Elite sport and the risks to mental health

Twenty-twenty three is shaping up to be one of the great sporting years. Following a tremendous Ashes series and an enthralling World Athletics Championship from Budapest, we now have the Rugby World Cup (RWC) in France, the Ryder Cup and the return of the NFL where the Baltimore Ravens seem destined for the Super Bowl. 

This is elite sport involving athletes performing at a level beyond the comprehension of us mere mortals, just have a look at the reaction of Tom Holland to Jon Rahm’s opening drive at the BMW Championship.  Despite this, sportsperson, at the elite level are not immune to mental health issues, indeed their job often brings its own unique set of issues that can trigger mental ill health.

For example, beyond the match day pressure and all-consuming physical commitment, elite sport is inevitably subject to intense social media scrutiny. The resulting  ‘pile-ons’ are an inevitable part of sport and an additional pressure on players, just keep in mind the unseemly social media reaction to Owen Farrell’s dismissal in the recent match against Wales, or Harry Maguire’s selection for England against Ukraine. How could the social media commentary not affect the players targeted?

What appears on social media is generally  beyond the control of the players’ clubs and national governing bodies (NGB), they do owe duties to the players in respect to other risks to mental health.

Developing attitudes to mental health in elite sport

Whilst France understandably celebrates the victory over the All Blacks in the opening game of the RWC, and lauds the players, it should not be forgotten that a former French international, Christophe Dominici, who was known to have a history of depression, passed away less than three years ago.

Whilst the cause of his death remains unconfirmed, the question was asked by his former fellow players, such as Abdellatif Benazzi, ‘why weren’t we there for him?’.  The link to elite sport and mental ill health doesn’t end there, John Kirwan, the legendary All Black wing, has not shied away from his own issues with mental health during his playing career. His knighthood cited his work in raising awareness about mental health and depression, in particular, before commenting upon his stellar rugby career.  He played in an era where support was scarce to non-existent and recalled the advice he was given when he outlined his concerns was, ‘harden up’.

Matters have moved on significantly since Kirwan’s playing days, not least because of his own efforts.  Dame Tanni Grey-Thompson’s 2017 Duty of Care review, undertaken at the request of the then Minister of Sport, sought to get to grips with the issue of mental health in sport. She made several recommendations, including the introduction of standard mental health training for coaches, and for NGB’s to take steps to ensure that a better approach filtered down to clubs. 

The legal framework and the duties of employers

From the purely legal perspective, the relationship between players and clubs, at the elite level is essentially one of employer and employee, and therefore the established law governing safe workplaces applies.

For the avoidance of doubt, an employer’s duties extend to the mental health of the employee. The decision in Walker v Northumberland CC (1994) established that an employer’s duty to take reasonable care to provide his employee with a safe system of work and take reasonable steps to prevent him from risks which are reasonably foreseeable extended to risks of psychiatric illness.

In Walker the claimant, who was responsible for four teams of social services field workers, suffered a mental breakdown leading to four months off work. That breakdown followed a lengthy period over which his work pressures had increased significantly and his attempts to prevail upon his employers to either increase staff or provide support were ignored.   Upon his return to work, the claimant was offered no additional support and by autumn, the following year, he suffered a second mental breakdown.  

In a sign of how different even fairly recent times can be, the claimant was  dismissed on the grounds of permanent ill health leading to the claimant deciding to bring a claim. The court held that there was no logical reason why the risk of psychiatric damage should be excluded from the scope of an employer’s duty to provide his employee with a reasonably safe system of work, and to take reasonable steps to protect him from risks, which were reasonably foreseeable.  

That decision was endorsed by the House of Lords in Barber v Somerset CC ( 2004 ). The House of Lords’ judgment set out a number of practical propositions including the following :-

• The ordinary principles of employer’s liability apply including the risks of psychiatric illness or injury arising from the stress of work;
• Foreseeability depends upon what the employer knows or ought reasonably to know about the individual employee;
• The test is the same whatever the employment – there are no occupations which should be regarded as intrinsically dangerous to mental health;
• The employer is generally entitled to take what he is told by his employer at face value; 
• The employer is usually entitled to assume the employee can withstand the normal pressures of the job unless he knows of a particular problem or vulnerability;
• An employer who offers a confidential advice service, with referral to appropriate counselling or treatment services is unlikely to be found in breach of duty.

The in-house legal teams at NGBs such as FIFA, and World Rugby, have taken on board the issue of mental health and detailed policies can be found on most NGB websites.  

It goes without saying, sport, as a form of employment, can present the employer with a unique set of mental health risks and clubs/NGBs may have to think about mental ill health risks beyond the scope of a normal workplace. For example, NGBs, whose sports have a high level of physical contact, currently face issues arising from head injuries and concussion.  

However, it is encouraging to note that there is growing recognition, not only the importance of mental ill health, but also the need to address, in particular, depression and anxiety as the two most common mental disorders. Furthermore, there is a growing recognition that mental ill health can persist beyond the time a player hangs up his boots, and that retirement itself can be detrimental to mental health.

Retirement and the consequences

Athletes are exposed to the same stresses as the general population, bereavement, health concerns and relationship issues (whether commercial or personal – as highlighted by recent comments by the Spurs striker Richarlison). They are also vulnerable to developing depressive symptoms due to their high status and extreme pressure they experience particularly via social media.  However, depression and anxiety can also be triggered by career-ending injury or retirement from sport. It is not difficult to see why, the sudden gear shift from intense physical and mental effort, the immense pressure, and adulation, to relative obscurity at a young age is mentally challenging.   

Tanni Grey-Thompson commented within her report that leaving sport “can be profoundly difficult for those whose identify has been very closely linked to their sport” and that careful management is required through that transition.  This may well be wishful thinking, as most sports (save possibly the NFL and football) have limited resources, but all NGBs should be ensuring that coaches within their sport have training and raised awareness of mental health, and at the very least should be looking to utilise existing resources such as the Sport and Recreational Alliance mental health charter for sport and recreation.

Sport has seen litigation in respect of concussion, bullying, safeguarding in addition to the usual  travails surrounding doping. It is not beyond the realms of possibility that in the future we could see an athlete pursuing an action for the impact upon their mental health because of the alleged failures at the NGB.