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
I certainly don’t enjoy drinking beers at 8am in the morning watching rugby games in NZ.
1 Go to commentsThis looks like a damage limitation exercise for Wales, keeping back some of their more effective players for the last 20/25 minutes to try and counter England’s fresh legs so the Red Roses don’t rack up a big score.
1 Go to commentsVery unlikely the Bulls will beat Leinster in Dublin. It would be different in Pretoria.
1 Go to commentsI think it is a dangerous path to go down to ban a player for the same period that a player they injured takes to recover. Players would be afraid to tackle anyone. I once tackled my best friend at school in a practice match and sprained his ankle. I paid for it by having to play fly-half instead of full-back for the rest of that season’s fixtures.
5 Go to commentsJust such a genuine good bloke…and probably the best all round player in his generation. Good guys do come first sometimes and he handled the W.Cup loss with great attitude.
2 Go to commentsWord in France is that he’s on the radar of a few Top14 clubs.
2 Go to commentsGet blocking Travis, this guy has styles and he’s gonna make a swift impact…!
1 Go to commentsWhat remorse? She claimed that her dangerous tackle wasn’t worthy of a red! She should be compensating the injured player for loss of earnings at the minimum. Her ban should include the recovery time of the injured player as well as the paltry 3 match ban.
5 Go to commentsArdie is a legend. Finished and klaar. Two things: “Yeah, yeah, I have had a few conversations with Razor just around feedback on my game and what I am doing well, what I need to improve on or work-ons. It’s kind of been minimal, mate, but it’s all that I need over here in terms of how to be better, how to get better and what I am doing well.” I hope he’s downplaying it - and that it’s not that “minimal”. The amount of communication and behind the scenes preparation the Bok coaches put into players - Rassie and co would be all over Ardie and being clear on what is expected of him. This stands out for me as something teams should really be looking at in terms of the boks success from a coaching point of view. And was surprised by the comment - “minimal”. In terms of the “debate” around Ireland and South Africa. Nice one Ardie. Indeed. There’s no debate.
2 Go to commentsThere’s a bit of depth there but realistically Australian players have a long way to go to now catch up. The game is moving on fast and Australia are falling behind. Australian sides still don’t priories the breakdown like they should, it’s a non-negotiable if you want to compete on the international stage. That goes for forwards and backs. The Australian team could have a back row that could make a difference but the problem is they don’t have a tight five that can do the business. Tupou is limited in defence, overweight and unfit and the locks are a long way from international standard. Frost is soft and Salakai-Loto is too small so that means they need a Valentini at 8 who has to do the hard graft so limits the effectiveness of the backrow. Schmidt really needs to get a hard working, tough tight 5 if he wants to get this team firing.
3 Go to commentsSorry Morgan you must have been the “go to for a quote” ex player this week. Its rnd 6 and there is plenty of time to cement a starting 15 and finishing 8 so I have no such concerns.
2 Go to commentsGreat read. I wish you had done this article on the ROAR.
2 Go to commentsThe current AB coaching team is basically the Crusaders so it smacks of wanting their familiar leaders around. This is not a good look for the future of the ABs or the younger players in Super working their way up the player ladder. Razor is touted as innovative, forward looking but his early moves look like insecurity and insular, provincial thinking. He is the AB's coach not the Golden Oldies.
10 Go to commentsSimple reason for wanting him back. Robertson wants him as captain. Otherwise he wouldn’t be bothering chasing him. Not enough reason to come back just to mentor.
10 Go to commentsI had not considered this topic like this at all, brilliant read. I had been looking at his record at the Waratahs and thought it odd the Crusaders appointed him, then couple that with all that experience and talent departing and boom. They’ve got some great talent developing though, and in all honesty I don’t think anyone would be over confident taking them on in a playoff match, no matter how poor the first half of their season was. I think they can pull a game out of their ass when it counts.
2 Go to commentsNot a bad list but not Porecki and not Donaldson. Not because they are Tahs, or Ex Tahs, they are just not good enough. Edmed should be ahead. Far more potential. Wilson should be 8 and Valentini 6. Wilson needs to be told by his father and his coach, stop bloody running in to brick wall defence. You’re not playing under the genius Thorn any more. He’s a fantastic angle runner. The young new 8 from the Brumbies looks really good too. The Lonegrans are just too small for international rugby as is Paisami, as is Hamish Stewart at 12. Both great at Super Rugby level. Stewart could have been a great 10 if not for Brad Thorn. Uru should be there and so should Tupou. Tupou just needs good Australian coaching which he hasn’t been getting. I don’t think Schmidt will excite him.
3 Go to commentsIf he wants to come back then he should. He will be a major asset to the younger locks and could easily be played as an impact player off the bench coming on in the last 30. He is fit, strong and capable and has all the experience to make up for any loss in physical prowess. He could also be brought back with a view to coaching within the structures one day. Duane Vermeulen played until he was 37 or 38. He is now a roaming coach within the South African coaching structures. He was valuable in the last world cup and has been a major influence on Jasper Wiese and other young players which has helped and accelerated their development and growth. Whitelock could do the exact same thing for NZ
10 Go to commentsBrett Excellent words… finally someone (other than DC) has noted that Hanigan is very hard and very good at doing what Backrow should do… his performance via the Drua sauna was quite daunting for those on the other side… very high tackle count… carries with good end result… constant threat to make a good 20-25 meters with those long legs… providing his mass effectively to crunching the Drua pack… Finally he is returning to quality form… way to much injury time over the last 2 years… smart-strong-competent in his skills… caught every lineout throw aimed at him and delivered clean pass to whoever was down below… and he worked hard for the whole 80 minutes… Ned has to be in the top 5 for backrow honors… He knows what is required as he has been there before…
20 Go to commentsI think Sam Whitelock should not touch a return with a bargepole. He went out on a high, playing in the RWC Final. He would be coming back into a team that will be weaker than last years, and might even be struggling to win games, especially against the Boks. Stay in France, enjoy another year with Pau, playing alongside his brother.
10 Go to commentsRyan Coxon has been very impressive considering he was signed by WF as injury cover whilst Uru has been a standout for QR, surprised neither of those mentioned
3 Go to comments