`The range of what we think and do is limited by what we fail to notice.` (RD Laing)
As a young man working in psychiatric settings, I would encourage patients to play football. The results were nothing short of amazing. The identity imposed by mental illness was immediately cast aside. We became a sophisticated work group. Those earlier isolated in the ward environment became connected.
Patients previously without a voice began to organise the team calling out to others to move strategically into space. Situational leadership replaced institutional and social passivity – the individual team members became a collective and each person could reinstate their sense of purpose, without the burden of an identity conferred by the experience of mental illness and orthodox psychiatry. For a while, in RD Laing’s terms, they were out of the woods.
Regaining a sense of self and establishing identity
French footballer Zinedine Zidane was `sent off ` in the 2006 World Cup Football Final for a head-butting incident. The popular notion at the time, that Zidane’s behaviour was irrational, is considered inaccurate. A deeper logic was at work – linked to Zidane reinstating his authentic identity, while rejecting one imposed on him by others (Kaelin, 2008).
Football is increasingly viewed as an accessible way of understanding human motivation and overcoming and promoting psychological health by developing a sense of positive identity and encouraging social connections.
The Gabbiano club
In Italy, for example, Psychiatrist Mauro Rafaelli conceived the Gabbiano club which provides football as a therapeutic activity for people suffering mental ill-health. In a recent FIFA paper concerning the innovation, Rafaelli commented:
`A football team is a social group, each individual has a role, everyone has a social place; rules and relationships are all-important. So when an isolated and excluded person joins a team, it teaches them to live in, and with, the larger community.`
(Rafaelli 2008 cited in FIFA 2008).
There are a reported 50 football teams forming the Gabbiano club and while not a universal remedy, football is viewed by Rafaelli as contributing towards social connectedness and overall good health for people experiencing mental ill-health.
Football as group psycho-education
In the UK, football is also being used as a therapeutic activity to advance recovery for people suffering mental ill-health. To illustrate, Pringle & Sayers (2004) developed a community mental health project located in Macclesfield Town’s Moss Rose football stadium in Cheshire, UK.
The project was initially funded for three years by the Laureus Foundation’s ‘Sport for Good’ initiative and promotes mental health promotion social identity and mental health within the local community.
The authors describe ways they employ football as a metaphor for modern day living, helping young people grapple with issues concerning depression, low self-esteem a poor sense of personal identity and social inclusion. Harnessing techniques taken from football and group work, sensitive topics related to mental health can be addressed in meaningful ways.
World Mental Health celebrations
Similarly, to commemorate World Mental Health Day in 2007, Unite the Union and the Kent and Medway NHS and Social Care Partnership Trust held a football tournament and coaching day. The tournament took place at the David Beckham Football Academy in London, UK and was organized for mental health services from across England and Wales.
Teams were made up of both mental health service users and mental health professionals contributing to a culture of working together for a common cause. Oldknow & Grant (2008) have also reported a comparable award winning project carried out in the Rotherham, Doncaster and South Humberside NHS Foundation Trust named REACT, which is an acronym for recreation enterprise-assisted client training.
The authors discuss the benefits and pitfalls of the enterprise in terms of football contributing to the quality of life of marginalized young people in ways perhaps not previously possible. Self-reports from participants include: feeling better about self-image, greater self-confidence, better bonding with others and a heightened sense of collective identity.
The examples cited represent only a small number of football initiatives linked to promoting mental health in the UK. Coping through football: the Football Foundation Utilizing football in a similar manner, the Football Foundation is a charitable organization funded by the Premier League, the Football Association, Sport England and the Government in the UK.
The Football Foundation – Coping through Football
The Football Foundation has also launched an inventive scheme, which concerns recovery from mental illness through football called ‘Coping through Football’. The innovation was launched at the Football Foundation’s Mental Health Summit at Arsenal Football Club’s Emirates Stadium in December 2007.
The scheme is aimed at young people and is intended to reduce the sense of personal isolation, which can form a major part of mental ill-health as well as acting as an impediment to recovery. The initiative is also designed to reduce stigma and discrimination along with strengthening a sense of individual and collective social identity for people suffering from mental health problems – encouraging health through collective sporting activity.
According to Rethink, a UK-based national mental health membership charity, a recovery approach to addressing mental ill-health requires a change from tradition and encompasses the following guiding principles:
• a focus on goals rather than problems;
• valuing the strengths people bring to their personal recovery;
• respecting self-directedness;
• creating an environment that supports personal recovery and valuing small steps.
Fundamental to a recovery approach are the ideas of appropriate hope and self-management together with developing the ability to identify strategies for self-help. Allied to these principles one might usefully add opportunities to clarify values, evolving an appropriate and helpful sense of identity while harnessing creativity.
As a final point, football can provide a beneficial shared language with opportunities to discover a reality for oneself rather than one imposed by others. Football as psychological therapy can embody all of these principles and so take people `out of the woods` of mental illness Football and other group activities,with appropriate moderation, have much to contribute to promoting mental health along with a healthy sense of personal identity within communities.