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Help us to help others: Coaches need coaching on mental health awareness

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Sophie Parsons, left, says playing flag football was a useful distraction that helped free her mind from the cycle of introspection and worry

The majority of coaches would be unsure of how to proceed if it emerged one of their players had developed a mental health problem. The capacity to spot the subtle signs and manage situations effectively is one of the most pressing challenges facing the coaching industry today, says Sophie Parsons – who suffers from post-traumatic stress disorder.

Another day, another story given prominent billing in the national press about inadequate mental health care. 

On the morning I write this, mental health services in England are back in the media glare for all the wrong reasons. 

Only 15% of those suffering from mental health crises are currently receiving treatment, the Guardian reports. 

This slow response time is not a case of dereliction of duty – health care teams provide fantastic support. Money, as usual, is the problem. 

The long waiting lists are due to a shortage of mental health professionals. 

The situation requires urgent attention as, by the time people get to speak face-to-face to a counsellor, or receive therapy, their problems have often spiralled out of control. 

Those needing help feel badly let down. 

You might question how relevant stories like this are to sports coaching. Isn’t that the domain of doctors, health care providers and mental health charities? 

Mental health awareness is highly relevant to coaches because they too have an obligation to help sufferers. The duty of care they have to those under their wing extends to managing mental illness in their athletes and being alert to the signs. 

Coaches who fail to do this are letting down those in need of help. With 15 million people in Great Britain affected by mental health disorders, that means, in all likelihood, there are several players within every sports club in the land who are vulnerable and at risk of their problems escalating. 

If that statistic alone doesn’t sway your thinking, Sophie Parsons’ story should serve to convince coaches of the need to remove the blinkers. 

Vicious cycle

She is keen to offer a player’s perspective on why it is so important for coaches to have a deeper understanding of the subject. 

‘Sport has been both a saviour and a devil for me,’ says Sophie, who goes on to explain in greater detail why the issue resonates with her. 

‘It’s only when the worst happens that we realise how vital it is to address this issue in a more effective way,’ she begins. 

‘I was diagnosed with post-traumatic stress disorder (PTSD), which brought with it quite a lot of anxiety and depression. 

‘It all came to a head when I started university. I had got away from the situations that were causing it, but then, when I had time to sit down and think, it all suddenly hit me.’ 

As Sophie knows all too well, anxiety and the physical symptoms associated with anxiety become mixed to form a vicious cycle – anxiety causes physical symptoms, which give you further anxiety, which in turn increases the symptoms... and so it goes on.

She adds: ‘I went through more than a year of dissociative seizures – blackouts – roughly once a week, and then I was having periods where I just wasn’t there. People could be talking to me or I could be doing something, and I would have no recollection at all. That’s quite a way of making friends at university! 

‘In my second year, I found flag football (the non-contact sport of American football, where tackles are made by pulling off a flag worn by each player). 

I ended up starting the team because I had a housemate who played American football, and he said to come along to these taster sessions. There were quite a few women there, and we were all keen to carry on with it. It was a great outlet for me and took my mind off things.’

Sophie can testify to the power of sport in the effective management of mental illness. However, it is not a one-stop shop, and other measures need to be incorporated into the treatment plan, as she would quickly discover.

Flashbacks and psychotherapy

In her first year of university, Sophie says that sport saved her.

She actually had her introductory PTSD treatment on the day of her first flag football practice.

‘The flag football was a constant source of friendship, self-confidence, endorphins and release,’ she says.

‘But in that first year, I also began to struggle. We went to a nationals tournament, and in the finals I just said I couldn’t play. I was having flashbacks, I couldn’t see the pitch.’ 

It all came as a bit of a shock to the coach, who wasn’t aware of the problems Sophie was going through. 

She had told him when she missed training once that she had to go to a physiotherapy appointment. Now, here she was, pitch-side before the opening match, admitting: ‘When I told you I was in physiotherapy, I was actually in psychotherapy.’ 

Sophie adds: ‘The coach responded brilliantly. He was a doctor in training, graduating that year, so probably his training in the health profession helped. 

‘He said: “Look, don’t play today, that’s absolutely fine. We don’t need to put your health at risk. That’s the primary thing here. If you want someone with you, that’s fine; if you don’t want someone with you, that’s fine too,” and left it in my hands. 

‘I spoke to him about what was going on but didn’t go into much detail, and he never mentioned it unless I brought it up, which was great for me. 

‘I think there are some situations where coaches should recognise when a player is acting differently and maybe just ask them if they are OK. In my situation, I was grateful that he took his lead from me.’

Sophie Parsons 2

Guides thin on the ground

In the realm of sports coaching, there are guides, manuals, workshops and a variety of other resources covering all manner of topics, and targeting every age group and level of ability.

Whether it is advice on bullying you want, how to manage disruptive behaviour or how to make your sessions fun and engaging, or in-depth coaching bibles that detail the latest sports psychology innovations, philosophies or coaching models, there is something for everyone.

You might have to dig a bit deeper, however, for a coaching guide on how to manage mental health conditions in the sports sector.

While it is refreshing to see mental health being talked about so openly in the present climate, it would be even more encouraging if guidelines or codes of practice were distributed to sports clubs as freely as people exchanging words on the subject.

‘That’s what I would say we need an emphasis on, guidance for coaches, because they can’t be expected to just naturally know what to do in that sort of situation,’ says Sophie. 

‘Plus, working with teenagers and young adults, they are at a particularly vulnerable age, and they place a lot of faith in the opinion of their coaches. Feeling let down by them can have a lasting effect, I think.’

Sophie turned to the Internet and searched for some sport-specific literature that might offer support and guidance. 

‘I wanted to see what was out there, see what the code of ethics said, what guidance there was from American football – there was nothing at the time. The university weren’t much better. 

‘Not once did anything mention mental health, and I was completely stumped because it still does have a bit of a stigma, and is still a subject people don’t necessarily feel comfortable approaching, even though there is a lot of talk about mental health and far greater awareness.'

Leading the way

The British American Football Association (BAFA) became a signatory of the Mental Health Charter for Sport and Recreation last year after its launch in March 2015. The charter was developed by the Professional Players Federation and Mind, and ‘sets out how sport can use its collective power to tackle mental health and the stigma that surrounds it’. More than 200 organisations have now signed up. 

Some excellent online guides for sports coaches have begun to emerge, compiled by charities like Mind and Rethink Mental Illness.

These include Mental Health Awareness in Sport: An introductory course for sports coaches. This resource pack has been produced by the Time to Change programme – a joint collaboration between Mind and Rethink – which is designed to challenge mental health stigma and discrimination. The two-hour course is offered free of charge. 

Meanwhile, the Athletics and Mental Health Resource produced by England Athletics and Berkshire-based charity Sport in Mind is aimed at providing guidance and support to athletics clubs, coaches and leaders to help them become more open and accessible to people suffering from mental illness. 

However, there is still considerable room for progress, and governing bodies need to invest more time in mental health projects, and forge closer working relationships with charitable organisations to provide better mental health support, while tailoring the many generic guidelines that exist to their own objectives. 

Sport-specific publicity campaigns, helplines and readily available support guides should become the rule, rather than the exception.

Panic attacks

Stories like Sophie’s should act as a stimulant for change. They need telling, and where better than on platforms such as ConnectedCoaches.

‘Once I had treatment for PTSD, the anxiety and depression all but went away. I’ll still have days, which I think is natural, where the anxiety does come back completely and everything is really hard, but it is so much better, and I think that is the key. 

‘Before, when I was having treatment for depression and anxiety, it wouldn’t work, nothing would change. But as soon as they said I had PTSD and I underwent intensive treatment, it was as if someone had flicked a switch; a cloud lifted, and I felt so much better. 

‘Even now, I’ll walk out the house, the birds will be singing and it will make me happy, and I will think to myself, “How did I become this person?”’ 

People often talk about genetics conspiring against them, blaming a faulty gene for being overweight or underweight, or crediting their sporting prowess – or lack of it – to their DNA. 

Sophie agrees the same is true of people’s mental health. She says she is an anxious person by nature. 

After soaking up a string of negative experiences over time, her mind couldn’t take any more, manifesting itself in physical symptoms. 

But while admitting her plight may well have been exacerbated by her genetic predisposition to anxiety, Sophie also maintains that you can be coached out of it. 

‘Changing your lifestyle can completely change you. So whether you are naturally athletic, prone to a certain anxiety level or level of depression or have a gene that makes you put on weight easily, you can be taught a lifestyle that can manage that more easily.’ 

Sport can be a real lifesaver on two fronts then. Not only is physical exercise highly effective as a medication, but a vigilant, self-aware coach can also serve as the catalyst that helps a player get the support they so urgently need. 

Another string to the bow 

It’s not easy being a coach, far from it. Role model, life-skills coach, mentor, amateur psychologist, friend and part-time agony aunt, all rolled into one. And that’s before we even get to their role as a fitness conditioner and educator in tactics and technique. 

The expression, ‘Who’d be a referee?’ or ‘Who’d be a manager?’ is often used in football circles. In a few years, if we add many more strings to the bow of a coach, you may start to hear the words ‘Who’d be a sports coach?’ with ever-increasing regularity. 

There are so many different forms of mental health conditions too, each with its own symptoms and set of issues: anxiety; depression; post-traumatic stress; self-harm; bipolar disorder; personality disorder; addiction; eating disorders; schizophrenia. 

‘You couldn’t possibly deal with all mental health issues in one code of ethics,’ says Sophie. ‘But even if it’s just pointing you in the right direction, that would be an important first step. 

‘I’d like to see a code of ethics that says, “Under these circumstances, you should probably chat to the player and let them guide themselves. Under these circumstances, maybe advise them to call a charity helpline, visit the doctor, or refer them to someone in the club who has more training.” 

‘And advice is needed on what to look out for in terms of changes in personality. It’s too easy to just decide someone’s being a pain in the backside. If someone was originally a driving force on the team, you have got to question why there has been that change.’ 

Do you agree more should be done to help coahces? Please leave a comment below. 

Here is a link to an article Sophie wrote for the flag football website Pulling the Flag, entitled The mental health of sport.

Advice guide for coaches

Here is a selected list of recommendations for sports coaches, adapted from advice provided by mental health charities Mind and Rethink, for how to engage with those you suspect may have an issue with their mental well-being:

  • Strive to build a good rapport with your players. There is a good chance they will tell you about their problems over their GP.
  • Certainly with children, you may be one of the most influential people in that child’s life. Ask them privately if there is anything they want to speak about.
  • Be approachable: There is more chance they will confide in you if they think you will care about their plight.
  • Do not press them for all the details if they are reluctant to divulge them.
  • Hold mental health well-being sessions. Integrate them into existing training sessions.
  • Recommend they speak to someone trained in mental health issues. Compile a club contacts list containing numbers and website addresses for charitable organisations such as Samaritans, Mind, Rethink and State of Mind, and the same for local NHS trusts, local mental health day service providers and your local NHS community mental health team (CMHT).
  • Member Jonathan Abra recommends the charity Papyrus Prevention of Young Suicide in this thread
  • Check with your club or organisation’s safeguarding officer what the correct procedure is for those who feel unwell during sessions.
  • Remember to keep sessions fun as excess pressure can make anxiety levels worse.
  • Challenge inappropriate behaviour: The way others behave can impact on someone with a mental health condition.
  • Many people feel anxious when joining a group so ensure you create a supportive environment where everyone feels welcome.

UK Coaching has many mental health resources will help you promote good mental health in your coaching. Check out the UK Coaching website for more information. 

Update 2019

UK Coaching, Mind and 1st4sport Qualifications are developing an online course that will help people feel more confident when dealing with mental health issues. Register with UK Coaching to receive a monthly newsletter to find out when its available.


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Comments (10)

   
CoachWYSE
Thanks for sharing this ...

And a minor amendment, it's Flag American Football, not Flag Rugby ! ;op
25/03/16
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pippaglen
Excellent read.

Workng with people with mental health problems this has helped me as a coach to recognise issues and how to approach the person. I feel more information and help should be out there for coaches.

Since I started my current job 6 months ago as a support worker for the homeless I have managed to get my residents participating in some form of physical activities, this in turn has helped there mental well being and finding life much easier to cope with day to day living and have been able look at life differently. Sending them for mental health support and just talking about the mental health state has also helped.
09/04/16
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Blake
Fantastic news on April 19 as England Athletics, supported by Mind the mental health charity, launched a Mental Health Ambassador programme.
The programme aims to establish a network of volunteer ambassadors in affiliated running clubs and groups across England to support those of us who are experiencing mental health problems. Support includes helping people to start running, get back into running, or continue running as well as to improve the mental wellbeing of their existing members.
Initially 128 ambassadors have been appointed from 91 different England Athletics affiliated clubs and registered groups across England. To learn more about the variety of areas the ambassadors will be working on with their clubs/groups, click on the link and read the full story on the sports coach UK website:
https://www.sportscoachuk.org/news/new-mental-health-ambassador-programme
20/04/16
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Quiet1
Very interesting post. As you get to know your players better, and they get to know you, they often start to open up and look for support. In these instances, beyond listening and trying to understand how the player feels, there's a concern that I have zero training in mental health. And actually, its unrealistic to expect that most coaches would go beyond this level. Information like the advice for coaches you've provided above is really valuable - it would be good if NGBs provided short example stories of a situation and ideas of who/how the coach could signpost the player to speak with. In many instances all that may be required is listening and being more mindful in my coaching. But at other times I want to help my players all I can, and part of that is recognising the limitations of my own knowledge and understanding of mental health, and knowing how and when to help them seek support from a professional. Thanks for making me think!
05/05/16
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robertkmaaye
I like that idea Krissi! I know sports coach UK are working with the charity Mind on a project at the moment but I wonder if this is something they might be able to include. I can also see about filtering the idea down to NGBs through their relationship managers. Thanks!
05/05/16
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andrewb62

Agreed - as with Safeguarding, the role of the coach, who has an existing relationship with an athlete, might be to identify an issue and know who to turn to for professional support.

07/04/17
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pippaglen

I feel that all coaches should be aware of how to recognise mental health issues and where to sign post athletes if they feel they have issues, my job has enabled me to work with a wide variety of mental health problems from eating disorders, self harm, ADHD, ASD, drugs and alcohol, foster care children, young homeless, YOT to family break down. With the knowledge and qualifications I have gained from my job this has enabled me recognise some of the issues athletes today face especially the young people of today, I have learned that metal health can be bought on by a number of contributing factors.

06/04/17
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nmackey

Very minor contribution from me on this as I am not qualified in this domain. I deal with junior tennis players only and we found an unexpected benefit from using an online coaching tool that allows you to send programs, assessments, videos, messages etc.. between coaches and players. I found that players were more comfortable raising issues through the messaging part of the tool then they were on a face to face basis. Examples would be around them feeling excluded from a squad, favouritism, perceived bullying in a squad, issues at home / school compromising their performance etc.. Once they raised them through this "safe" medium they were happy to engage on a one-to-one basis and find a solution either with myself or referring them to a qualified professional. Benefit for me as well is I didn't lose these talented individuals as would have happened in the past due to lack of knowledge and communication.

07/04/17
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Blake

A valuable contribution too Niall, thank you. Coaching as an industry can come in for criticism for not tapping into technology as much as it probably should do but this is a fantastic example of how modern tech has a vital role to play. It just needs a bit of conjoined thinking. The youth of today 'speak' through their smart phones/computer apps/social media so an online coaching tool that creates an open channel that facilitates discourse and gives youngsters the confidence to speak out about mental health can only be a good idea.

10/04/17
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pippaglen

I think this will continue popping up over the next few months, Its not just athletes that suffer mental health its also those outside of sport that are too suffering from mental health from business men and women, school teacher, coaches, service men and women etc.
When you look at the pressures our athletes today are facing, compete to win , being in the media, competing at high standards, to stay at the top, stress to the mind a body, diet, fitness, the need and want to be No1 in what ever sport your competing in. What happens when you don't win, when your no longer a competing Athlete, you have retired, all this will still have a massive effect on the mental health, who's going to pick up the pieces of theses athletes once the curtains have closed. Some individuals don't have the mental capacity to be able to cope with all the above I have mentioned and this is why athletes are suffering today which is why more athletes are coming forwards with mental health issues. Without information of how to recognise mental health how can coaches possibly help athletes.
I'm one of many that has been given the opportunity to be able to work with, help and recognise mental health, If I remember last year I wrote a conversation about a mental health awareness course I attended on self harm, drug and alcohol, eating disorders (a form of self harm) PTSD, suicide, Over exercising. On attending this course it made me open my eyes a little wider and be more aware and vigilant, it helped me to best recognise and help individuals with mental health issue and that this would also help me to recognise this with my athletes, some parents today aren't aware of issues of our young people as they hide it very well. Please don't think for one minuet that your athletes aren't suffering most will suffer in silence due to feeling worthless and not worthy. If you don't know how to recognise mental health then do something about it, you might actually save someone's life. There is no need for ignorance this day and age there is enough information out there and enough individuals suffering.

I feel that Governing bodies should be putting on course for coaches to attend to know what signs to look out for. I also feel that this should be part of the (Safeguarding and protecting children and adults.)

A few weeks ago my twin daughters said they really wanted to watch a series on Netflix (13 reasons why) I had a week off work so decided to watch it with them, a little boring to start with but once I started watching I couldn't stop. I watched it until the end why? Because I wanted to know why she had depression, what cause and effects it had on her and her family. A real learning curve how young people of today can hide depression and mental health issues. If at any point you have time watch it.

10/05/17
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Anthonyderrick

Emma , I fully agree with your view and comments. Recently I have under gone a 2 day course with work to become a mental health first aid person, which fully opened my eyes and understand to problems people can experience. On major problem with athletes is the aspect of control and precision. When this is effected they will try harder and the cycle commences, causing overload , breaking their resilience . They will hide their problem but us as coaches need to watch the slight changes , recognise them and provide support. A question for all to think about . How many times do you ask someone how are they, once or twice. By asking twice you may get a more truthful answer, rather than the standard OK

10/05/17
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David_T

Hi Emma

Hope you are well.

Just thought I would provide a bit more info about why sports coach UK don't specifically include it in our Safeguarding and protecting children (http://www.sportscoachuk.org/site-tools/workshops/about-our-workshops/safeguarding-and-protecting-children ). We worked with the NSPCC (who are only funded to work with children) to develop the workshop and so it is a children only workshop - I do try to reference where policy overlaps, but the workshop is primarily aimed at safeguarding and protecting children. The Ann Craft Trust are the Charity funded to support Adults at Risk. The workshop does not specifically cover this topic as if someone had concerns over a child's mental health you would be obliged to report that to the appropriate person, as you would any other concern. As I know you'll be aware, we try to keep it more general and some of he signs would often be the type of behaviour change concerns you would have over a child that would cause you to pass those concerns on. We'd love to include loads more specific topics but due to the time constraint of three hours, we have to keep it to general topics which have a sport based link and focus on the principles of good practice & safeguarding and recognising and responding to concerns.

Going forward this could be a great topic for an module that forms part of our online renewal of training for those updating their SPC training. I love the fact we have this option now as for returners, we can help broaden and deepen safeguarding knowledge.

Hope this helps clarify why it's not included in our workshop

All the best

Dave

11/05/17
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pippaglen

Hi Dave

I'm well thanks, Hope your good.

Thanks for your response, I think an add on to the safeguarding would be a fantastic idea.

12/05/17
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gstutch

I wonder if society is treating the symptoms and ignoring the root cause of a lot of mental health issues. There are a number papers that show that maternal care in rats regulates the stress response. I'm not qualified to comment on this but a quick search of scholar.google.com for - rats stress mothers care , throws up a number of these papers that made me wonder if the pressure to get mothers and fathers back to work quickly is an issue we should address.

10/05/17
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SallyH

Just been reading this thread with interest. I'm a psychotherapist doing doctoral research on mental health in elite sport. I agree with the posts about the need for greater awareness amongst coaches of mental health symptoms as well as how and where to refer people onward if necessary. There's lots of research that suggests that there are specific deterrents to support seeking amongst athletes due to stigma and the perception of mental health issues as reflective of 'weakness.' Sometimes it seems that the emphasis on mental toughness typical in sport can really undermine the efforts to encourage openness about mental heath problems- especially when many people hold a view of toughness as equating to being invulnerable. Coaches are in a great position to present a more nuanced understanding of mental toughness that includes having the courage to acknowledge vulnerability and seek support when things are difficult.

10/05/17
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