By Andrea Scott-Bell
Aaron Lennon’s Sectioning under the Mental Health Act on May 2nd is the latest addition to the list of professional footballers experiencing mental health difficulties.
The day after news broke of Lennon’s detention, the PFA claimed that mental health issues among footballers were on the rise, with 160 reported cases in the previous year. Unlike broader contexts where we have seen a decline in mental health services (1), professional football can afford the best healthcare resources, and yet, mental health concerns continue to increase. Why is the reporting of mental health on the increase within this sport and how are doctors and healthcare professionals able to respond to this?
The Culture of Professional Football
There is considerable research that emphasises the role sport and physical activity can play in the prevention and treatment of mental health conditions such as mild to moderate depression (2). However, this relationship is not entirely straightforward or unproblematic. Studies also show how everyday demands and workplace practices in professional sport can contribute to mental health conditions in athletes. This research delves beyond popular, simplistic representations of professional sports as arenas characterised by fit, highly skilled bodies and minds, huge financial rewards, luxurious treatment and public adoration. Indeed, Lennon’s story highlights that mental health issues do not discriminate against background, profession, or wealth.
So, what are some of the reasons that contribute to the increase in mental health issues within professional football? Evidence suggests that problems stem from the sporting culture in which players are enmeshed. For example, studies have shown that professional footballers’ work is characterised by uncertainty (contracts, injuries, and relocation), paranoia, loneliness, superficial working relationships and mistrust of others. These issues are connected to certain forms of occupational masculinity, which discourage players from revealing and discussing weakness with others. Indeed, players fear that the disclosure of mental health issues could lead to their stigmatisation; one that will endanger their continued employment in this highly competitive industry. Arguably then, it is these deeply embedded subcultural norms that lead players to both experience and hide mental health difficulties from those who are responsible for their welfare and well-being. These include coaches, managers, and, importantly, medical professionals employed by football clubs.
Mental Health Support for Active Footballers
In order to remedy this situation, the PFA have initiated a series of support services including access to a 24-hour counselling helpline, a self-help publication, and affiliation to A Sporting Chance (a respite clinic set up by former footballer Tony Adams). Notwithstanding this support, it is not surprising that 98 of the 160 calls to the PFA’s counselling helpline were from former footballers no longer hampered by the parameters of football industry. The minority of current players who have contacted the PFA’s services is bound to represent the tip of the iceberg and tells us a great deal about the constraints of the social setting that footballers are enmeshed and why effective management of mental health difficulties is limited during footballers’ playing careers. Explicitly, the specificities of medical support in football raise a series of further problems:
1) Footballers often rely on the services of club doctors rather than being registered an independent GP, compromising what they may wish to disclose in this context.
2) Despite the PFA’s recommendation that players first seek support from club doctors (4), most are appointed on part-time contracts, and are therefore less able to provide regular support in a confidential environment.
3) The physical environment of the football club comprises shared medical facilities that limit chances for players to access private spaces when medical staff are in attendance
3) Treatment is often sourced on the basis of trust (usually the physiotherapist) rather than medical expertise (medical doctor) and physiotherapists are less certain of the appropriate referral procedures and available treatments
4) Conflicts of interest between physiotherapists and managers are well documented, and this may lead to breaches to the ethical conventions of patient confidentiality
5) Where specialist services are available within clubs (e.g. sports psychologists) their remit is skewed toward performance-enhancement over player wellbeing.
These compromises to the make-up of medical care for current footballers, combined with the subcultural constraints of football clubs, are fundamental to the barriers footballers face in reporting mental health problems while actively playing. Mental health continues to be particularly well hidden within sport and this context poses particular challenges. Nevertheless, if elite athletes are enabled to speak about mental health more openly, mental health services/charities will be able to better challenge the prevailing stigma. Concomitantly, without substantial improvements in the training needs of sports clinicians related to mental health, satisfactory reporting mechanisms, appropriate physical location and autonomy of medical staff vis-à-vis others in clubs, we are bound to see more athletes only reaching out when they hit crisis point or, most worryingly, when it is too late.
(1) Lancet Global Mental Health Group. Scale Up Services for Mental Disorders: A Call to Action. The Lancet. 2007;370 (9594): 1195-1197
(2) Rosenbaum S, Tiedemann A, Sherrington C. Physical Activity Interventions for People with Mental Illness: A Systematic Review and Meta-Analysis. Journal of Clinical Psychiatry. 2014;75(9): 964-974
(3) Roderick M. The Work of Professional Football: A Labour of Love? Oxon: Routledge; 2006
(4)The Professional Footballers Association. Available from: https://www.thepfa.com/wellbeing [Accessed 15th May 2017]
Andrea Scott-Bell PhD, FHEA, Senior Lecturer Sociology of Sport/Sport Development, Department of Sport, Exercise and Rehabilitation