Tackling stigma through sport
Harnessing the power of sport to reach out to vulnerable groups of men who do not readily access support in traditional ways.
State of Mind Sport (SOMS) was established in 2010, following the death of Terry Newton, a popular international rugby league player. Terry took his own life not long after being banned from the sport for testing positive for banned substances.
SOMS was set up by experienced NHS staff who all had a passion for rugby league. They were keen to prevent similar incidents, but were uncertain as to how best to make an impact. They were joined by two former team mates of Terry Newton, who following retirement from playing the game had become Sky TV commentators. Crucially, they brought player perspectives and important contacts in the sport and media, and gave SOMS some valuable credibility.
This resulted in the recruitment of top professional players as SOMS ambassadors, who gave media interviews about the programme, and featured in films designed to promote awareness of mental health problems and the stigma attached to them, and change attitudes.
75 to 85%
of men who take their own lives who have not been in contact with mental health services
The group increased their expertise and connections by adding commissioners, public health specialists and a representative of CALM, who brought expertise in understanding the vulnerabilities of men, and designing specific messages to address their thinking and behaviours.
The two nurses involved were enabled by their employer, the Five Boroughs NHS Foundation Trust, to have time to develop the initiative. SOMS now has psychiatrists and others who bring their own expertise and experience of mental health problems, alongside a passion for Rugby League.
Our initial search for evidence highlighted the high rate of suicides among men in the areas where rugby league is played, largely in the north of England. These were in deprived areas, with high levels of unemployment and a dominant "macho" culture where males did not seek help as it was looked on as a sign of weakness.
total audience reached who saw information about State of Mind Sport in the rugby league
Research shows suicide is the biggest killer of men under 45 and 75% to 85% of men who take their own lives have not been reached by public health messages and not received support from mental health services. Men aged 45 to 59 are now the highest risk group.
We strongly convey the message that suicide is preventable, not inevitable, and everyone has a part to play. We do not aim to provide direct support but we do target a vulnerable group of men.
The aims of SOMS is to influence rugby league players, fans and their communities by:
- Raising awareness of mental fitness.
- Promoting health, wellbeing and resilience.
- Encouraging early help-seeking behaviour.
- Providing information about where to seek help.
- Tackling stigma to prevent suicide.
SOMS has been supported by the Time to Change campaign, Mind, the Samaritans and the suicide prevention charity PAPYRUS, which has enabled the former players to access their training programmes.
We initially delivered mental fitness and building resilience sessions to players and coaches of super league and championship clubs. Uniquely, the workshops were delivered by ex-professional players who had experienced mental health problems themselves, and a nurse consultant. The players told personal stories and described what worked for them in sustaining their recovery. They also spoke about the benefits of setting goals and talking about problems and feelings if someone mentions they are feeling suicidal.
The team make it clear that it’s okay for men to talk about problems and feelings. This should not be seen as a sign of weakness, rather it is a strength. We also seek to guide people to start conversations and what to say to someone in distress.
This approach brought healthcare specialists' expertise and valuable player insights. The sessions were designed with the support of ex-players including use of humour to engage participants. Sessions lasted no longer than 40 minutes. Specific language and terminology is used – ‘help a mate,’ ‘mental fitness,’ ‘feel good, play better’ – to avoid stigma and bring a credible sporting identity. Interestingly more than 96% of attendees had never before received any education regarding mental health issues.
These training events have subsequently been delivered to community sports clubs and tailored to schools, colleges, universities and in the workplace. So far, more than 15,000 individuals have received the training. Workshops have been attended by staff in construction companies, the police, fire and rescue services and health and social care staff.
The presenters now include a former referee and a student mental health nurse, who as a former academy player, was not offered a professional contract. They bring valuable experiences and perspectives of dealing with stress and disappointment.
For the past five seasons during Round 21 of the super league competition, all of the weekend fixtures are dedicated to SOMS. Each year we have chosen a different theme, two years ago it was the Rugby League Family. Last year: concern for others, and this year’s theme was dealing with change and adversity, with players describing the problems encountered, including short term contracts and having to move home and schools when changing teams.
Each year we have commissioned a film on the chosen theme, which is used for education purposes. Clips are shown on Sky Sports TV as part of the coverage of the two matches. This reaches an enormous TV audience of more than 350,000 viewers per game.
number of people who received SOMS training
At each game the players warm up in distinctive State of Mind Sport t-shirts and volunteers engage fans with information cards for well-being. Website details are also provided to fans to show where support can be obtained, both nationally and locally.
In the week leading up to the weekend fixtures and during the weekend, player ambassadors use twitter to convey positive messages, which SOMS provides. Incredibly, this season, our messages reached more than 7.5million fans.
The ‘boot room’ project
We developed a project targeted at middle age men and older men, who are socially isolated in a socially deprived community. We used the power films of classic matches and the attendance of former players who played in the games as a magnet to attract people to four events in stigma free environments, such as schools. Copies of the match programmes were made available and pop music from that era was played.
We invited blokes to attend the films by advertising them in pubs, barber shops, chip shops and other community locations frequented by men. This proved a remarkably effective way of encouraging the attendance of groups of men who were regarded as hard to reach. Each event attracted 30-35 men.
The sessions began with refreshments and by asking the players how they prepared for the "big match" and how did they cope with their pre-match ‘nerves’. This was a subtle way of prompting discussion on mental and physical fitness and the distribution of relevant information.
A number of people who attended reported the presence of depressive moods, and we were able to encourage people to access local services.
Mental fitness and resilience
Recently, in partnership with Rugby League Cares, the Rugby Football League Charity and three rugby league club foundations, SOMS has obtained Big Lottery funding for a two-year mental fitness and resilience programme, targeted at groups of men at risk of developing mental health issues.
The ten-week programme – each session is a ‘fixture’ – is specifically designed using sporting metaphors and recreational themes, as a hook for participation. The sessions are to be delivered by current and former players and healthcare professionals.
This programme will be tailored to identify men’s needs and delivered in sports stadiums and will aim to be fun. A further intended outcome will be to give people the tools to cope with and manage recurring stressors, and develop new interests and skills for life.
There will be a complementary focus on physical activity, including touch or walking rugby, as well as a range of sports orientated activities and social events, designed to engage and sustain involvement throughout the ten-week programme and afterwards.
As the Big Lottery funding includes a significant amount of money, we are exploring how to evaluate our effectiveness and impact with a number of academic institutions. We have several examples of individuals contacting us for support or to speak in schools or at events, which indicate establishment in rugby league culture as the ‘go to’ organisation for mental health and well-being.
There are also examples of individuals experiencing personal distress and suicide ideation, contacting us to tell us that State of Mind Sport had been the catalyst in them seeking help, and in their words, ‘State of Mind Sport’s message, to talk and seek help, has saved my life’.
Key messages for success:
- Work in partnership with key national and local organisations.
- Deliver simple, acceptable messages.
- Have the passion to ensure and sustain a momentum.
- Form partnerships with governing bodies of sport and clubs.
- Seek to involve and give ownership to gain commitment.
- Make sure that steering group meets regularly.
- Scan the horizon scan for new policy, or associated initiatives, embrace national policy and be optimistic about getting involved.
- Seek sporting stars, to support and act as ambassadors.
- Develop a website and capitalise on social media opportunities.
- Collaborate with partners, use key dates and events to raise awareness.
- Give out broader messages and encourage local responses.
- Seek to effectively communicate and keep everyone in the loop.
- Develop a media strategy and links.
- Seek methods of evaluation and use evidence as leverage to raise awareness and access resources.
- Celebrate success.
About the authors
Malcolm Rae is an independent consultant
Phil Cooper is a mental health and substance misuse nurse consultant, Five Boroughs Partnership NHS Foundation Trust
Allan Johnston is a consultant psychiatrist, Derbyshire Healthcare NHS Foundation Trust