How can sport help eradicate prejudice and raise awareness of mental illness?

“Haven't tweeted most of this week and wasn't going to until I felt 100% but it's important I do (I think). I'm midway through the mother of bouts of depression, something I've had many times in my life, and will continue to til, when, you know.”

These were the words of former footballer and current talkSPORT pundit Stan Collymore, posted on his Twitter on November 25th following the 40-year-old’s latest bout of depression.

(Image from Wikimedia Commons) Wales manager
Gary Speed committed suicide on November 27th,
shocking the nation.

That same day, it was revealed Bundesliga referee Babak Rafiti had been diagnosed with depression, after attempting to take his own life hours before he was due to officiate Koln vs Mainz on November 19th. Just a few days after Collymore’s confessions, Wales manager Gary Speed was found hanged at his home, although reasons behind his suicide remain unclear.

So many had watched Speed’s appearance on Football Focus just 24 hours earlier, yet there was nothing to suggest to anyone of what was to follow; presenter Dan Walker was ‘staggered’ by news of his death, tweeting: “Was with him for much of yesterday. I genuinely cannot believe it…Gary was full of life yesterday talking about his kids, bright future with Wales, twitter, golf. Can’t get my head round it.”

It is easy to assume that Speed may have been suffering with some form of mental illness, such as depression, which led to his decision to take his own life. Whether or not this assumption is correct is a different story. But one certainty is that following his death, and other recent events such as Collymore and Rafiti, the issue of mental health in sports is once again firmly at the forefront of public interest.

Mental health issues such as depression can often be behind
addictions to alcohol, drugs, gambling and sex

Those outside the industry may be unaware of just how common mental health problems are within sport. Fleetwood Town’s Steve Pope, a sports psychotherapist who has worked with Premier League footballers, offers a small insight. “80% of footballers will suffer from depression at some stage during their career,” he claims. “I get onto the bus to go to an away game and we’ve got people who have got gambling problems, drink problems, drug problems, people with relationship problems, people who are depressed, people who are anxious, people who’ve got no confidence, people who’ve got too much confidence. It’s like looking at a mental health ward at times.”

“Most footballers do have an addictive personality – obsessional.  That’s why they’re good at what they do,” Pope added. “They practise, practise, practise. Then it can go off track and become drink, drink, drink, sex, sex, sex, whatever it is.”

Sports psychologist Phil Johnson, who played football for Bolton Wanderers and has participated in a range of sports including swimming, tennis and athletics, has also encountered a wide range of mental health issues within the profession. “I have come across a significant number of swimmers who have chronically over-trained and developed eating disorders and depression,” he said. “Collision sports such as rugby and boxing don’t just take their toll on player’s bodies, and sport trauma such as Post Traumatic Stress Disorder is not unusual. I come across a significant number of equestrians who have PTSD as a result of falls from and falls under their horses.”

Despite this, it is rare that sports players are open about any mental health issues they are suffering with, and certainly not in the midst of their career. The likes of Neil Lennon, Marcus Trescothick and Dame Kelly Holmes have spoken about their battles with depression, but all after retiring from playing sport. German goalkeeper Robert Enke, who tragically took his own life in November 2009, tried desperately to conceal his depression, not only because he wrongly feared his adopted daughter Leila would be taken away from him, but also because he worried it would destroy his football career.

(Image from Wikimedia Commons) Neil
Lennon described how his depression left
him feeling 'worse than playing in an
Old Firm game' 

This reluctance to speak out suggests there is a certain attitude surrounding sports players struggling with mental health problems, both within and outside of the industry. When Collymore, then at Aston Villa, openly admitted to suffering with depression and was admitted to the Priory clinic for treatment in January 1999, his manager John Gregory was unsympathetic. “Stressed out?” he said. “Try telling that to a 29-year-old at somewhere like Rochdale with three months left on his contract, a wife, three kids and a mortgage.”

Reaction in the press was similar, with Paul Weaver writing in the Guardian, “With the weary hope that the players concerned are not otherwise engaged with their shrinks or wriggling in strait-jackets in the local giggle house, with the wistful dream that the 22 footballers might keep hold of their marbles for at least 90 minutes, I plan to attend a Premiership football match on Saturday.”

Certainly, the response to Collymore’s illness insinuated a general perception that professional sports players should not be suffering from mental illnesses as they are getting paid highly to play sport for a living, an opportunity that many would gladly take. Twelve years on this prejudice is not quite as strong – unfortunately it seems to have taken tragedies such as the suicides of Enke in 2009 and Rushden & Diamonds goalkeeper Dale Roberts in 2010 to open people’s eyes.

The stigma surrounding mental health in sport from those outside the industry has not, however, been completely eradicated. PFA chairman Clarke Carlisle, who went into rehab himself in 2003 for an alcohol addiction which was borne out of depression, is aware that these misconceptions still exist. “Depression and mental health issues are like any other illness,” he said. “They have no boundary of race, colour, creed, religion, wealth or profession, they can strike in anybody's life at any given time, whether they have a good job or not.”

Many sportsmen and women are also often guilty of misunderstanding a mental health problem in their fellow professionals. Lennon admitted that he failed to understand Collymore’s depression until he himself suffered from it. "When Stan Collymore said he had it the reaction with a lot of players and even myself was, 'What's he got to be depressed about?’” he said. “But it's more than that. It's a common illness, common among young men, regardless of what they do in life.”

Alan Brazil and Rob Shepherd discuss cricketer Michael Yardy, who revealed in March 2011 that he was suffering from depression.

Carlisle agrees that there is a ‘taboo’ around mental illness from those within sport as well as outside of it. “The perception is that mental health issues are a reflection of self, that they denote mental strength or weakness, which is completely wrong,” said Carlisle. “It's because of this that many sportsmen are afraid to come forward for help with these issues because they feel they're expected to ‘pull themselves together’ and ‘man up.’”

A professional sports player, then, not only has to appear as a strong and focused individual, but must be able to withstand enormous amounts of pressure. There are very few professions whereby the performance of participants are watched by thousands, judged by those with no expertise, and publicly scrutinised by the media. In Germany, for example, magazine 'Kicker' included surveys from players to name the worst referee in the league.

This public criticism, however, seems to have evolved and become part-and-parcel of sport nowadays, and players are expected to deal with it. As one fan put it, “it's part of the game, and if you can't handle it then how did you get to the top in the first place?” If a player is having trouble coping with pressure, the issue does not seem to be how do we reduce this pressure, but rather how do we help them to cope with it?

Johnson believes that help should be provided to ensure the effect on players is minimal. “We need to offer training in dealing with the media for players, and coaches need to be more supportive and more skilled in their own feedback to athletes,” he said. “If self-esteem – self-value, self-belief and assertiveness – is developed around the ‘person’ and not the sport, then athletes cope better with criticism, and consider it more in context of selling newspapers.” Pope, meanwhile, has a simpler approach. “We encourage them not to listen to the fans or read the media,” he said. “The Great British media puts somebody on a pedestal to kick them off.”

Interview with Steve Pope by lizavfc92

There is also the problem that mental health issues among sports players can be so difficult to spot. In his suicide note, Enke described how he had 'deliberately concealed his state of mind over recent days, that was necessary in order to be able to put his suicide plan into action.' “I diagnose a range of clinical mental health conditions that have been present for some time in players, often years without others knowing,” Johnson said, “thus the prevalence of clinical mental health condition is, and can be, ‘masked’ by the sport itself.”

It seems, then, that a combination of eradicating prejudices and making sure there is adequate help available is the best way to combat mental illnesses in sport. There is definitely more advice and guidance available for those currently suffering than there was a decade ago.

(Image from Wikimedia Commons) Clarke
Carlisle, pictured training for Burnley

The Sporting Chance Clinic was founded in 2000 by former Arsenal captain Tony Adams, who battled an alcohol addiction for many years, and has helped hundreds of professional and amateur sports players seek treatment for behavioural problems and mental health issues. In addition, the notion of sports players having access to a sports psychiatrist is becoming more common. But how much is really being done? 

“I think that the tragic recent events have highlighted the fact that we are not doing enough,” said Carlisle. “The support is there, as is the literature and the avenues of recovery, but they are not cohesively run and barely advertised at all. We need to destroy the stigma that surrounds these issues and bang the drum about what is available to our members so that nobody ever feels further than a phone call away from help.”

After Speed’s suicide, it was revealed that the PFA plan to send out a 36-page guidebook on handling depression to its 4,000 members. “The handbook was produced in order to hopefully educate all our members on the stresses of their careers, the signals and symptoms of depression and what to do if they have any concerns about themselves or others,” said Carlisle, who contributed to the handbook himself.

“It was after the tragic suicide of Robert Enke that we decided to act in order to be pro-active rather than reactive about mental health issues. It contains quotes from players like Paul Gascoigne and Neil Lennon who refer to their personal experiences in the hope to help others. It has been decided to circulate the handbook to all 50,000 former members too, to hopefully prevent another tragedy like Gary Speed just recently.”

(Image from Wikimedia Commons)
German goalkeeper Robert Enke, seen
here training with his club Hannover 96,
stepped in front of a train after suffering
from depression for a number of years.

Of course, this is not just happening within sport. “Whilst main sport organisations have moved forward in their understanding and promotion of mental health,” said Johnson, “sport tends to reflect the wider society, where mental health problems remain the subject of prejudice, a lack of knowledge, and limited resources to treat those we know of, but still with a great deal of stigma.”

Those outside sport who suffer from mental health issues, such as depression, anxiety, eating disorders and addictions, are also likely to have encountered great ignorance and misunderstanding. Nine out of ten people with mental health problems have experienced some form of discrimination, while the UK has one of the highest rates for self-harm in Europe - 400 per 100,000 population. These alarming statistics highlight the need to raise awareness of mental illnesses and try to overcome the narrow-minded attitude faced by so many.

The sporting world is a truly global industry, with billions of people regularly participating in or watching sporting events. With such a massive audience and such potential for accessibility, it is a fantastic platform for promotion. This surely opens up the possibility for sports to promote charities and spread awareness of certain issues. The influence that the actions of well-known professional sports players can have on those both in and outside of the industry cannot be underestimated. For example, within 72 hours of Speed’s death, 10 players had contacted the Sporting Chance Clinic to seek help. Imagine the effect of a famous Premier League star or a gold medal-winning Olympian publicly backing a mental health-related charity, speaking about mental illnesses, or even describing their own troubles in depth.

“Sport has been the flag bearer for social issues ranging from anti-racism, homophobia, anti-semitism, and islamaphobia to the plight of the nurses and local children's hospitals,” said Carlisle. “By instigating national campaigns that are advertised through the Premier League, they will be witnessed by 600 million viewers every week. What better vehicle to disseminate ideas and campaigns on such a global scale, than the Premier League?

“And then, with over 35,000 social inclusion visits by pro footballers last year – that is, trips into schools, hospitals, local communities and clubs – the players can take these campaigns into the local community on an individual and personal level. There can't be a price put on the extent of that impact.”

Stan Collymore outlines his intentions to raise money for Depression Alliance by auctioning off sporting memorabilia

In the wake of Speed’s death, as well as his own recent  bout of depression, Collymore has been trying to boost understanding of mental health through social network sites. He has posted lengthy tweets about his own experiences of depression, opened a Google Plus page aiming to ‘share stories with those struggling and give information of where help is at hand,’ and is currently organising a charity auction to raise money for Depression Alliance, with a number of footballers such as John Hartson, Danny Murphy and Neymar donating shirts and memorabilia.

Mental health problems within the sporting industry are more common than we are aware of, but, as Pope put it, “the players are just a microcosm of society.” There are millions of others outside sport who are victims of prejudice or suffer in silence. We may never know why Gary Speed chose to take his own life on November 27th, and it may not have necessarily been down to a mental illness, but it should not take the death of a high-profile sporting figure to raise awareness about such issues. The likes of Collymore, Carlisle and Lennon are currently striving to achieve this, and more should follow their example. By highlighting mental health issues in the sporting environment, to hear the sporting figures we see in the media every day speaking out against the stigma of mental illness, it can encourage someone – whether they are a sports player or not – to seek help. The world of sport has the power to do this; it’s time to put that power into action.

Many thanks to Steve Pope, Clarke Carlisle and Phil Johnson for their contributions to this article.