Rugby's invisible issue: Breaking down the barriers between players and psychological treatment
Dr. Thomas McCabe is a psychiatrist working in Glasgow with a specialist interest in the emerging field of sports psychiatry.
Within the past couple of years there has been an increase in coverage focusing on mental health issues within sport. High profile rugby players have described their journey through difficult times and the size of the problem is under-reported. Subsequently coaches and administrators in the game have asked questions on how to identify and assist. Given that psychological issues are difficult to see, this article will identify some of the barriers in the way of players getting a diagnosis and appropriate treatment.
Mental health problems are hard to recognise. If a player has a twinge at the back of his or her leg, they know immediately that they have pulled their hamstring. They know that this is a muscle which will require rest, icing and physio. They will usually expect to recover well and will have no qualms attending the physio. Compare this with depression where presenting symptoms aren’t always as clear or well understood.
Going to see an unfamiliar ‘shrink’ or team doctor with a ‘mental’ problem may in itself produce feels of anxiety and apprehension.
Common symptoms of depression can include being ‘tired all the time,’ disturbed sleep, shortening of temper, change in personality, unexplained dip in on field form and hopelessness with regards the future. These can be minimised, put down to other factors or not acknowledged at all. Similarly in anxiety related problems – poor concentration, on edge most of the time, avoidance and tummy upset may not be noticed or taken seriously.
If a player does suspect they have a mental health problem, it is not always clear to them whom they should consult and what help looks like.
This causes apprehension and many of the misperceptions about long psychological couch based ‘deep and meaningful’ sessions emerge – which is far from reality. A professional rugby player will usually have access to a trained practitioner employed by their club.
Understandable worries with regards how this affects future contracts may limit full assessment being carried out. A team doctor may not have the time or skills to deal with complex presentations and performance psychologists may not be comfortable dealing with complex mental health diagnosis.
An amateur rugby player would probably attend their GP if they suspected a problem. Exercise therapy would likely not be an option in these cases. Options from here might include a long wait for psychology referral and this may not with insight or understanding into a rugby player’s environment.
It is difficult within rugby culture to show ‘signs of weakness.’ Many individuals suffer in silence and when stressors accumulate – a crisis occurs making things much more difficult to deal with from a medical perspective. Preventing this escalation at source and strengthening the brain, just as you would increase cardio fitness, should be a long term aim for medics, administrators and management in the global game.
In summary, clarification of referral processes in mental health need to be high on the priority list for schools, clubs and national bodies.
Screening or asking players at risk (for example those injured or coming to end of career) could assist with identification. There are many positive stories as stigma is reduced and understanding of treatment increases. There is a realisation that poor mental health is hard to spot – we must ask to find out. We are entering the ‘psych era’ in world sport and just like in concussion, rugby needs to lead the way with treating the brain as any other muscle, requiring attention and strengthening.
Dr McCabe can be found on Twitter @Dr_t_ McCabe or reached via email at Thomas.mccabe@nhs.net.
Comments on RugbyPass
We’re building a bridge but can't agree where the river is.
2 Go to commentsfirst no arms shoulder or helmet tackle into his rib cage is going to be so very painful even to watch. go back to RU mate.
2 Go to commentsBulls by 5. Plus another 50.
3 Go to commentsJohan Goosen avatar. Cute. Surely someone at RP knows how to do a google image search?
3 Go to commentsCan’t these games play a little earlier? Asking for a friend.
3 Go to commentsIt’s impressive that we can see huge stadiums with attendance in the 40 000 to 50 000 region. It shows how popular this competition is becoming. What is even more impressive is the massive growth in broadcast viewership. The URC is one of the two best leagues in the World, the other being the Top14.
7 Go to commentsChristie is not Sottish, like the majority of the Scotland team.
2 Go to commentsHold the phone, decline over-rated. Is it a one game, dead cat bounce or the real thing? Has the Penney dropped? Stay tuned.
45 Go to commentsTotally deserved win for the Crusaders Far smarter than the Chiefs who seem to be avoiding the basics when it matters Hotham showed them what was missing and Hannah seems a real find - a tad light but that can be fixed over time
8 Go to commentsGreat insight into the performance culture with Sarries and I predict Christie will be a fixture in the Scotland team now for some time to come. However, he is slightly missing his own point around Scotland “being soft” when he cites physicality examples in defence of that slight. The issue is much closer to the example he referenced around feeling off before a game but being told “it doesn’t matter, you can still play well” by Farrell. Until Scotland can get their psyche in that square, they will carry on folding under extreme pressure…
2 Go to comments> We are having to adapt, evolve and innovate more than when we were in Super Rugby where there was only really one style that everybody had to play to gain the most success. Have = able to? Interesting what that one style might be? I thought SA sides still had bad tours now, or at least bad schedule, months away? Those extra few hours flights have to be a killer though, no surprise to see their sides doing so badly at the start of the season each year. I wouldn’t enjoy that unfairness as a supporter.
7 Go to commentsThe problem for NZ, and Aus, is they ripped up the SR model and lost a massive chunk of revenue that hasn’t been replaced. Don’t forget SA clubs went North because they were left with no choice, Argy unceremoniously binned and Japan cast adrift. Now SR wasn’t perfect, far from it, but they’ve jumped into something without an effective plan, so far, to replace what they’ve lost. The biggest revenue potential now lies in Japan but it won’t be easy or quick to unlock, they are incredibly insular in culture as a nation. In the meantime, there is a serious time bomb sitting under SH rugby and if it happens then the current financial challenges will look like a picnic. IF the Boks follow their provincial teams and head north then it’s revenue meltdown. Not guaranteed to happen but the status quo is a very odd hybrid, with the Boks pointing one way and the clubs pointing the other way. And for as long as that remains then the threat is real.
45 Go to commentsI think Etene has had some good tuition, likely while at the Warriors to be a professional that helped his rugby jump, but he was certainly thrown in the deep end way too early. Should have arguably 20 less SR caps, and therefor a way better record that he does at his age, but his development would have been fast tracked by the need to satiate his signing away from league. Again, credit to him and others that he has done it so well. Easy to fall over under that pressure in the big leagues like that but he kept at it when I myself wasn’t sure he was good enough.
1 Go to commentsAwesome story. I wonder what a bigger American (SA) scene might have mean for Brex.
1 Go to comments“Johnny McNicholl and the Crusaders” save a Penney. Who has been in camp this week and showed them how to play?
8 Go to commentsSo, reports of the Crusaders’ demise / terminal decline are perhaps just - slightly - premature/exaggerated…? 🤔 Will we see a deep-dive into that by the estimable Rugbypass scribes, and maybe one or two mea culpas? Thought not.
8 Go to comments1. The Chiefs are rudderless without DMac, which enhances his AB chances 2. Chiefs pack are powderpuffs. The hard men arent there anymore 3. They had their golden title chance last yr and wont threaten this yr. Gone in second round of playoffs.
8 Go to commentsHonestly, why did you have to publish such a foolish article the day they play us? 😂
45 Go to comments> They are not standalone entities. They are linked to an amateur association which holds the FFR licence that allows the professional side to compete in the league. That’s a great rule. This looks like the chicken or egg professional scenario. How long is it going to be before the club can break even (if that is even a thing in French rugby)? If the locals aren’t into well it would be good to se them drop to amateur level (is it that far?). Hope they can reset from this level and be more practical, there will be a time when they can rebuild (if France has there setup right).
1 Go to commentsWhat about changing the ball? To something heavier and more pointed that bounces unpredictably. Not this almost round football used these days.
35 Go to comments