Interview: Sam Diss
Images: Offside Sports Photography

It can be a tough thing to remember, when you’re in the pissing rain watching your team lose, that these people you’re shouting at are humans.

The area of mental health and emotional wellbeing in professional footballers is a hideously under-researched subject, especially given the extensive part the sport plays in the lives of pretty much everyone in this country. Andrew Bethell is a clinical psychologist in training at University of Liverpool and lead researcher of the new study, titled On The Head, aims to help fans—the people that pay all our money to watch it—and those that run the game better understand the people playing it.

We caught up with Andy to pick his brain on his new project.

MUNDIAL: Why was this an important project to do, and how did it start?

ANDREW: I’m a clinical psychologist in training and I wanted to run a research project. Being a fierce Cardiff boy, a Welshman, Gary Speed’s suicide was huge for us, so working in mental health with a massive interest in football, that kind of made me interested in understanding a bit more about mental health and wellbeing within football. So it took a little while to get the study off the ground, we did a lot of reading around the science and the literature—what’s out there already—what we noticed was more and more players and former players sharing their stories with the press about any issues they’ve had with mental health and wellbeing, but when you turn to the scientific literature and looked at the support that was available to players there was a very limited understanding about what was going on. Some of the research that had been done was looking solely at prevalence rates—how many players through their careers will have difficulties with mental health or wellbeing. We wanted to take that further and look at psychological predictors of mental health and wellbeing. We knew some of the prevalence rates from previous studies, but what we wanted to do was look at what’s going on with these people and are there any differences between how people respond to events that maybe leave them more likely to develop mental health difficulties, or more likely to have positive mental health. Essentially, we want to improve the support that's available for players.

Why do you think it has been so under-researched?

It’s difficult to get access to people who play sports. Anecdotally, football is the hardest, the most protected environment. It’s hard for researchers to gain access to these types of environments. Secondly, and probably more importantly, is just the stigma that surrounds it, players not necessarily wanting to come forward. There’s a change at the moment with lots of people coming forward. There’s been a massive stigma around how we’re talking about this.

I suppose it’s still just a small sample size who are coming forward.

Exactly, there are more people coming forward in the press but it’s still a very small number, so it’s hard to get a true, representative number of how many people are struggling. Doing more research, it’s important; the more people we can encourage to come forward, the better an understanding we’ll have of players’ experiences and difficulties.

When it comes to what you’re trying to measure or understand, what sort of things are you looking for? It is pressure, stress, or something else?

That is part of it. We know that as human beings, footballers are going to be subject to the same life stresses that we all are. But they’re also a very unique population. There’s this perception that footballers are just making a shitload of cash and money is protective from bad mental health, and we know that that’s not true. So there’s loads and loads of misconceptions to deal with. Plying your trade in the public eye all the time, experiencing criticism from fans in the ground, media, social media from players, managers, whatever, and the other staff that are around. So when people get dropped or injured, maybe go on loan, contract insecurities the lower down you go in the leagues there’s loads of pressures these people face. We’re not saying these people face these experiences and difficulties and then go on to have mental health difficulties, what we’re interested in is not just mental ill health—diagnosable conditions like anxiety, depression—we’re looking at psychological wellbeing. What we mean by that is the absence of mental illness does not necessarily mean the presence of mental wellbeing. Mental health is not just the absence of a mental health disorder. We’re interested in how players feel about their life, how they evaluate their life, evaluate their happiness, their satisfaction with life. These are really important things in a sporting context where that kind of stuff is being challenged all the time.

It must also be very hard to be in an industry where the wins and losses are so black and white, to have your mental, economic, and physical wellbeing hanging in the balance like that must be something that is very hard to come to terms with.

Completely, and that’s what players are saying—it is completely black and white. There’s so much pressure on the each game, the next game, to perform, and one of the questions we’re looking at is how is mental health affecting performance. If you’re struggling with your mental health, are you able to perform to the best of your ability? Also, as you move down the leagues, as contracts and employment are less secure, how is that affecting players? We’ve spoken to a lot of players who might be semipro playing through injury, because if they don’t play they're not going to get paid, and they don’t have that job security, so how is that impacting on their psychological wellbeing?

The vast majority of people come to football as fans—watching it on TV, listening to it on the radio, or watching it live in the stadium. Do you think that aspect of it is something that fans don’t really understand—the mental health aspect of it and the toll that it can put on players?

Yeah, I think it is very misunderstood. What’s positive is that seems to be changing—we’ve had lots of players and ex-players coming out in the media, so perceptions do seem to be shifting, but there still is a lack of understanding among the general public that footballers are humans, like all of us. They make mistakes on the football field; they struggle with their mental health at times. I think the pressures that players face are very different from people like you and me, and I don’t think that the general public have a grasp of how difficult those pressures can be.

One thing that happened very recently was Ainsley Maitland-Niles trying to respond to criticism on his Instagram page by Arsenal fans, and the role that social media plays in a lot of modern mental health issues is huge, but as a footballer you’ve got this forum where anyone in the world can tell you what a shit job they think you’re doing, must be incredibly hard thing to deal with.

I don’t think you can escape it. I’m not saying this is all down to social media, but before the age of social media, you would play your 90 minutes, you might get abuse from the crowd, but you could go home and escape that for a couple of days. Now, what we know is that many of the players are very active on social media and you can’t really escape it. Fans straight away are on social media slagging you off, commenting on your Instagram or Twitter page, it’s difficult to escape from. The adulation is there when you’re playing well, but alongside that, if you have a poor game or drop form, it’s difficult to escape because social media is always there.

The rise of social media in the last few years is kind of unprecedented, so it’s hard to go to older heads at the club, the manager, or whoever and get that direct bit of experience and guidance, apart from just shutting yourself away from everything, which is obviously not a healthy way of dealing with things either.

Exactly, it’s a relatively new thing for players to have to deal with.  We know that academy players are being taught about the dangers of social media, and that is fantastic, but some of the abuse that players get is just relentless. 

You’ve been talking to both male and female players, do you see a difference in the way that mental health is addressed in either game?

We’re still at the early stages. We’ve had over 100 players take part so far, and a big proportion have been women. We haven’t dived into the data that we’ve got yet, and we won’t be doing that for another couple of months, but what we know from speaking to female players is that there’s so much, and there was a report that came out last year, from FIFPro, into the women’s game, there were lots of difficulties around women not getting paid on time, some people not getting paid at all, the denial of professional status. There's still lots of discrimination around women's football, and that brings its own challenges. We don’t ask specifically about that in our questionnaire, but when we’ve spoken to players 1-to-1 these are the issues they have been talking about.

Is the the study something that looks at amateur football and five-a-side, too? There'll be a lot of players for whom football is a release, or a way to better themselves.

Completely, yeah it is something that as a research group we are interested in. There’s loads of brilliant stuff being done by clubs in the premier league, and football league clubs as well. So in Liverpool, there’s Everton in the Community, in Wales, there’s an initiative run by the FAW called We Wear the Same Shirt and they’re great initiatives to encourage people to get involved, and it does have an amazing effect on mental health and wellbeing. There’s no doubt it has a really great effect on mental health and wellbeing too. It’s great for reducing stigma, social isolation, so there’s loads of great stuff being set up by these trusts. But also generally I know for me playing on a weekend or midweek is great, for me it’s a really great way to step away from the stresses of real life, have a kickabout for an hour, it’s a really good way for me to connect with people and move away from the stresses of work and the shit you go through day to day. Playing football is great for mental wellbeing generally.

It’s a double-edged sword for professionals; when they’re playing is when they’re happiest but there’s also a lot of downtime from that, and there’s such a disparity between the high of playing and the down of injuries or being a free agent.

Precisely, and we know that players can be isolated for huge amounts of time, spending loads of time on their own, and that’s not just if they’re injured. Football can be a very lonely and isolating place. Sometimes if they’re training and they spend a couple of hours at the ground, and then they go home, suddenly players might be away from friends and family, and we know that isn’t great for mental health and wellbeing. Combined with being injured, or being dropped, or when people come to the end of their career. It’s common for players to develop a strong ‘athletic identity’ where sports players have their whole identities being wrapped up in being a sports player, that can really suffer when you’re out of form, injured or retired. Your identity is so wrapped up in being a football player, your self-worth, that when that changes, how do players cope with that transition, that challenge. We know that’s a huge risk factor, providing support for those players is really really important. There are some great organisations out there that are helping players prepare for life after football, but when it comes to mental health and wellbeing, support tends to be reactive, so shit has to happen before players get support. What we want to do is encourage clubs and organisations to make that support a bit more proactive, and create environments that promote positive wellbeing, even when players are dropped or injured or whatever. We know that there’s still a huge stigma around mental health and players are unlikely to seek support for fear of judgement or being dropped, so if we can promote environments that promote positive mental health, as opposed to being reactive.

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