Mental health is an issue that soccer has an uneasy relationship with. Despite all the advancements in the game from physical conditioning, boot design and treatment of injuries the topic of mental health still draws uncomfortable breaths from players and coaches alike. Mental health is still an area that is considered taboo in football circles although there are ongoing efforts to lift the stigma attached it.

World Soccer Talk discussed the topic of soccer and mental health with Dr. Vincent Gouttebarge, Chief Medical Officer of the World Players’ Union FIFpro.

Here are his thoughts:

World Soccer Talk: You played professional football but then transitioned to sports science and health. What was that journey like? What convinced you to set on this path?

Dr. Vincent Gouttebarge: When I was 14-15 years old and when professional clubs wanted to have me in their youth academy, my parents told me that a proper education was also important as the chance to become a professional footballer is not big and as a professional career can ended suddenly after an injury for instance. Consequently, I was always driven to combine studying and playing professional football. During the last five years of my career, I was doing my PhD in the morning, starting at 6.15am up to 12.30pm…then going to the club for the afternoon training session!

WST: How did you find the approach to mental health in your playing days? Was it a topic that clubs, management or players knew how to approach let alone discuss?

VG: During my career, mental health was not an important issue….metal skills were important to perform optimally. Through my career, I saw that mental trainers were included to the staff in order to achieve better performances, or we had several sessions with a mental coach. Things have been changing but the only aspect important for a club is performances. From my position as Chief Medical Officer of FIFPro, I’m looking at the long term mental health of players, both during and after their career.

WST: The late Andreas Biermann, formerly of St. Pauli, once said “if any footballers out there are suffering from depression I’ll advise them to keep it for themselves”. It seems inconceivable that football hasn’t made any worthwhile strides to help players with depression or anxiety. Is that view too naïve? 

VG: We know that mental health problems are kind of taboo in professional sports such as in football. We need to change it and I’m sure that it is a question of time. Some high profile players start to speak about their mental struggle and this is a way to break the barrier.

WST: Are clubs and associations better equipped to help players who are suffering from mental health issues? Are coaches or teammates taught to look out for telltale signs?

VG: As long as mental health remains a taboo to talk about, then it remains difficult to recognize symptoms and signs. Once all actors within professional football are properly educated about the potential mental health problems that might occur during a football career, then it will be easier to recognize it.

WST: Equally do you find that players are more ready to speak about their battles with depression and/or anxiety?

VG: Things are changing in professional sports, in football also. Some high profile players start to speak about their mental struggle and this is a way to break the barrier.

WST: As the CMO of FIFpro what are the most common questions you get from clubs and players regarding mental health and what do you advise them to do?

VG: I always emphasize that mental health problems can occur as much as physical health problems….and that it is important to recognize it, to speak about it with the proper person, and to seek the proper support.

WST: In general does the nature of professional sport, i.e. the need to win and avoid failure, discourage players or coaches from speaking out about problems they could be suffering from?

VG: Professional football (as other sports) is a kind a macho environment, and consequently, it might not be favorable to feel free to speak about it.

WST: How much does injury play a part in the mental health of a footballer? Do you find that the more injuries a player suffers the more susceptible they become?

VG: Severe injuries lead to a long period of time without training or competition. Those are huge stressors for players and these injured players have to cope properly with it. It is not easy, especially when other stressors in social context might combine with an injury. Mental health problems are multifactorial: it is often the combination of stressors (football specific or outside football) that leads to mental health problems.

WST: How about finances too? There are cases, unfortunately, where player wages have been withheld by poorly run clubs. That kind of mental strain must take its toll.

VG: Yes it is also considered as a potential stressor for the mental health of the players.

WST: How much of a factor does retirement play? How common is the struggle for former footballers to make the transition from player to ex-player?

VG: Transitioning out of football is not easy and remain difficult for many players. We know from scientific studies that players forced to retire (because of an injury or no contract) are more likely to report mental health problems than those who choose to retired.

WST: Have you noticed any noticeable difference between the men’s and women’s game with respect to mental health issues?

VG: We do not have a lot of information about that but it seems that both male and female players are likely to report mental health problems.

WST: At which level of football do you think need to make the most advances with respect to mental health? The elite may have good infrastructure but what about more modest clubs and organizations?

VG: At all professional levels: money does not make anyone immune to mental health problems. Mental health problems might occur at all professional levels but the stressors that play a role in the occurrence of mental health problems might differ from the elite to the lower professional leagues.

WST: How have you found the approach of governing bodies, such as FIFA, towards the issue of mental health? Are enough studies being done and solutions being found?

VG: FIFPro was the first organization in 2013 to look to mental health in large groups of players. Since then, FIFA has started few projects on that so it can have only some positive and added value for professional football.

WST: Do you find that certain nations and associations treat the issue of mental health more seriously than other?

VG: In some countries, mental health in the community and in professional sports has a lot of attention, for instance in the UK.

WST: Are clubs making talent aware of professional opportunities beyond football or better yet helping them to prepare? Do such programs help give peace of mind as they show people involved in football that there’s more from a career point of view beyond playing and coaching?

VG: I believe that clubs but also agents (not working for a players’ union) should emphasize more and more that education and career planning are very important to prevent mental health problems on the long term but also to achieve better performances.

WST: How do you find the media’s approach to the subject of mental health? The tragic deaths of Robert Enke and Gary Speed were rightly covered extensively but beyond high-profile tragedies is there enough focus from the media about mental health?

VG: Media remains media: they want to capture some sensational stories and are very keen to publish about the mental struggle of any player.

WST: FIFpro conducted its own study and found that 38% of the 826 players surveyed admitted that they suffered from mental health problems. What was like carrying out this study? How difficult was it to organize and for players to open up and do you fear that the percentage is a conservative number?

VG: In 2013, we first conducted a pilot-study in 6 countries (Australia, New Zealand, USA, Scotland, Ireland, and The Netherlands) in order to get an insight about the mental health problems among current and former players but also in order to estimate whether a larger study would be feasible. As this pilot-study was well received by players’ unions and their members, we decided to launch a larger studies across 11 countries on three continents. It was logistically challenging of course but thanks to the support of all, it has been a very successful study…for the football family but also from a scientific point of view!

WST: It’s important to stress that mental health issues are not confined to football other sports have to deal with it too. What have you discovered from your contemporaries in different sports?

VG: I have been initiating similar studies across many other professional sports such as ice hockey, handball, cricket, rugby or even in professional football referees. Mental health problems occur also in all other professional sports.

WST: This is a very general question but what are the primary solutions for football to help tackle mental health issues?

VG: For any health issue, we always want to work on prevention. In order to prevent mental health issues, we first need to make it easier to talk about and to recognize it properly and in early stage. Education of players and staff about it is an important prerequisite.

WST: Finally, for any player or coach at any level (or their friends and family) suffering from mental illness what are the first steps they need to make?

VG: Talk about it to someone you know and trust…this is a big step but a necessary one!

You can follow Dr. Vincent Gouttebarge on Twitter @VGouttebarge