Worldwide there are concerns for the quality of healthcare available to elite sport men and women experiencing mental health problems. One in four people, regardless of position or status, will experience mental ill-health at some point in their lives. For elite athletes to achieve their potential while maintaining a sense of personal well–being, mental health is as important as physical health and so should not be thought of separately. Whatever walk of life, faith, values, beliefs, sexual orientation, culture, age or ethnicity – dignity and respect are legitimate human rights and arguably critical to emotional and physical health.
In recent years, various elite athletes have been documented as experiencing mental ill-health. The plights of footballers Stan Collymore, Paul Gascoigne, Robert Enke, Gary Speed, Tony Adams, Clarke Carlisle and Vinnie Jones have contributed to a greater awareness of the distress endured by many elite athletes because of pressures related to the culture of success accompanying elite sports.
More recently, Everton footballer Aaron Lennon spoke of a burden he carried since the age of twelve and because of the need to excel on an almost daily basis. Later in his career, Isolation from team mates, sanctions, worry about renewed contracts and differences with colleagues, all contributed to him becoming mentally unwell. Aaron Lennon eventually fell ill emotionally and was admitted for psychiatric in-patient treatment under a section of the mental health act.
The Professional Footballers’ Association (PFA) shares the wider concerns for the prevalence of mental ill-health and list four prominent factors, which can impact on the mental health of elite athletes and specifically football players.
These are as follows:
- Change & Anxiety, Contracts & Stress, Performance & Panic, Retirement & Anger.
Andrew Cole, formerly of Manchester United, captures succinctly the sense of fear, panic and isolation, anxiety and anger, concerning performance expectations, in the following statement:
“I had my own torture chamber. It was my bedroom. Every day I would return from training, quickly smuggle myself in through the front door, and get to that private sanctuary as fast as possible. Then I would stay there, locked in with my own very confused thoughts. I felt isolated and a little desperate, persecuted as well, and I had to overcome all those messed emotions. It wasn’t easy and it took time. Probably eighteen months followed before I had truly come to terms with life at United and I wouldn’t want to go through such an ordeal again.” (PFA, 2017)
Mental ill-health impacting on elite athletes is by no means confined to football. The boxer Frank Bruno’s struggles with mental ill- health are well documented. Similarly, cricketer Andrew (Freddie) Flintoff publicly discusses his experience of a major depressive episode and is currently active as a mental health advocate. There are many more elite athletes who experience or have experienced mental ill-health and because of their acquired experiential knowledge are encouraging others to access support.
Researchers Hughes and Leavey (2012) contend that in although physical activity is related to good health, at elite sports levels the intensity of training can compromise both physical and mental health. The authors also suggests that the personal investment required of elite athletes can bring about conflicts in identify as limited opportunities are available to develop their personalities outside of sport. Because of the overinvestment in sporting achievement, they imply that a range of psychological difficulties can ensue. Examples include eating disorders, grieving following injury and burnout which, if unchecked, can lead to more serious depressive illness.
Burnout, anxiety and depression can be mixed and so complex. Nonetheless, each is treatable and manageable and in certain circumstances avoidable. The tendency to distance a person experiencing emotional difficulties has been a feature of many elite performance cultures where failure is not easily tolerated. It is as if to say `I am not like you and this cannot happen to me.’ It is used as means of coping with potentially irrepressible levels of anxiety.
Below I have listed a twelve bullet points, which indicate some areas of concern for the mental health and well-being of elite athletes. The list is not exhaustive but serves as an indicator of some of the personal, organisational and social dynamics, which can impact on an elite athlete’s mental health and well-being.
These are as follows:
- During periods of emotional upheaval confidentiality, respect and protection are critical to the recovery of an elite athlete
- Media stereotypes are often unsympathetic to the vulnerability of elite athletes
- Adverse exposure can result in stigma and an overall sense of shame
- Stigma is a construct in which a social meaning, usually adverse, is attached to behaviours, individuals and groups
- Some healthcare professionals consider stigma to be an outward sign of shame
- Shame makes a person want to hide in obvious and obscure ways
- Shame can result in avoidance, non-adherence to agreed treatment plans and missing appointments
- Shame can also bring about non-compliancy or anger resulting in antisocial behaviours
- Because of occupational pressures, elite athletes can experience mild to marked anxiety and moderate to severe depression periodically resulting in suicide
- To cope with their feelings some elite sports men and women will sometimes develop addictive behaviours, misuse substances or engage or in inappropriate relationships
- The culture in elite sports generally does not encourage self-calming but harnesses achievement to keep anxiety at bay
- Subsequently, at times when achievement is not possible, many elite sports men and women may not have the necessary personal resources to maintain emotional balance
Elite athletes’ experiences of pressures concerned with their day-to-day life are a crucial but generally insufficiently explored as a dimension of health care. Research and collaboration with university academic departments would prove helpful contributing to a whole systems culture change, in which all participants of elite sports acknowledge the physical and emotional effects of repeated achievement and competitive environments.
Expectation is frequently accompanied by disappointment and academies, athletes, coaches, managers, in fact all involved with elite sports, will be vulnerable to mental ill-health of varying severity. Affiliations with universities and a curriculum approach to developing academy players would offer an ethical framework based on sound educational principles. Appropriate support to elite sports men and women, following the end of an active career would provide a sense of renewed identity and belonging. Collaboration is the key to a joined up philosophy in which throughout an organisation, the values are understood and demonstrated by all involved with elite sports.
`Anxiety is a type of fear usually associated with the thought of a threat or something going wrong in the future, but can also arise from something happening right now. Life is full of potential stressful events, it is normal to feel anxious about everyday things. There can be a single trigger or event that raises anxiety levels, but generally it’s be a number of things that increase anxiety levels, including exams, work deadlines, how we think we look, …` (Mental Health Foundation, 2017)
`Depression is a low mood that lasts for a long time, and affects your everyday life.. It doesn’t [necessarily]stop you leading your normal life but makes everything harder to do and seem less worthwhile. At its most severe, depression can be life-threatening because it can make you feel suicidal or simply give up the will to live. ` (Mind, 2017)