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The publication of the second edition of the International Olympic Committee (IOC) Consensus Statement on Mental Health in Elite Athletes 1 represents a major step forward in continuing to advance elite athlete mental health and well-being as a core component of athlete health. Yet, applying the recommendations of the consensus statement in low- and middle-income countries (LMICs) requires deliberate and context-sensitive adaptation (figure 1). Furthermore, mental health symptoms and disorders among elite non-disabled athletes and elite Para athletes in LMICs remain understudied, leaving significant gaps in evidence to guide local implementation.2 Building on frameworks for culturally adapted interventions,3 this editorial highlights key LMIC realities and proposes feasible strategies to support elite athlete mental health in under-resourced contexts.