy, and/or pharmacology. The screening and surveillance of elite athletes repeatedly over a sporting season are essential in order to identify, at an early stage, those who are potentially at risk of or are already experiencing mental health symptoms. The prevention of mental health symptoms focusses especially on stress control, maintaining an optimal life balance and regular sleep cycles, increasing resilience, and boosting low self-esteem. Clinicians should remain knowledgeable and skilled in order to protect and promote both the short- and long-term mental health of elite athletes.