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Batting against mental health in elite cricket
  1. Hassan Jamaal Sadiq Mahmood1,
  2. Daniel Jonah Friedman2
  1. 1 Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
  2. 2 Alfred Health, Melbourne, Victoria, Australia
  1. Correspondence to Dr Hassan Jamaal Sadiq Mahmood, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK; hassanmahmood{at}nhs.net

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Elite athletes have always struggled with mental health. This is not news. But it does seem to be featured more often in newspapers and newsfeeds. Although sport is protective for mental health, athletes suffer from similar rates of anxiety, depression and substance abuse as the general population.1 Just as the sport and exercise medicine community are calling for more athlete mental health support through international consensus statements,2 the public are also waking up to athletes’ daily battles on and off the pitch. Now is the time to ensure cricket is not left behind.

Why cricket?

In many countries, cricket is inseparable from religion and culture; players are worshipped by billions. The select few who represent their nation carry incredible responsibility—and failure leads to ultimate shame and financial insecurity. Cricket shines an unforgiving spotlight on individual players who can spend 300 days a year away from home.3 Statistical analysis of individual performance combined with extended time alone to reflect on errors likely predisposes cricketers to anxiety, depression and burnout.4

To make matters worse, ubiquitous and relentless social media prevents cricketers from ever leaving the field. Cricketers have spoken publicly about mental health struggles caused by direct and personal online criticism, and racial abuse.

Limited data suggest that the prevalence of mental health disorders in cricketers can be up to 38% for sleep disturbance, 37% for anxiety/depression and 26% for adverse alcohol use.5

Cricketers in England,4 South Africa,5 Australia6 and New Zealand7 have suffered (and retired)8 from the above. Indian cricketers suffer from similar problems9; however, little is known about cricketers from Pakistan, Sri Lanka and Bangladesh—perhaps due to silence in the face of stigma.

An indefinite global pandemic is amplifying these problems, as athletes live away from loved ones in heavily restricted environments. Some cricketers have already left the bio-secure bubbles due to mental health concerns, whereas others have declined contracts altogether to avoid them.10

Mental health does not discriminate

As women’s sport is growing, we are learning that these struggles are not unique to men.11 Women cricketers are batting against the same problems, but find themselves lost within underfunded and under-resourced support systems. Gender stereotypes of anxiety and depression in women and substance abuse in men may be reinforcing social stigma and constraining help-seeking.12

Cricketers’ delays in speaking openly about their mental health highlight insufficient access to mental health services in developed and especially developing countries. Athletes may lack mental health literacy and worry about their story becoming the next headline if reaching out.

So what is the game plan?

When developing comprehensive mental health support for cricketers, an ‘ecological’ system-based model13 can help us respond at levels of the organisation, team and athlete (figure 1).

Figure 1

Cricket mental health game plan; an example of a top-down, bottom-up system-based approach needed to support the mental health of cricketers at all levels (icons sourced from: http://www.rawpixel.com, http://www.freepik.com and http://www.flaticon.com).

Mental health and social media literacy

Awareness does not create behaviour change, but education is key to laying foundations. Cricketing organisations should deliver mental health literacy programmes to all cricketers, coaches and supporting staff to identify key mental health symptoms and risk factors, how to seek help and learn basic self-care techniques such as mindfulness and coping strategies.

Social media education for athletes currently focuses on building personal brands and abiding by organisational policies. Why not educate athletes how to protect themselves online and switch off?

Screening

Early detection of mental health symptoms enables early intervention and prevention of disorders. Mental health screening, such as the International Olympic Committee Sport Mental Health Assessment Tool 1,14 should be routinely performed alongside physical examinations by medical staff regularly throughout the year. Coaches and support staff can help to destigmatise and promote help-seeking. In South Asian cricketing nations, existing screening questionnaires could be translated and validated to support clinical assessment according to local context and culture.

Professional mental health support

The role of the psychologist within elite sport has traditionally centred on performance. It is time to refocus and support athletes’ psychological development and well-being across the lifespan. In addition to a mental health and well-being lead, every team should have a dedicated psychologist to support athletes, and coaches face the intense mental pressures of the game and the world around them. This could spark generational change if younger cricketers become accustomed to psychologists as core members of the medical team.

Dedicated mental health support staff can also help teams develop individualised mental health emergency plans,15 when athletes present with acute disturbance in mental state or suicidal ideation. This is when a psychiatrist is needed, who can assist with psychotropic medication.

Silence is no longer an option in what is no longer just the male’s game. Cricket must learn from other sports to adopt a system-based approach that prioritises screening to prevent an emerging mental health crisis. Strategic action combined with dedicated research is crucial to better understand how to support the mental health of all cricketers long after the innings are over.

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References

Footnotes

  • Twitter @Hassanmahmooddr, @ddfriedman

  • Correction notice This article has been corrected since it published Online First. The twitter handle for Dr Mahmood has been added and the provenance and peer review statement has been included.

  • Contributors HM was responsible for the conception and initial draft of the manuscript. DJF was involved in revised drafting and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DJF is an associate editor for BJSM.

  • Provenance and peer review Not commissioned; externally peer reviewed.