As several players and fans have recently been participating in activities to raise awareness of mental health issues as part of Movember, this week we'll be posting several features about football and mental health. We're kicking things off today by discussing football and mental health with Gary Souter from the University of Leicester, who is studying for a PhD that examines the impact of mental health on male professional footballers.

There seems to have been increasing focus on mental health in a footballing context in recent years. Why do you think this is?
The mental health of professional footballers has been highlighted in recent years with the untimely deaths, by suicide, of high-profile players such as Gary Speed and German goalkeeper Robert Enke. In recent years the exploits of former elite players have been highlighted within the media (usually portrayed negatively), or through the range of autobiographies that are released. A number of former players such as Tony Adams, Paul Gascoigne, Kenny Sansom, Paul Merson and Stan Collymore have discussed their struggles with issues such as alcoholism and addiction.

Traditionally players that are currently playing were very reluctant to open up about their personal stories, especially related to mental health. However, when Danny Rose bravely spoke about his struggle with depression during the 2018 World Cup, the world listened. Since then a growing number of footballers have publicly shared their experiences of mental health issues. Some stand-out players include Kevin Ellison, Marvin Sordell, and Martyn Waghorn. More recently, Ben Chilwell has spoken about the impact of the Covid lockdown and how he struggled with a lack of confidence. In addition to this, the recent death of Nobby Stiles, and the news that Sir Bobby Charlton has been diagnosed with dementia, has further raised the profile of the link between professional footballers and mental health.

Could you tell us about your own research into football and mental health, and what led you to take an interest in this topic.
I have been studying part-time for a PhD based on professional football and I am aiming to complete in 2021. My current working title is ‘How are male professional footballers affected by mental health within football?’. I have always been a huge football fan. My earliest memories were watching the 1986 World Cup and ‘that’ hand of God whilst collecting Panini stickers.

I also have 20 years’ experience as a mental health nurse and my clinical background is working with high secure offenders. I am currently an Associate Professor in Nursing at the University of Leicester and I am the Program Lead for our MSci Nursing with Leadership and Dual Registration course, and I am passionate about mental health awareness and education. I knew that studying for a PhD would be really hard, so I decided to combine my passions of mental health and football. The more I read into it the more I realised that there appears to be a huge lack of support for first team footballers.

There is some great work being done by Vincent Gouttebarge, who is the Chief Medical Offer at FifPro, the World Player’s Union although the published research is mainly statistical. I wanted to explore the lived experiences of players, so I have managed to interview 18 current first team players from across the EFL. Some of these players have premier league and international experience. I am in the process of writing up my findings but my key themes involve social networks (many players have spoken of the importance of a female role model within the family), the environment (particular the culture within the dressing room), masculinities (the perceived macho culture), help seeking behaviour, and mental health. The mental health theme is split into two sub-themes – impact on self, and reaction of others. I am hoping that my findings and recommendations for practice can help positively impact the support available for professional footballers.

Throughout this study I have able to publish some of my work. I have published a narrative review about ‘men, mental health and elite sport’ in the Sports Medicine journal. I was invited to write an article about gambling and substance abuse in professional football which was published in the Football Medicine and Performance Association Journal, and I have written a paper about the impact of covid on professional footballer’s mental health which has been submitted for publication and is currently under review. I have developed this paper in collaboration with Dr Alan Tonge, who is a lecturer with UCFB, and Dr Alex Culvin at Salford University. Alan previously played for Manchester United and Exeter City, and Alex has previously played in the Women’s Champions League with Everton, AZ Alkmaar and Bristol Academy.

In November 2019, I was invited to present my research as the keynote speaker on mental health at the Football Collective conference, which was held at Bramall Lane, home of Sheffield United FC. This was a fantastic opportunity and I took the unique approach of interviewing ex-Mansfield Town goalkeeper Bobby Olejnik on stage. This drew some brilliant feedback from the audience.

What do you think clubs can do in order to promote positive mental health?
I think that there are a number of clubs across the UK that do some great work within their local communities and they work closely with fans with a range of mental health issues. I think clubs should also focus on the importance of positive mental health within their players, managers and support staff. There should be a culture of seeking help and if players reach out for help, they should be supported.

One of the participants in my research talked about becoming really anxious during a warmup in front of a big crowd and he felt overwhelmed. He decided to feign a physical injury to sit out the match rather than state that he struggled with anxiety and then potentially lose his place and maybe his contract. Football is such a pressurised environment and the priority is always about winning and getting those three points. I have previously had a conversation with a football academy who asks the players to complete a daily rating scale about their mental health which is brilliant, but then the staff lack the knowledge and training for any player who rate their mental health as needing support.

I would love to see a club take a completely different approach by prioritising wellbeing and positive mental health instead of performances and results. I believe that if a club has a positive mental health culture and the players are well supported and encouraged to thrive in that environment, then the results would take care of themselves. It is worth remembering the incredible pressure that the managers and coaches are under as some clubs are quick to issue a P45 if results are not going well. I am aware that the League Manager’s Association are doing some great work in supporting managers.

During lockdown, we've heard that there have been increasing numbers of people affected by stress and anxiety and that part of this may be due to increased social isolation. Are there any things that you think people should try to focus on in order to get through these challenging times when not all of us can as easily meet up with friends and family or do things like attend football matches?
Lockdown has had a huge impact on everybody. Stress and anxiety have increased across all communities and across the lifespan. It seems that everybody has made sacrifices and not been able to see friends and family. I think that everyone now seems skilled with Facetime and Zoom but it’s not the same. Exercise is a huge help with maintaining positive mental health and that can be anything from doing Joe Wicks' PE lessons to just going for a steady walk.

I always like to promote the 5 ways of wellbeing, which is about connecting with others, being active, taking notice of the world around you, learning (hopefully you have learnt something from reading this), and giving (this is about being kind and maybe giving your time to others). Watching live football has always been a great stress reliever for me. Watching it on TV is fine but it does not replace the euphoria of celebrating a last-minute winner with a group of strangers.

Finally, please could you tell us about the team you support (Doncaster, isn't it?) and what you hope they will achieve this season.
2021 will be my 30th year paying to watch Doncaster Rovers play and I have missed very few home games during that time. I have also travelled the country watching them play and steadily working towards ‘doing the 92’. I am currently on approximately 50 Premier League and EFL grounds with Rovers. I’m always positive and optimistic and I think we are on course to have a good season. It was really exciting recruiting Darren Moore as manager, as he has proven he can manage at the top level.

This season is an important one as the ‘greatest player of all time’ James Coppinger has announced that this season will be his last. (My youngest son is named James – my wife claims that he is named after her Dad, but he is really named after Copps). I just hope we get back into the Keepmoat Stadium to see him play in person again as he deserves the perfect send-off. I wouldn’t be surprised to see him score a last-minute winner on the final day of the season to give us the title (a 2013 Brentford re-run will do). We have a mixture of exciting young players – Tyreece John-Jules is an England Under-19 international striker and currently on loan from Arsenal and he is a standout for me. Captain Ben Whiteman resisted offers to play elsewhere and arguably the best centre midfielder outside the championship, and along with rock solid Tom Anderson and Joe Wright in defence we should at least reach the playoffs. With luck with injuries and some consistency don’t bet against us finishing in the automatic promotion places.

Thank you to Gary for taking the time to respond to our questions. Later this week, we'll have some more features on our website and social media about football and mental health.