Macho culture, stigma and pressure to perform affect players, but while help is on offer, challenges remain.

In the months after he left professional football, Christopher Mitchell’s mental health deteriorated.

A spinal injury had forced the ex-Falkirk FC, Bradford City, and Scotland Under 21 international to retire in January 2016 at the age of 27.

He became introverted and anxious, his sleeping patterns unravelled, his eating became erratic.

He told his sister that he was having suicidal thoughts. His relatives took him to the doctor, who prescribed medication. But in May 2016, he took his own life at a railway line close to the family house in Stirling.

His father, Philip Mitchell, recalled trying to make sense of it all in the weeks that followed.

“And we were finding out from players that, although there were support services in place in Scottish football, the players weren’t seeking the help available to them, or they just didn’t know [about it],” he told Al Jazeera.

In 2017, Philip and his family launched the Chris Mitchell Foundation, which aims to challenge the stigma associated with mental health in Scottish professional football, and works for mental health to be integrated into physical health and fitness training programmes.

It is part of a growing number of initiatives aimed at tackling football’s mental health crisis.

Chris Mitchell died at the age of 27 in 2016 [Courtesy: Chris Mitchell Foundation]

A 2015 study by FIFPro, the worldwide representative organisation for professional footballers, found that former and current professional footballers are more likely to suffer from mental health problems than the general population.

Footballers often face overwhelming pressure to succeed; a psychological impact from injuries; and loss of identity on retirement or release, among many other challenges.

A macho culture in football has traditionally taught players to suppress difficult emotions and has stigmatised talking about depression and anxiety as “weakness”.

But in recent years, several current and former players have spoken publicly about their struggles with mental health (including Marvin Sordell, Chris Kirkland, and Aaron Lennon, among others.)

For some mental health advocates, it suggests the “code of silence” has broken in football.

But others question whether attitudes are changing and ask how the conversation can be taken forward.

Support services within football clubs have grown in recent years, with more clubs employing psychologists, counsellors, welfare officers and mental health first aiders. But Philip Mitchell believes many people working in football still fear a detrimental impact to their career if they admit to struggling with mental health issues.

“Football’s full of bravado and [talking about] mental health is still considered to be a weakness,” said Mitchell. “And until we change that, footballers and managers will not come forward, they will just suffer in silence.”

So far, the Chris Mitchell Foundation has helped to train about 200 people in the industry in offering mental health support.

Michael Bennett, director of Player Welfare at the English Professional Footballers’ Association (PFA), says there is still a way to go.

“When a player pulls a hamstring, they’ll go to a physio straight away. That’s an injury. And we want mental health [issues] to be treated the same way. It’s [also] an injury.”

The PFA delivers mental health workshops to clubs and offers counselling and support services.

In 2016,160 people used the PFA’s services. Last year, that number rose to 438.

When the general public see their sporting heroes coming out and admitting they have problems, it maybe makes them realise that these people are not invincible. Michelle Evans, PFA Scotland spokesperson

PFA Scotland also offers a private and confidential support service, runs workshops and produces case studies of players who have faced issues such as depression and gambling addiction. It is also planning to launch a mental health support app.

Michelle Evans, PFA Scotland spokesperson, says it is vital to be proactive.

She contacts footballers when she hears they have been injured, and runs recruitment and support events in the summer, when many players are out of contract.

“We are constantly making them aware of the support that’s there for them, so they know where they can turn if they have any issues.”

Kevin George, a performance consultant who authored Soccology, a book about psycho-emotional factors in football, argues there is also a need to educate players and coaches so that they can acknowledge, understand, and manage emotions, and have empathy for others, before problems arise; building resilience to stress and depression and avoiding a potential fallout of broken relationships, domestic violence, alcohol and drug abuse, bankruptcies and wasted talent.

He teaches emotional literacy workshops at football clubs so “they can actually become aware of their feelings, they can take responsibility, be accountable and manage themselves”.

George believes that adding mental health to the syllabus for coaching badges would be a positive development.

“It’s no good, for example, everyone saying that they want to ‘make change’ – if the coaches aren’t capable, then they can’t do that,” he argued.

But football is often about succeeding at all costs. A certain “football character”, partly defined by a supposed fearlessness, remains prized.

George said he would like to see more ex-footballers become psychologists and counsellors, but added that the support should focus on the patient’s entire character, “because sometimes players lose themselves in their identity as a player”.

The consensus is that football has come a long way in a short time, but needs to do more.

Some believe the sport can now also influence wider attitudes to mental health.

“When the general public see their sporting heroes coming out and admitting they have problems, it maybe makes them realise that these people are not invincible,” said Evans.

“They seem to have what many perceive as glamorous lives, but they have all the same problems that you and I have, so it’s ok to admit that you’re not feeling great.”

Many football clubs now support mental health projects in their own communities, such as Everton and Newcastle United in England, and Motherwell in Scotland.

“I think it’s going to be a generational change,” said Philip Mitchell, “and that’s where the government needs to get an education strategy in place and teach people from a young age that [talking about mental health] is not a weakness.”

Three years after his son’s death, the work with the foundation gives Philip and his family some solace and a sense of purpose.

“If we can get mental health first aiders licensed in clubs, similar to physical first aiders, then we will have achieved that in Christopher’s name, and we would be very pleased with that.”