Results of two survey rounds showing level of agreement with statements regarding club doctor role and responsibilities
| Round 1 | Round 2 | |
| 1. Prevention and mental health promotion activities | ||
| 1.1. Club doctors should be aware of all whole of club promotion and prevention programmes. | 100% | |
| 1.2. Club doctors should be engaged in whole of club mental health promotion and prevention programmes. | 89.3% | |
| 1.3. Whole of club mental health promotion and prevention programmes should be delivered by appropriately qualified professionals. | 100% | |
| 1.4. Club doctors should contribute their specific expertise as relevant to the design and delivery of promotion and prevention programmes. | 85.7% | |
| 1.5. All prevention and health promotion activities should be evidence based and multidisciplinary. | 96.4% | |
| 1.6. Providers of mental healthcare develop a rapport with athletes, even if this is outside professional consultations, given the importance placed by athletes on establishing relationships with providers to facilitate help seeking. | 89.3% | |
| 1.7. When working with elite athletes, club doctors should reconceptualise ‘mental toughness’ as ‘mental fitness’ to help to decrease perceptions of stigma around working with sport psychologists and talking about mental health. | 85.7% | |
| 2. Screening and risk identification | ||
| 2.1. Each club has at least one nominated health professional with relevant expertise, who is responsible for mental health screening. | 92.9% | |
| 2.2. Screening should involve suitable valid and reliable standardised screening tools for mental health disorder. | 89.3% | |
| 2.3. Screening tools should include population tools, such as the PHQ), DASS21, K10 and/or AUDIT. | 64.3% | 69.6% |
| 2.4. Screening tools should include athlete specific screening tools, such as the Athlete Stress Inventory or the Barron Depression Screener for Athletes. | 75.0% | 69.6% |
| 2.5. In applying screening tools, for initial screening, compare results with population norms. | 53.6% | |
| 2.6. In applying screening tools for subsequent screening, compare results with individual’s own baseline. | 100% | |
| 2.7. Screening should be conducted regularly. | 75.0% | 78.3% |
| 2.8. Minimum screening is indicated at recruitment. | 96.4% | |
| 2.9. Minimum screening is indicated at preseason/end of season. | 71.4% | 91.3% |
| 2.10. Minimum screening is indicated at mid-season. | 35.7% | |
| 2.11. Minimum screening is indicated at end of contract/retirement. | 85.7% | |
| 2.12. Additional screening is required as indicated in case of injuries. | 71.4% | 78.3% |
| 2.13. Additional screening is required as indicated in case of concussion. | 64.3% | 78.3% |
| 2.14. Additional screening is required as indicated in case of critical life events/stressors. | 85.7% | |
| 3. Engaging external specialists | ||
| 3.1. If screening is indicated, a qualified mental health professional should conduct a comprehensive psychosocial assessment. This may involve one or more specialists as needed. | 64.3% | 47.8% |
| 3.2. The club doctor must be aware of and engaged in coordination of external mental health assessment. | 96.4% | |
| 3.3. The club doctor is responsible for making referrals for external mental health assessment. | 75.0% | 91.3% |
| 3.4. Club doctors should consider psychological, as well as physical factors, when treating and coordinating care for injured players. | 100% | |
| 3.5. If a player is referred to an orthopaedic or neurosurgeon, they should not be relied on to address the psychological issues related to injury, surgery or rehab of an athlete. | 78.6% | 95.7% |
| 3.6. A qualified mental health professional should be engaged for assessment and management of any associated psychological issues. | 82.1% | |
| 4. Duty of care | ||
| 4.1. The club doctor holds duty of care for the player’s mental health. | 89.3% | |
| 4.2. A nominated club health professional (either the club doctor or another suitable mental health professional internal to the club) is the case coordinator. | 100% | |
| 4.3. If the club doctor who holds duty of care refers to a specialist psychiatrist, they share duty of care for the player’s mental health. | 96.4% | |
| 5. Assessment, treatment and case coordination | ||
| 5.1. If the club doctor has appropriate clinical expertise, they can be responsible for delivery of comprehensive assessment, treatment plan, specialised pharmacotherapy management and ongoing evidence-based psychological interventions. | 88.0% | |
| 5.2. If the club doctor does not have appropriate clinical expertise, the club doctor is responsible for coordination of comprehensive assessment and treatment plan, including specialised pharmacotherapy management and evidence-based psychological interventions. | 80.0% | 87.0% |
| 5.3. Players should be discouraged from playing through distress, whether physical or mental. | 26.9% | |
| 5.4. If the club doctor has appropriate clinical expertise, they can be responsible for primary delivery of evidence-based psychological interventions. | 88.5% | |
| 5.5. If the club doctor does not have appropriate clinical expertise, they are responsible for coordination of communication between multidisciplinary providers and documentation. | 92.3% | |
| 5.6. This coordination role can be delegated to the case coordinator, but the club doctor must maintain duty of care and oversight of treatment progress. | 96.2% | |
| 5.7. Secondary and tertiary management: the club doctor is responsible for referral to appropriate external expertise, including IP admissions and residential programmes. | 92.3% | |
| 5.8. If the club doctor has appropriate clinical expertise, they can be responsible for ongoing mental health delivery of evidence-based psychological interventions. | 77.8% | 69.6% |
| 5.9. If the club doctor does not have appropriate clinical expertise, they are responsible for coordination of communication between multidisciplinary providers and documentation. | 96.4% | |
| 5.10. This role can be delegated to the case coordinator, but the club doctor must maintain duty of care and oversight of treatment progress. | 92.9% | |
| 5.11. The club doctor should engage secondary referrals and consultations with trusted expertise as needed to support delivery. | 100% | |
| 5.12. Case coordination meetings should be led by the nominated case coordinator. | 96.4% | |
| 5.13. The club doctor is responsible for providing a discharge summary, with player consent, on club transfer, retirement or delisting to a designated physician. | 78.6% | 78.3% |
| 6. Communication | ||
| 6.1. The club doctor should be aware of the club’s social media policy. | 100% | |
| 6.2. The club doctor should be involved in a decision to notify, or not notify, the media of a player’s mental health disorders. | 92.9% | |
| 6.3. The club doctor should not communicate directly with the media about players. | 85.7% | |
| 6.4. The club doctor should ensure adequate support is provided to a player when unwanted media attention is gained. | 96.4% | |
| 6.5. Club doctors should take advantage of social media and online platforms to disseminate knowledge about protecting the mental health of elite athletes. | 14.3% | |
| 6.6. The club doctor should encourage a player to communicate to the media/public about a mental health disorder. | 0% | |
| 6.7. The club doctor should encourage the involvement of family and friends in the management of a player’s mental health disorder. | 64.3% | 73.9% |
| 6.8. Key family members should be present when the club doctor delivers individual or group interventions regarding alcohol or substance use. | 10.7% | |
| 6.9. The club doctor or case coordinator should be the point of contact between the club and the family and friends of a player with a mental health disorder. | 60.7% | 52.2% |
| 6.10. The club doctor or case coordinator should communicate updates on a player’s mental health disorder to the coaching staff. | 28.6% | |
| 6.11. Education programmes should be made available to coaching staff to enhance their understanding of mental health disorders and needs and to assist them to facilitate help-seeking among players. | 96.4% | |
| 6.12. Clubs should encourage and actively facilitate a positive relationship between players and their mental health staff. | 96.4% | |
| 6.13. Clubs should ensure all staff who have contact with players are educated to increase their mental health literacy. | 92.9% | |
| 7. Confidentiality | ||
| 7.1. Club doctors should be familiar with all relevant Commonwealth, State and Territory legislation, particularly where relevant to private and medical records. If in doubt, club doctors should consult with the AMA or their medical indemnity insurer. | 100% | |
| 7.2. Other than exceptional circumstances permitted or required by law (see below), a club doctor should not, without the patient’s express up-to-date written consent, release medical records to persons other than the patient unless the patient would reasonably expect such disclosure to take place, in accordance with relevant privacy legislation. For example, it is likely a patient who has consented to the collection of their personal information for their healthcare may reasonably expect the doctor to share the patient’s medical record among the treating healthcare team. | 100% | |
| 7.3. Club doctors should base any decision to disclose a patient’s medical records to a third party on considerations of individual well-being of the patient, other identifiable individuals or groups and the public interest. | 75.0% | 82.6% |
| 7.4. Where possible, any decision to disclose information should be discussed with the patient, and the nature of the discussion, the agreed level of disclosure and implications, should be documented in the medical record, including whether the patient consented to this disclosure. | 100% | |
| 7.5. Where disclosure of medical records is required by a third party under legislation, as in warrants, subpoenas or court orders, the club doctor should make all possible efforts to notify the individual of this occurrence and seek consent if possible. | 100% | |
| 8. Sleep management | ||
| 8.1. Treating comorbid mental health disorders will likely be unhelpful unless any primary sleep disorder is treated | 71.4% | 82.6% |
| 8.2. The club doctor or appropriate club personnel should have the ability to track how much sleep a player is getting. | 82.1% | |
| 8.3. The club doctor should provide sleep hygiene advice to players. | 82.1% | |
| 8.4. The club doctor should encourage sleep as part of a healthy training protocol. | 100% | |
| 8.5. Non-pharmacological treatment (such as CBT) for insomnia is preferred over medication. | 82.1% | |
| 8.6. Melatonin should be the first line pharmacological agent for players with insomnia. | 53.6% | |
| 8.7. The club doctor should only prescribe sleep aid medication according to evidence-based guidelines. | 96.4% | |
| 9. Substance use and addiction management | ||
| 9.1. The club doctor’s role is to provide evidence-based treatment for alcohol use disorders. | 69.6% | |
| 9.2. The club doctor’s role is to coordinate evidence-based treatment for alcohol use disorders. | 82.6% | |
| 9.3. The club doctor’s role is to provide evidence-based treatment for gambling disorder. | 43.5% | |
| 9.4. The club doctor’s role is to coordinate evidence-based treatment for gambling disorder. | 56.5% | |
| 9.5. The club doctor’s role is to provide evidence-based treatment for substance-use disorder. | 56.5% | |
| 9.6. The club doctor’s role is to coordinate evidence-based treatment for substance-use disorder. | 73.9% | |
| 9.7. The club doctor should include clinical urine testing in the treatment and behavioural management of players with a substance use disorder. | 36.4% | |
| 9.8. The club doctor is the primarily responsible for the decision stand a player down who has an uncontrolled alcohol, gambling or substance use disorder. | 54.5% | |
| 9.9. The club doctor should coordinate a residential stay for a player who has an uncontrolled substance use disorder. | 59.1% |
Green indicates > 80% endorsement of statement as essential or important.
Yellow indicates 60%–80% endorsement of statement as essential or important.
Red indicates ≤60% endorsement of statement as essential or important.
Initial wording of some survey items used the phrase ‘mental health condition/s’ but for consistency, this has been altered to ‘mental health disorder/s’ throughout.
AUDIT, alcohol use disorders identification test; DASS21, depression, anxiety and stress scale 21; K10, kessler psychological distress scale; PHQ, patient health questionnaire.