Written by Dr Steffan Griffin (PhD Student) and Heather Lewis (Mental Health Foundation)

Since the LooseHeadz charity was formed in 2017, they have been relentlessly raising money and awareness around mental health and wellbeing in rugby. Through the selling of clothes and merchandise, they have raised thousands of pounds to support various mental health initiatives, and through their band of high-profile ambassadors, spread key messages relating to mental health and wellbeing to the rugby community globally. Their ultimate goal is to place a ‘LooseHead’ – a mental health and wellbeing lead – into every club worldwide.

Having worked with LooseHeadz on a range of small projects, and through being involved in research in this area, we were both thrilled to be invited to form part of LooseHeadz’ mental health advisory panel to help ensure that all efforts to ‘tackle the stigma’ associated with mental health were evidence-based and informed by latest science.

In our first meeting, we unanimously agreed that there was a glaring need for a contemporary evidence-informed educational resource to help increase the mental health and wellbeing literacy of those who are involved with the sport. The goal was never to train  people to be able to give clinical advice, but to better understand what is meant by ‘mental health and wellbeing’, and how they might be able to shape their rugby environments to maximise the mental health and wellbeing of those who play the sport.

How did we go about it?

Once a partnership was agreed between LooseHeadz and the Mental Health Foundation, a few key pillars for the project were introduced. We wanted the content to be free, engaging, interactive and evidence-based. The following aims were drawn up:

• To provide each ‘LooseHead’ with an evidence-based toolkit that demonstrates how to maximise mental wellbeing
• To introduce the concept that positive mental health isn’t just the absence of mental ill-health and everybody exists across a spectrum
• To provide an overview of the signs for common mental health disorders
• Support the LooseHead to know how to provide basic support and advise someone going through a mental health crisis.
• To provide information around how to identify a mental health crisis

With the generous support of LooseHeadz’ range of superstar ambassadors who had agreed to present the content (including past and present international players and TV personalities), we also agreed that we would try and de-medicalise the concepts as much as possible and make the modules relatable to everyone.

In terms of what we wanted to cover, following a consultation meeting, we agreed on the following themes and questions that we felt should be covered:

• What Is Mental Health?
• What Is Mental Ill Health?
• Tackling the Stigma and Creating Kind Cultures
• Top Tips for Looking After Your Mental Health
• Next Steps – Signposting, Resources and ‘LooseHead’ Top Tips

For the informative aspect of the module, information was taken from pre-existing Mental Health Foundation resources, and reinforced by a further literature review. This was subsequently reviewed and endorsed by clinical experts in the field.

For the more practical aspects of the module, we collaborated with a number of relevant parties and rugby stakeholders to design a survey to collect data around how rugby affects people’s mental health and wellbeing. This survey was subsequently disseminated to a diverse range of individuals involved in rugby in various capacities and was completed by over 350 people in total. A thematic analysis of the responses was then performed, and used to inform discussions at focus group meetings, where there was representation from a diverse group of players, coaches, parents and administrators. Common messages, themes and initiatives were noted and formatted into a script for a diverse range of rugby players, broadcasters as well as LooseHeadz panellists to subsequently read.

What did we end up with?

As you can now see from the module, the content has been formatted into a series of videos, underneath which is a text version of the content to enhance the experience of those with various learning needs or styles.

At the end of the resource, we have incorporated a questionnaire for participants to complete at the end based on the content covered in the videos, which has been endorsed by CPD UK. Since then, we have also had the module reviewed and endorsed by a number of experts or specialists with either sport or mental health expertise.

Where next?

We sincerely hope that this module now fills a gap and will provide a practical tool to help maximise the mental health and wellbeing of those who play rugby. Through hard-work and the kindness of a number of individuals, we believe that despite very limited resources, we have produced a resource that will help to tackle the stigma associated with mental health in rugby.

We hope that this is just version 1.0 of this module and we look forward to collaborating with other organisations in future to ensure that the key messages reach as wide an audience as possible.

LINK TO MODULE: https://looseheadz.learnworlds.com/course/looseheadz

Acknowledgments:

We would like to thank the LooseHeadz team for their unending support and enthusiasm, and for allowing us to be part of this venture. We also thank everyone at the Mental Health Foundation for all the support, and to Jack Zorab for writing the scripts. A huge thanks also goes out to all the ambassadors and panellists for their time and expertise.  Finally, we would like to thank Dr Tim Anstiss as well as Dr Phil Hopley and Sam Rogers (of Cognacity) for reviewing the material.

Authors and Affiliations:

Dr Steffan Griffin is a junior doctor based in London. He is undertaking a Sports Medicine Training Fellowship at the RFU, and is also undertaking a part-time PhD looking into rugby, health and wellbeing at the University of Edinburgh. He also works clinically across various sports.

Heather Lewis manages sports projects at the Mental Health Foundation and is an Elite Athlete Lifestyle Advisor.  She is undertaking research with St Mary’s University, Twickenham looking into elite rugby players mental health and wellbeing.

References and key sources of information:

• How many people have an eating disorder in the UK?. Retrieved from https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/how-many-people-eating-disorder-uk/
• Health and Safety Executive. (2021, December 16). Work-related stress, anxiety or depression statistics in Great Britain, 2021. https://www.hse.gov.uk/statistics/causdis/stress.pdf
• McManus, S., Bebbington, P., Jenkins, R., Brugha, T. (Eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. NHS Digital.
• Mental Health Foundation. (2021, July 8). Anxiety. Retrieved from https://www.mentalhealth.org.uk/a-to-z/a/anxiety
• Mental Health Foundation. (2021, July 8). Depression. Retrieved from https://www.mentalhealth.org.uk/a-to-z/d/depression
• Public Health England. (2017). Chapter 2: Major causes of death and how they have changed.