July 10, 2013

Clip of footballers training from BBC 3's Football's Suicide SecretUntil retirement at the end of the 2013 season, Clarke Carlisle was a professional footballer. He's also the chair of the players' union, the PFA, and is becoming established as a proficient broadcaster.

His previous documentary for BBC3 was about racism in professional football, and was made sensitively and intelligently, drawing on Carlisle's personal experience.

This film used a similar approach, and was even more effective and moving. It focussed primarily on how professional football influences the mental health of players, and how the sport supports - or fails to support - players having difficulties.

It's powerful stuff - Carlisle interviews Lee Hendry, an Aston Villa player who made two suicide attempts, Ronald Reng, a friend of the late German goalkeeper Robert Enke, and Lesley Speed, sister of the Wales manager who took his own life in 2011.

He talks openly about his own suicide attempt

He also talks openly about his own suicide attempt, and in the most powerful segment of the documentary, visits the children's play park where he took an overdose. Recollecting the incident, he starts to cry. As I did, watching it, moved by Carlisle's openness, and thinking about the time when I was plagued by suicidal thoughts.

Clarke says that "In our game, you know - you can bottle things up. And if you do that, you can come unstuck". The dangers of bottling stuff up isn't confined to football. In 2009, I spent hours hunched over my desk, playing a Goldfrapp track over and over again on my iPod, unable to work, desperately hoping that no-one would talk to me and that the pain I felt would all go away.

Football is fundamentally an insecure profession

I think that - anecdotally, without evidence to back this up other than personal experience - that mental health issues in young men are often linked to threats to personal identity. And, conversely, that a strong strength of that identity can support mental wellbeing and resilience. That's why professional sport can be particularly cruel.

The Football Association have delivered some work in mental health, in partnership with Time to Change. In the film, David Bernstein, FA Chairman, notes that "Football is fundamentally an insecure profession". Carlisle says that "In football, you're only one tackle away from losing everything." Sport also produces incredible highs and lows, and provides the capacity for athletes to face very personal, direct feedback - and often sustained abuse - from spectators.

In the documentary, Carlisle notes that his identity as a person was completely tied up with his profession. Following serious injury that left him unable to play for two years - and initially unsure of whether he'd be able to walk without a stick - he says his darkest fear was thinking about family, and that "Without football, they're going to see me for what I really am. And that is nothing". Carlisle says that part of the problem was "I was Clarke the footballer... I couldn't see any other reason for anyone to be proud of me." And these feelings spiralled into a lengthy depression.

I have a strong mind but that can get injured and broken down

Professional sport is unique, but there are issues around identity that have parallels in everyday life for lots of people. People - and I suspect more often men - experience particular risk to mental resilience when livelihoods are at risk, when we're not only faced with loss of income and threats to lifestyle, but also more fundamental challenges as to who we are and what we're here for. That's certainly what happened to me. And these questions are more prevalent - and the impact therefore more important - in times of economic uncertainty.

Later in the documentary, Clarke says that "I have a very strong body... It can get injured or break down. And I have a very strong mind. But that mind can get injured and broken down". And this is key for me - as a society, we have an unhealthy fear of talking about mental health and mental illness. We often like to think in terms of a false, simplistic dichotomy of sane vs insane - that most people are forever healthy and sound of mind, that mental health problems are confined to small group of 'others'.

Mental health problems can affect anyone

We know that's not true - 1 in 4 people will experience a mental health problem in any given year . And mental health problems can affect anyone - including successful, elite athletes. But that simplistic approach is pervasive and that fear of engaging with and recognising mental health problems, in ourselves, in family, neighbours and friends, is hugely problematic.

Because it stigmatises those who are experiencing problems, creates complex levels of shame and self-stigma, and ultimately can prevent people from seeking the help they need. We don't do that for physical injury. Mental health problems, like physical issues, can be treated or managed, and reducing stigma can fundamentally help that process.

He didn't feel confident talking about mental health

Aidy Boothroyd, Northampton's manager when Carlisle faced depression in 2013, told teammates and the media that a bout of flu was responsible for him missing games. Interviewed for this programme, he says that he didn't feel confident talking about mental health. There's no particular blame to be attached to Boothroyd - his attitude is reflective of the way that society thinks about mental health.

We're not generally sure about it, and don't like talking about it. But we wouldn't be this squeamish about a physical injury, and most football managers would happily face the press and talk about the technicalities of an anterior cruciate ligament tear, or the intricacies of a fractured metatarsal. We need to be open to talking about mental health, to reduce stigma, and make it easier for people facing problems to get help when they - we - need it. Because lives are at stake, and we need to change the way that we, in Britain, right now, think about and talk about mental health.

There is a hopeful ending to the film

There is a hopeful ending to the film. Clarke says that although his Northampton side failed to win promotion at the end of 2013 - in his last game as a professional footballer - that he is more secure in his identity as a husband and father, and is excited about the next phase of his life. He seems like a top guy, and I was inspired by his bravery in speaking out.

There are steps that can be taken to support elite footballers - in particular - through issues associated with release from contract, injury and retirement, when challenges to identity are most severe. These are touched on in the film. But because of its reach, its popularity and its resources, football is also uniquely positioned to help address the way that people think about mental health more widely. It would be great to see football rise to meet this challenge. Programmes like this are a fantastic start.

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