How many eggs have to break before elite sporting codes realise they are scrambling their approach to mental health?
It’s a metaphor Martin Cohen has pondered ever since he watched his brother-in-law fall apart after the death of revered Australian rugby player Dan Vickerman two years ago.
Cohen and his brother-in-law had played at Sydney University with Vickerman, the big Wallabies second-rower, and were blindsided when he took his own life, aged 37.
“The entire rugby community was shattered,” recalls Cohen, a psychiatrist and Deputy Commissioner for the New South Wales Mental Health Commission.
“As somebody who had never seen the really strong culture and bonds that exist between current and past elite athletes, I was quite touched and concerned by the impact it had on my brother-in-law.
“I figured if he’d been affected in this way … I thought I’d have a look at whether there was something I could do to improve the mental health and well being of elite athletes.”
The result is a mental health tracking system Cohen and his business partner, Norm Johnston, developed specifically for athletes, to educate them about their psychological strengths and weaknesses, help them track their mental health and alert team medicos when risk factors crop up.
How do you keep up the medals without breaking a few eggs? That’s what the perception is and we need to break it down.Gearoid Towey, Irish Olympian and Crossing the Line founder
It’s prevention before treatment is necessary, or too late.
“We’re looking to prevent people evolving psychological symptoms and signs that then are only identified by a clinician once they have an identified illness,” he says.
“We know that takes people off the field, away from their professional trajectory, and takes at least six to 10 weeks to recover from a moderate case of depression or anxiety. Often it’s much longer than that.”
There is one problem. Cohen and Johnston are in advanced negotiations with a European football club that want to implement their system. They have taken it to America and found receptive audiences, including a former college basketball player who wept at a boardroom table over what help could have been available to those friends of his who didn’t make it in the pro league.
But Cohen says conversations with Australian sporting bodies have exposed some worrying attitudes.
“One senior figure said to me ‘We need people who will take risks, we need people who will go out and put their bodies on the line’,” he says.
“I agree with that, but that’s a separate issue from a person being as psychologically fit as they can be to take on their task. I think codes and clubs in Australia are concerned they will lose the aggression that their athletes will display on the field if they are psychologically well.”
Gearoid Towey was a world champion rower and represented Ireland at the Beijing Olympics. By his own definition he was a textbook case for a successful athlete “transition” from elite sport to the real world. He retired on his own terms, to a career he had set up while rowing.
Yet when he learned of the suicide of his Beijing teammate Darren Sutherland, the Irish boxer who won a bronze medal then turned professional, it was a life-changing moment.
Towey, now living in Australia, created Crossing the Line, which he describes as “Beyond Blue for sportspeople”. They are on the cusp of partnering with a leading consulting firm to roll out a nationwide program that will put leading athletes into schools, clubs and academies to talk about why being psychologically well will make them better athletes.
Towey says Australian attitudes to toughness have to change and coaches need to lead it.
“When you have an environment where a coach is measured on their performance and wins to maintain their jobs, there can be a conflict of interest,” he says.
“‘How do you keep up the medals without breaking a few eggs?’ That’s what the perception is and we need to break it down.
“Define what is a tough person. My definition has completely changed. I’ve seen the stiff upper lip approach but now I know that a tough person is a person who confronts their inner demons. That’s a lot tougher than going on to the field and smashing yourself for 90 minutes.”
The roll call of elite athletes to have suffered mental health problems makes for harrowing reading. It includes Vickerman, or Vicks, as he was known by a game in which he was universally adored. Also Karmichael Hunt and Wallaby James Slipper, whose life spiralled out of control after his mother’s cancer diagnosis. In the AFL, North Melbourne’s Majak Daw is, by all acounts, now learning to see the sun again. And there are talented young rugby league players who have taken their own lives when they should have been savouring their successes – Wests Tigers prodigy Mosese Fotuaika. Alex Elisala, Regan Grieve, Francis Winterstein and Hayden Butler.
Many sports administrators are keen to point out that it is not the sport, per se, that causes the issues. Depression and mental health problems are endemic in society.
While that is true, Cohen is adamant athletes face unique pressures that warrant a bespoke approach.
“As young children they are identified as being talented, they perform at an extremely high level all the way through their schooling, they are recognised for their skill and talent,” he says.
“At the end of their schooling they are offered a professional contract and are suddenly on the same level as everyone else, except for one or two who are maybe standout super stars. They then have to compete for a place in a team and their bodies become their enemies as they become injured. They train and sometimes they over train.
“They have normal life stresses, relationships, finances, babies on the way, parents getting ill, but for the first time in their life they’re not guaranteed a spot and their entire well being hinges on their ability to perform. That’s how they get paid, progress their career and set themselves up for life.
“A clinical system has to understand how those specific attributes correlate to psychological health and ill-health and take quite a sophisticated approach so that people don’t feel they’ll be stigmatised by reporting that they’re under stress.”
Former Wallaby Justin Harrison agrees with Cohen’s emphasis on education and prevention. Now in charge of the Classic Wallabies, Australia’s alumni of former Test players, the mental health of a growing cohort of retired professionals is a big focus of Harrison’s work.
“We need to be careful about creating organisations that just treat and maintain people who are having difficulties in life and don’t look at trying to prevent and provide some sort of remedy for what is clearly looking and sounding like it seems to be a sickness running through people, rather than just a circumstantial life journey,” Harrison says.
There is more attention than ever before on mental health. The NRL announced in 2017 it would fund a three-year study into youth suicide and rugby league at James Cook University. The Rugby Union Players Association puts its members through formal mental health first aid courses with past players and the Queensland Rugby Union and charity Rugby Unite are poised to announce a major partnership to further their work in that area.
Cohen believes it could all come down to how money. When a player is taking home $30,000 a week but not playing, it puts a new value on prevention.
“If you have $100 million in contracts and you’re on the board of a football club and have a number of people you’re worried about psychologically, what you can do is invest in direct medical care, but that doesn’t give you an overall system for monitoring the health and well being of your player group,” he says.
“In Australia you have multiple small groups who, in a piecemeal way, approach professional sporting bodies. The NRL uses the same (mental health) assessment process that I use in one of my hospitals and it’s not valid. It’s a measure of current distress for you and me, average people, that should form part of a broader mental health assessment to determine whether you are at risk and need to go into hospital.
“The only way athletes are going to experience a psychologically safer professional environment is if the culture of a club changes over time.”
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This piece by Georgina Robinson was first seen on ‘The Sydney Morning Herald‘, 23 Feburary, 2019.