Taking the initiative in tackling mental health in sport

Without question, Shakiba Oftadeh Moghadam's statement addresses an important topic. It is disappointing to see that rugby players, like athletes in many other professional sports, still show reticence to seek support for their mental health issues. After the suicide of the goalie of the German national football team, Robert Enke, in 2009, bold statements were made by officials that more attention should be paid to the mental state of football players (Reng, 2011). By and large inaction rather than action has resulted. In 2018, Per Mertesacker, a player with Arsenal FC and long-time member of the German national football team, disclosed in an interview that somatic and psychological stress is more than ever a threat to players' physical and mental health and well-being. A study by Nixdorf et al. (2013) already revealed that sport-specific stress and lack of recovery are major determinants of the development of psychological problems, especially depression. This problem must be addressed and Moghadam certainly deserves praise for resurrecting the topic within the rugby context.

Mental Health Literacy programmes typically focus on improving overall knowledge of mental health disorders, symptom recognition and attitudes towards help-seeking (Sebbens et al. 2016). However, a question posed by Gulliver (2017) is whether increasing knowledge and confidence in assisting a person with a mental health issue leads to increased helping behavior. The limits of mental health literacy are that it may further stigmatise mental illness and psychological distress.

We argue a more dramatic paradigm shift is required. This is illustrated by a well-known parable adapted from the story by Irving Zola: A crowd standing at a river bank suddenly hear a baby crying. Shocked, they see an infant struggling in the water. One person immediately dives in to rescue the child. Suddenly another baby comes floating down the river, and then another! People continue to jump in to save the babies. One person has started to walk away from the group still on shore. Accusingly they demand to know where they are going as all hands are required on deck to help save the children. That person responds: 'I'm going upstream to stop whoever's throwing babies into the river.'

Certainly, risk factors need to be identified to understand what is needed to support athletes and multi-stakeholders in elite sport (Nixdorf et al., 2015). A more comprehensive approach would entail upstream prevention. We posit that there is a need to develop and validate preventative approaches in sport settings. This involves developing a broader set of skills that those encompassed by mental health literacy. MacIntyre et al. (2017) suggested a reconceptualisation of the term psychological literacy in their editorial of a recent research topic on mental health challenges in elite sport. Psychological literacy can include the effective application of psychological skills, an understanding of wellbeing in addition to mental health and the knowledge and skills of resilience. For example, young athletes should be given the opportunity and skills to develop resilience early on, so they may survive and perhaps thrive from the multiple transitions they will encounter. Furthermore, youth academies across professional team sports should be rewarded by their national governing bodies for including preventative psychological programmes for their emerging performers. This is an important step forward and would address issues of the duty of care of sporting organisations.

The problem should not be underestimated – there still is a lot of resistance to openly addressing mental health in sports like rugby and football where disclosing any psychological vulnerabilities may be seen as weakness (Bauman, 2016), and mental problems in sport are still stigmatized (MacIntyre et al., 2014). Understanding the causal relationships in developing mental problems and developing programmes to promote resilience and psychological literacy in athletes has to involve overcoming individual, institutional and political forces of resistance.

Dr Juergen Beckmann Professor and Chair of Sport Psychology,Technical University of Munich

Dr Tadhg MacIntyre CPsychol AFBPsS Health Research Institute, University of Limerick

References

Bauman, N.J. (2016). The stigma of mental health in athletes: Are mental toughness and mental health seen as contradictory in elite sport? British Journal of Sports Medicine, 50, 135–136. doi:10.1136/bjsports-2015-095570

Gulliver, A. (2017). Commentary: Mental health in sport: Improving the early intervention knowledge and confidence of elite sport staff. Frontiers in Psychology: Movement Science and Sport Psychology, 8, 1209. doi:10.3389/fpsyg.2017.01209

MacIntyre, T.E., Barr, J. & Butler, C. (2014). The good, the bad and the ugly of elite sport: A reply to Martindale, A., Collins, D. & Richards, H. (2014). It's good to talk…Is elite sport good for you? Sport and Exercise Psychology Review, 10(3), 68–76.

MacIntyre, T.E., Jones, M., Brewer, B.W. et al. (2017) Editorial: Mental health challenges in elite sport: Balancing risk with reward. Frontiers in Psychology: Movement Science and Sport Psychology, 8, 1892. doi:10.3389/fpsyg.2017.01892

Nixdorf, I., Frank, R., Hautzinger, M. & Beckmann, J. (2013). Prevalence of depressive symptoms and correlating variables among German elite athletes. Journal of Clinical Sport Psychology, 7, 313–326. doi:10.1123/jcsp.7.4.313

Nixdorf, I., Frank, R. & Beckmann, J. (2016) Comparison of athletes' proneness to depressive symptoms in individual and team sports: research on psychological mediators in junior elite athletes. Frontiers in Psychology: Movement Science and Sport Psychology, 7, 893. doi:10.3389/fpsyg.2016.00893

Reng, R. (2011). A life too short: The tragedy of Robert Enke. London: Yellow Jersey Press.

Sebbens, J., Hassmén, P., Crisp, D. & Wensley, K. (2016) Mental health in sport: Improving the early intervention knowledge and confidence of elite sport staff. Frontiers in Psychology: Movement Science and Sport Psychology, 7, 911. doi:10.3389/fpsyg.2016.0091