In the current era of highly paid professional and highly competitive amateur sport stars, the presence of a sports psychologist or a motivational coach in the back room team no longer raises an eyebrow.
We have become accustomed to buzzwords such as ‘visualisation’ and ‘mental fitness’ in pre and post match interviews. Players will talk about ‘holding their nerve’ to take that pressure kick or commentators will suggest that the more experienced team will have ‘the psychological edge’ in the last fifteen minutes of the game.
From GAA to golf, there are numerous examples of sports stars and commentators who use the language of ‘mental fitness’ and who are happy to engage with professionals who work in this area. With this in mind, I am hopeful that the people who access this website for their regular sporting updates will also be interested in reading a little about mental health and psychological wellbeing.
Most of us will experience mental health difficulties at some stage in our lives. We may experience a stressful work environment leading to feelings of irritability and sleep disturbance; we may experience low mood and anxious feelings if we are unemployed; we may have been in an unhappy relationship which has contributed to low self-esteem. These experiences are quite common and the associated negative mood state will generally respond to low level interventions such as employee assistance programmes, support from our loved ones, time for reflection and reassurance.
However, a significant number of us will be diagnosed with a mental illness that requires a more professional intervention. Illnesses such as depression, anxiety, obsessive-compulsive disorder, bipolar mood disorder, schizophrenia and eating disorders are regular presentations to the mental health services.
The mental health services exist to care for those who are most in need of specialist treatment yet unfortunately due to social stigma, personal embarrassment, or lack of knowledge many people who require these services do not access them. So if you or one of your loved ones requires psychological support, what can you expect when you decide to access this service?
The multidisciplinary mental health team will generally consist of a psychiatrist, a clinical psychologist, an addiction counsellor, a psychiatric social worker, an occupational therapist, and a number of nursing staff who frequently have additional qualifications in cognitive behavioural therapy or psychotherapy. These teams accept referrals from GPs and then decide on the most appropriate team member to assist the referred individual. Some clients will have input from several members of the MDT (multi-disciplinary team) whereas others may require support from one specific discipline. New referrals are always assessed for priority content and every effort is made to attend to the needs of clients in crisis.
A common presentation to the mental health service is a person who is experiencing symptoms of depression. In recent times we have become more aware of the incidences of depression among our sporting heroes. Alan Quinlan, the former Munster and Ireland rugby star, has spoken about his experiences of this illness and how he accessed support in the form of his family, his GP, and eventually a psychologist. He has gone on record as saying that he suffers predominantly from anxiety leading to secondary depression. In fact, the two mood disorders regularly co-exist. In his memoirs, Neil Lennon: Man and Bhoy, the Glasgow Celtic manager revealed that he has experienced recurrent depressive symptoms for a number of years and has been prescribed medication as part of his treatment plan. His story reveals very important insights into how depression can be masked with physical symptoms such as weight loss and fatigue and how this can sometimes lead to a delay in accessing the appropriate health services due to preoccupation with physical health.
Research carried out in Ireland found a relatively high level of depression in a representative community sample at 12% compared to other European countries.[i] The associated symptoms include low mood, sleep disturbance, irritability, lack of positive future thinking, appetite disturbance, impaired concentration, and lack of energy. In order to ascertain if somebody is experiencing a clinical depression, as opposed to the situational type depressed mood that most of us will feel from time to time, we ask if the symptoms have been consistently present for a two-week period.
Depression can be experienced from mild to severe in nature and a psychologist will ask the client to complete a brief mood assessment to ascertain their level of depression. During the assessment the person will be asked about suicidal ideation (thoughts of harming himself or taking his own life) and suicidal intent (plans to harm himself or to take his own life). Clinical psychologists and psychiatrists have specific training in assessment of suicidal risk, responding to acute suicide risk/expressed intent, and crisis management. If the risk is deemed acute, then the first response may involve taking the person to a safe place such as a hospital setting; restricting or removing access to means (e.g. medications, sharp objects); involving family and the community mental health crisis team in support of this person. If the risk is not currently acute, or when the acute period has passed, an acceptable treatment plan is agreed with the person. This will typically involve psychotherapy and possibly psychotropic medication for a period of time. Depending on the person’s situation, the treatment plan may involve addiction counselling or a referral to a family systems therapist.
Each client who presents to a mental health service will have individual psychological needs and these are addressed to the best capacity of the service.
In 2010, there were 486 suicides in Ireland. In that same year, there were 12,000 cases of deliberate self-harm who presented to the emergency departments around the country. Based on their registry, the National Suicide Research Foundation believes that there are approximately 60,000 ‘hidden’ cases of deliberate self-harm every year in Ireland. This is the number of people who do not access the healthcare services and are therefore not being followed up or supported. It is quite a figure. Perhaps these people were not aware of the services that exist, perhaps they thought that suicidal thoughts are a shameful secret that they should keep to themselves, perhaps they felt that if they spoke about it to their friends that they would not be understood or supported.
But it is up to all of us to make it ‘ok’ to talk about depression, about anxiety, and especially about suicidal thoughts or self-harming behaviours. It is up to all of us to acknowledge that, for example, depression is a real illness and has a genuine debilitating effect when untreated.
It is up to all of us to realise that sometimes people who are severely depressed and have not experienced the support of trained professionals see no other possible relief from their state of mind than the act of ending their life. At that point, they are unable to access thoughts of the devastation that their death will bring to their loved ones, in fact it is typical for a person experiencing suicidal ideation to actually believe that their family and friends would be ‘better off’ without them.
The sporting world has recently mourned the death by suicide of Mr Gary Speed (RIP). It previously mourned the deaths of Mr Darren Sutherland (RIP) and Mr Robert Enke (RIP). In writing this article I hope that any readers who are experiencing psychological distress will contact their GP to arrange onward referral to the help that really is out there.
I have also listed the details of some agencies that many people find helpful as a first contact. We are very familiar with the idea of mental fitness in sport, now let’s get back to basics and encourage our friends, team mates, family members, and supporters to look after their mental health in 2012.
The Samaritans (24-hour support to anyone experiencing distress, despair, or suicidal thought)
1850 60 90 90 www.samaritans.org
www.aware.ie (Aware: helping to beat depression)
www.spunout.ie (Ireland’s national youth website)
http://ie.reachout.com/ (Helping you get through tough times)
[i]Lehtinen et al., 2003, Soc Psychiatry Psychiatr Epidemiol, 38