Sport comes with injuries; it’s a fact of life. Whether it’s a rolled ankle or fractured leg, a strained hamstring or broken nose, play long enough and you’ll get hurt. Professional clubs have an army of doctors, trainers, physiotherapists and medics on the payroll to deal with these mishaps quickly, with seriously injured players rushed straight to hospital and into surgery, then supported through their rehabilitation.
But what happens when it isn’t a physical condition, but a psychological one?
Adjunct Associate Professor Patsy Tremayne, a sports psychologist with Western Sydney University’s School of Social Sciences and Psychology, said sporting codes -- so good at dealing with bodily injuries -- are still not up to scratch in terms of dealing with mental health problems.
“Players don’t like to talk about mental health. It is almost a sign of weakness to mention it,” she told The Huffington Post Australia.
“If they perceive that as a weakness, they are less likely to ask for help. They think it is humiliating or shameful.”
Fellow psychologist Kate Wensley, with the Australian Institute of Sport, said mental health issues are often overlooked in sport as physical injuries take precedence.
“My mantra is mental health problems are really common. People in sport are not immune. It’s really important we talk about this,” she said.
Mental health has historically languished unaddressed in the Australian sporting landscape, but several high-profile athletes have recently opened up about their battles with depression and anxiety, catapulting the issue onto television screens and newspaper front pages. Swimmers Ian Thorpe, Libby Trickett and Leisel Jones, rugby league players Darius Boyd and Dan Hunt, and AFL star Lance Franklin have all recently revealed their struggles with mental health and dealing with their schedules of relentless training, competition and evaluation.
A 2015 report found that almost half of A-League football players found their transition from playing to retirement “difficult to very difficult” and one in five had experienced mental health problems. Professional Footballers Association chief executive Adam Vivian said the code was “failing” players.
“The code has a duty of care to ensure the wellbeing of players and these findings illustrate that this duty of care is not being fulfilled,” he said at the time.
Beyondblue, Australia’s national initiative raising awareness of anxiety and depression, has partnerships with sporting organisations including the Canterbury Bulldogs, Hawthorn Hawks, Sydney Swans, NSW Waratahs and Sydney FC, encouraging players, staff and fans to open up about mental health. Beyondblue chairman Jeff Kennett said athletes had “special needs” in terms of mental health that were not being properly addressed, but recent revelations from sporting stars had given others the inspiration to speak up.
“They get put in a cocoon and taken away from what I’d call normal life. They’re in positions where they train hard, the expectations are hard. Those pressures mount, and they don’t seek help -- they’re fearful of going public, scared of being dropped or not selected, or being seen as unsuccessful,” he told HuffPost Australia.
Kennett singled out the Swans for particular praise, the club sidelining Franklin at a crucial stage of their finals campaign so he could seek treatment for an “ongoing mental health condition”.
“That sent a profound message to people, that mental health is more important than winning,” he said.
Tremayne said such high-profile cases had helped spark deeper conversations about athletes grappling with mental health, not just physical health, but that the nature of competition meant sportspeople faced “unique challenges.”
“An athlete in competiution, if they come second or third, they’re upset because it’s not first and they didn’t win. They are not always grateful or excited about gaining a place. It starts young -- when a youngster goes to swimming, mum or dad asks ‘did you win?’ not ‘how did you perform today?’,” she said.
“The expectation is they win. From a young age, youngsters are taught to think winning is all there is.”
She said athletes are susceptible to mental health issues not just during competition, but after a major event -- such as an Olympic Games or championship -- or in retirement. She’d know. She was an elite diver, winning bronze at the Commonwealth Games, and has worked as a sport psychologist with the Australian women's water polo team.
“After those events, it can feel like a tremendous loss for an athlete. They have been very disciplined, training at all hours, then suddenly it’s over and they go home. But in the meantime, life has gone on without them, and they’re lost without that structure,” Tremayne said.
“That can exacerbate depression, most definitely. After competition, some might fall into a hole, or go back to sport again simply because they can’t stand having nothing else to do. They think their life will be so much better, but it’s not. They’re grieving.”
At the AIS, Wensley said early intervention was critical. Many young athletes leave home at an early age to live at the AIS facility in Canberra, meaning she deals often with issues around isolation and loneliness.
“When athletes are under prolonged stress, they’re more vulnerable to developing mental health problems. Athletes have these unique stresses, being in the limelight and performing, alongside the normal ones everyone else experiences,” she said.
“Psychology plays a huge part, developing resilience and readiness in preparation for major events; anything from managing nerves on big stages to staying in contact with family and friends while still staying focused.”
The National Rugby League has had several high-profile players reveal their struggles with mental health in recent years. The league’s senior welfare and education manager Paul Heptonstall said the NRL now has strong mental health frameworks in place to support players through their careers.
“The reality is, we fit into every high-risk category for mental health; young men, risk-takers, relocated people, indigenous and Pacific Islands people. Destigmatising mental health is an issue we’ve been working on in recent years, encouraging players to seek help and showing it’s OK to have a problem,” he said.
“We’ve come a long way in that space, largely on the back of players telling their stories.”
Heptonstall said all club staff were trained in mental health first aid and every NRL club had a welfare manager who can refer players or their families to free counselling or rehabilitation facilities for issues such as alcohol or gambling.
“The fact is, players are evaluated almost every single day. In every training session, every game, they’re under such scrutiny. It can be a very anxious environment, so the education is around to tell players to control what they can and that there are certain things they can’t control,” he said.
Heptonstall said the code had identified a group of potential triggers -- unrealistic expectations on young athletes, the relocation process from home to a new club, giving players an identity outside being a footballer, dealing with behavioural issues, being injured and retirement -- where mental health conditions could be exacerbated, with specialised help and counselling available for each scenario. He said the code had made big steps in recent years to address psychological conditions and that more progress was on the horizon.
“Our focus over the next 12 months is on positive psychology. Not just worrying about the players in a negative space, but preventative measures to keep them in a positive mindset,” he said.
Going forward, much research is currently being undertaken Australia-wide on how to support athletes’ mental health. While competition can exacerbate stresses and underlying conditions, a Wollongong researcher said sport can also actually support those grappling with mental health.
Dr Stewart Vella, a research fellow at the University of Wollongong, is investigating how sport can help adolescent males identify and overcome mental health issues. UOW -- partnering with the Australian Sports Commission, the AFL, Cricket Australia, Tennis Australia, Swimming Australia, Basketball Australia and Football Federation Australia -- will use a $2 million grant from the Movember Foundation to provide grassroots clubs with tools necessary to support young athletes through mental health issues.
“Typically people haven’t associated sporting clubs with having that role of supporting mental health, but they already play an important role. Our research shows kids who drop out of community sport are at a 10 or 20 per cent increased risk of developing mental health problems,” Vella said.
“We are targeting mental health literacy. It’s about giving players, parents and coaches the ability to recognise signs of mental health, being able to talk to each other. Some people don’t know what to say or how to have the conversation. We need more education about that, how to ask and listen, where to go for information about professional help.”
Vella said sporting clubs were a place for frank discussion between players, which can be all-important in seeking help.
“Clubs are an opportunity to get to kids in an environment where they’re motivated and they pay attention,” he said.
“They’re great places to notice potential problems and give avenues for support. Peer support, team mates and coaches are a fantastic outlet, with that community feel.”