Professional Footballers’ Association Counselors’ Perceptions of the Role Long-Term Injury Plays in Mental Health Issues Presented by Current and Former Players

Abstract

The purpose of this study was to investigate counselors’ professional understanding of the long-term psychological consequences of injury in UK football players. Semi-structured interviews were conducted with 11 counselors who were registered to work for the Professional Footballers’ Association (PFA). The interviews examined the counselors’ perception of the relationship between long-term injury and presenting mental health issues, the antecedents to those mental health issues, and recommendations for psychological intervention following injury. The critical finding was the mental health problems regularly presented to PFA counselors were often the psychological and behavioral consequences of long-term injury. Counselors recommended that early and sustained psychological intervention with long-term injured players would act as a preventative measure against future mental health issues.

A review of the psychological support mechanisms available for long-term injured footballers in the UK throughout their rehabilitation

“…This aligns with the recommendations from the American College of Sport Medicine (2006), Gervis, Pickford andHau (2019) andNICE guidelines (2009). This was exemplified by one club who stated; 'I think that it is crucial and this maybe the only club that has a comprehensive treatment plan that runs alongside the physical rehabilitation'.…”

“…Fear of re-injury was identified as the single most common psychological issue among long-term injured players, which concurs with previous literature (Ardern, et al, 2012;Lentz et al, 2014). However, substance misuse and addiction were not identified as common issues despite previous evidence to the contrary (Gervis, Pickford & Hau, 2019;Heaney, 2006). Moreover, there were some clubs who did not identify any psychological issues associated with long-term injury as exemplified by one respondent who stated: 'I never had any psychological issues that required professional input'.…”

“…Findings reveal that the majority of clubs acknowledged a need for psychological support to a large extent, which aligns with recommendations (American College of Sports Medicine, 2006;Gervis, Pickford & Hau, 2019;NICE, 2009). In order to understand 'who' was available to treat long term injured players, clubs were asked to identify how many staff were employed in the categories below.…”

“…This is exemplified by one participant who stated: 'I think an experienced physiotherapist is often in the best position to recognise and assist'. Given the wealth of evidence (Gervis, Pickford and Hau, 2019;Heaney, 2006;Tracey, 2003) one has to question this approach as assumed expertise with limited knowledge could potentially put players' mental health at risk.…”

“…Emotional reactions to rehabilitation include feelings of loss, frustration, denial, anger and depression (Clement et al, 2015;Tracey, 2003). Notably, research has demonstrated that these psychological responses to injury can trigger and/or uncover mental health issues such as depression, suicidal ideation, anxiety, eating disorders and substance use/abuse (Gervis, Pickford & Hau, 2019;Heaney, 2006;Putukian, 2016;Smith & Milliner, 1994;Sundgot-Borgen, 1994). The implication is that there is a need to provide psychological screening and support for athletes suffering from severe injuries to mitigate the risk of suicide.…”