The official magazine of the Football Medicine & Performance Association
football medicine & performance
Issue 30 Autumn 2019
Feature
David Cotterill’s Road to Recovery FOCUS ON: Mental Health The Role of a Psychotherapist in a Football League Club Hidden in Plain Sight – Mental Health Challenges in Football Clubs Substance Abuse and Gambling in Professional Football Managing Mental Health Emergencies in Elite Football
Legal Ţ Education Ţ Recruitment Ţ Wellbeing
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CONTENTS WELCOME
8
Updates
FEATURES
10
Injury Mitigation in Team Sports. Part-1: A Review of Current Dogma Colin W. Fuller
13
The Role of Football Clubs in Supporting Community Mental Health Initiatives Dr Alan Pringle
15
David Cotterill’s Road to Recovery
16
The Role of a Psychotherapist in a Football League Club Gary Bloom
20
Mental Health Symptoms in Professional Football Vincent Gouttebarge, Gino Kerkhoffs
24
ABOUT
27
Golf. The Ultimate Mind Game? Dr Andrew Murray
28
Substance Abuse and Gambling in Professional Football Gary Souter
32
Mental Health of the Elite Young Athlete Manroy Sahni, Johnson Pok-Him Tam
34
Managing Mental Health Emergencies in Elite Football Tim Rogers
37
Getting Back in the Driving Seat: Taking Control of Your Work, Life and Wellbeing
40
FMPA Register
Hidden in Plain Sight – Mental Health Challenges in Football Clubs Dr Misia Gervis, Lara Baker, Osimeiro Imoedemhe
Football Medicine & Performance Association 6A Cromwell Terrace, Gisburn Road, Barrowford, Lancashire, BB9 8PT T: 0333 456 7897 E: info@fmpa.co.uk W: www.fmpa.co.uk FMPA_Official Officialfmpa fmpa_official LinkedIn: Football Medicine & Performance Association FMPA_Register FMPARegister fmpa_register Chief Executive Officer Eamonn Salmon eamonn.salmon@fmpa.co.uk
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Contributors Colin W. Fuller, Dr Alan Pringle, Gary Bloom, Vincent Gouttebarge, Gino Kerkhoffs, Dr Misia Gervis, Lara Baker, Osimeiro Imoedemhe, Dr Andrew Murray, Gary Souter, Manroy Sahni, Johnson Pok-Him Tam, Tim Rogers Print Media Village www.media-village.co.uk
COVER IMAGE Birmingham City’s David Cotterill. Birmingham City v Nottingham Forest - Sky Bet Championship - St Andrew’s. Dave Howarth / EMPICS Sport / PA Images
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mental health
football medicine & performance
THE ROLE OF FOOTBALL CLUBS IN SUPPORTING COMMUNITY MENTAL HEALTH INITIATIVES FEATURE / DR ALAN PRINGLE
Dr Alan Pringle Assistant Professor University of Nottingham School of Health Sciences
In recent years football clubs across the UK have begun to develop and deliver a range of programmes and projects aimed at mental health promotion and mental health interventions. Applying mental health interventions through football is effective as it can act as a “hook” to empower people to discuss mental health issues1. Components of the club infrastructure and identity, such as the ground or the badge can be important for engaging supporters, especially men2, and can help reduce the stigma attached to exploring mental health issues. Using football grounds as a venue, applying the language of football as a metaphor, and utilising the sport itself as a tool for engagement has meant that some football clubs have begun to have a very positive impact on the mental health of their local communities. While the clubs lend their brand to these initiatives, the majority of the mental health work carried
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out is by the “Football in the Community” (FITC) branches of the clubs. Often, the delivery of these programmes is carried out by football coaches rather than mental health professionals, and most of the mental health interventions offered seek to complement rather than replace “standard” or conventional treatment3. Football is Medicine – the use of football to treat mental health conditions Many of the programmes designed to support those with mental health problems involve playing the game itself. The physical benefits of playing are matched by the fact that engaging in exercise has positive benefits on mental wellbeing and psychological functioning in adults4, children and young people5. It is well known that engaging in exercise can lead to improvements in mood, sleep6 and impacts positively on psychological stress7.
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mental health
In some specific mental health conditions, like schizophrenia, research suggests football can have a marked impact. Programmes for people with psychosis have had a positive impact on the mental health of participants, and participation provides a distraction from illness, leads to improvements in concentration and alertness, and improvements in selfesteem8. Further studies have found that, overall, physical activity has a beneficial effect in helping contain the symptoms of schizophrenia9,10. Within the field of mental health, the most extensively researched condition to benefit from football and other forms of exercise is depression where the impact has been very positive11,12. In a 2013 Cochrane review examining the effect of exercise on depression, it was found that the inclusion of an exercise component typically enhanced the efficacy of treatment programmes13. Developing Mental Health Initiatives within Football Clubs The idea of using football environments as a venue for mental health interventions has become more common in recent years. The positive impact of using such venues has been seen in evaluations of several programmes1,3 as has the delivery of mental health interventions by football coaches14. The fact that the venues are a non-clinical environment is felt to be important for some people who say that they can feel intimidated by hospital settings or are afraid that people will see them accessing a mental health unit1,14. The development of mental health expertise in some organisations has seen
football medicine & performance some football clubs delivering a whole portfolio of mental health programmes from within the club. For example Everton in the Community offer programmes like Tackling the Blues for school age children, Imagine Your Goals for men, Pass on the Memories for older people with dementia, and Blue Belles a project that offers advice and support of mothers who have children with conditions such as autism and ADHD. Similarly, clubs like Notts County have mental health groups for men, women, school age children, and for prisoners with mental health complaints. One of the developing strengths in the football and mental health world is the consolidation of relationships between football clubs and other organisations that can help in the delivery of these projects. Everton in the Community have been working closely with Mersey Care NHS Trust since 2007 and have built a very strong relationship between the two organisations. Similarly, Notts County Football in the Community have developed strong relationships with Nottinghamshire Healthcare NHS Trust and have senior staff from the organisation on their strategic steering group. Conclusion There is overwhelming evidence that football may be highly beneficial in the management of mental health conditions. This gives hope to the relationship between football and mental health provision developing further, and perhaps in the future one of the first places someone might go for help, support, or advice about a mental health issue might indeed be their local football club.
1. Spandler, H. and McKeown, M., (2012) A critical exploration of using football in health and welfare programs: gender, masculinities and social relations. Journal of sport & social issues, 36 (4), 387–409. 2. Pringle A., Zwolinsky S., McKenna J., Robertson S., Daly-Smith A. and White A. (2014), “Health improvement for men and hardto-engage-men delivered in English Premier League football clubs”, Health Education Research, Vol. 29 No. 3, pp. 1-18 3. Friedrich, B and Mason, O (2017) “What is the score?” A review of football-based public mental health interventions. Journal of Public Mental Health , 16 (4) pp. 144-154. 4. Malcolm, E., Evans-Lacko, S., Little, K., Henderson, C. and Thornicroft, G. (2013) The impact of exercise projects to promote mental wellbeing. Journal of Mental Health 22(6): pp. 519-527. 5. Lubans, D. R., Plotnikoff, R. C. and Lubans, N. J. (2012) Review: A systematic review of the impact of physical activity programmes on social and emotional well-being in at-risk youth. Child and Adolescent Mental Health. 17(1): pp. 2-13. 6. Carter T, Morres I, Repper J and Callaghan P, (2016). Exercise for adolescents with depression: valued aspects and perceived change Journal of psychiatric and mental health nursing. 23(1), 37-44 7. Hamer, M., Stamatakis, E. and Steptoe, A. (2009) Dose-response relationship between physical activity and mental health: the Scottish Health Survey. British Journal of Sports Medicine 43(14): pp. 1111-1114. 8. Moloney L and Rohde D, (2017) “Experiences of men with psychosis participating in a community-based football programme”, Irish Journal of Occupational Therapy, Vol. 45 Issue: 2, pp.100-111, https://doi.org/10.1108/IJOT-062017-0015 9. Crone, D., Tyson, P. and Holley, J. (2010), “Improving health, well being and cognition in schizophrenia: making the case for physical activity”, Journal of Public Mental Health, Vol. 9 No. 2, pp. 32-35. https://doi.org/10.5042/ jpmh.2010.0380 10. Gorczynski, P. and Faulkner, G. (2010) Exercise therapy for schizophrenia. Cochrane Database of Systematic Reviews [Online]. Available at: http://onlinelibrary.wiley.com/ doi/10.1002/14651858.CD004412.pub2/ abstract. 11. Brown H.E., Pearson N., Braithwaite R.E. (2013) Physical activity interventions and depression in children and adolescents: a systematic review and meta-analysis. Sports Medicine 43, 195–206. 12. Hughes C.W., Barnes S., Barnes C., et al. (2013) Depressed Adolescents Treated with Exercise (DATE): a pilot randomized controlled trial to test feasibility and establish preliminary effect sizes. Mental Health and Physical Activity 6, 119–131. 13. Cooney G.M., Dwan K., Greig C.A., et al. (2013) Exercise for depression. Cochrane Database of Systematic Reviews (9), Cd004366. 14. Pringle, A. (2009), “The growing role of football as a vehicle for interventions in mental health care”, Journal of Psychiatric and Mental Health Nursing, Vol. 16 No. 6, pp. 553-7.
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