A study into player welfare across all levels of the professional English game has revealed a damning lack of psychological support provided by clubs to long-term injured footballers.

The review, carried out by the Brunel University London in association with the Professional Footballers’ Association, found that out of 75 clubs surveyed across the Premier League, English Football League and Women’s Super League, the majority offered limited access to psychologists.

Instead, clubs were typically dependent on physiotherapists to provide psychological support for injured players, despite lacking the appropriate expertise.

In response to the question “Do you have staff trained in the psychology of injury?”, only 37 per cent of clubs reported that they employed staff with the relevant training.

A further 62.3 per cent reported to have “never” or only “occasionally” screened injured players for psychological issues during their recovery.

Athletes who have spoken out Show all 13 1 /13 Athletes who have spoken out Athletes who have spoken out Heavyweight boxer Tyson Fury "I woke up every day wishing I would not wake up any more. But I am living proof anyone can come back from the brink.



"There is a lot of people out there suffering with mental health problems who think all their days will be grey, but life can improve again and you will start to enjoy the little things again." Getty Images Athletes who have spoken out Former Olympian Dame Kelly Holmes “I’ve been to the lowest point and to the highest point and everything in between. It shows we can go through life and have struggles and still actually achieve.” Getty Images Athletes who have spoken out Ex-England cricketer Freddie Flintoff "I was sitting in the room as this fella who will drag everyone with him. If I had turned around and said, 'look lads, I'm really struggling,' it would have sent shock waves. So I thought I shouldn't." Getty Images Athletes who have spoken out Ex-England footballer Kelly Smith “Even now talking about it, I'm thinking is this the right thing to do, to tell you and to tell the world.



“But if I can help other people along the way, because there are so many other athletes and people who go through these same things, that it's okay to talk about it, it can help other people.” Getty Athletes who have spoken out Former heavyweight boxer Frank Bruno “Mental illness can affect anyone, whether you are the heavyweight champion of the world or you’re working in a shop.



"It is the toughest fight I have ever had to face and the darkest period of my life. I did not know how I was going to get through.” Getty Images Athletes who have spoken out Former Olympian Crista Cullen "The first time I retired I was 27 after the London Olympics.



"I felt lost. It was like I had fallen off a cliff. It took me six months to find my feet, but I was still looking for that identity.



"I hadn't appreciated the impact that transitioning out of elite sport would have on me. I'm an extrovert but still really struggled." Getty Images Athletes who have spoken out England and Tottenham footballer Danny Rose “It’s no secret that I’ve been through a testing time at Tottenham. It led to me seeing a psychologist and I was diagnosed with depression, which nobody knows about. I had to get away from Tottenham.



"It was really hard, and being referred to a doctor and psychologist helped me massively to cope." Getty Athletes who have spoken out Ex-England Women’s rugby union captain Catherine Spencer "I was at the top of my game - England captain, first choice, 63 caps, I knew what I was and what I was doing. I felt like I was at the top of my mountain.



"Then suddenly it feels as if you're not needed on the top of that mountain and you plummet to the bottom. You don't know where you're going or how to look up. Your whole being is almost taken away from you.” AFP/Getty Images Athletes who have spoken out Somerset and former England cricketer Marcus Trescothick “No one knew. I guess I never told anyone about the pain I was going through because I didn’t understand it myself. It made no sense to me that I felt so bad. How could I explain something I couldn’t understand?” Getty Images Athletes who have spoken out Paralympian Danielle Brown "When you are training your whole life revolves around winning medals. For that structure then to be taken away from me was devastating.



"Having the plan that has come crashing to a halt, you're devastated. You have no idea what you are or who you are, want you want to do, where you want to go." Getty Images Athletes who have spoken out Former Olympian Michael Phelps “You’re at the highest level of sport you can possibly get. Then you’ll want to do something new, something crazy. That high to low can put you in a dark spot.” Getty Images Athletes who have spoken out Former Olympian Victoria Pendleton "It’s a very strange feeling. Being numb. Just. Physically. Numb.



"There were mornings I woke up and I thought: ‘I don’t want to see the end of the day.’ I was a zombie. Emotionless. I was so low. So helpless." Getty Images Athletes who have spoken out Ex-England rugby player Jonny Wilkinson “When you finish a career in professional sport, it can feel like nothing will ever make you as happy as the career you had. And as that happens you can start to feel alone, disengaged, unable to be happy any more.



"Hang in there. Keep looking for help...you're definitely not alone. Talk about it, people want to hear because everyone wants to share deep down. Talk about it, but also understand that also that this is potentially the beginning of something that will change lives forever." Getty Images

According to the study, a number of clubs did not identify any psychological issues associated with long-term injury, as exemplified by one respondent who stated: “I never had any psychological issues that required professional input.”

The study was critical of such an outlook, stating in response: “Given the plethora of evidence which demonstrates the prevalence of mental health problems associated with a long-term injury, this statement speaks to the lack of awareness within support teams. The implication of this is that players are being put at risk.”

Seventy-five heads of medical departments from first teams and academies across English football took part in the survey. The overwhelming majority said that they wanted to access professional support, either from a sport psychologist or through referral to other mental health specialists.

The study, led by sports psychologist Dr Misia Gervis, concluded that: “A lack of support mechanisms may be explained by a lack of training of medical staff in the role of psychology in sport injury and a culture within football where psychological support is stigmatised and not understood.”

Speaking to The Independent, Dr Gervis added: “Professional football does not seem to be acknowledging the mental health challenges associated with long-term injury.

“In my experience rarely is the psychological trauma associated with long-term injury given equal weight to the physical suffering, and this is borne out by our findings.

“The fact that there aren’t enough qualified psychologists employed means that there is a reliance on other staff to recognise mental health problems when this is not their area of expertise. So I feel that there will be players that can slip through the net.”

This follows The Independent’s investigation into mental health in sport, which highlighted the football’s shortcomings in providing sufficient support for athletes during times of injury.

In one case uncovered as part of the Sporting Mind series, Ipswich Town was accused of failing to adequately support the mental health of a former academy youngster after mishandling an injury the player sustained during his time at the club.

The player, who was 16 at the time, alleges that the club’s physiotherapists ‘didn’t really 100 per cent know what they were doing’ and “ran out of ideas” in treating him as a back injury came to repeatedly hinder his form, fitness and even the ability to walk on some days.

During his rehabilitation, numerous hours of each day were spent hanging around in the changing room, waiting to see the physiotherapist, “not really doing anything”.

Although he did not raise concerns at the time, the youngster himself admitted to the English Football League in July 2018 that, “looking back now”, it’s likely he struggled mentally during his time at the club.

Weekly informal approaches were made by Ipswich’s welfare officers and coaches to inquire about his wellbeing, but the player insists he never had a one-on-one meeting with the club’s sports psychologist.

His experience – which can be read in full here – saw the PFA “urgently” demand the FA carry out a “thorough and far-reaching safeguarding investigation” into the matter. Despite Ipswich’s insistence that the PFA, FA and EFL “found no substantiation to such allegations to warrant any action,” the EFL is continuing to investigate the episode.

Ipswich says it “acted to the highest standards in the player’s medical treatment in line with the National Institute for Clinical Excellence (NICE) guidelines and in his general well-being.”

QPR’s ‘RETURN’ protocol R – Rehabilitation (Physical) E – Emotional/Psychological Recovery T – Team based support (physiotherapists, sport psychologist, sport scientist, coach) U – Unique to each individual player R – Readiness, both physically and psychologically, to compete. N – Normalised (all long-term injured players receive psychological support throughout recovery, and are regularly screened)

Dr Gervis, who also works as psychologist as Queen Park Rangers, said cases such as these were to be expected within football given current attitudes towards the issue.

“As a practitioner I am very aware of the potential of this happening which is why we [QPR] do rehab very differently to try and guard against this with constant psychological support,” she said. “If there is no routine psychological support then the risk of such cases is increased.”

In treating long-term injured players, QPR deploys a “holistic” approach to rehabilitation rooted in the club’s ‘RETURN’ protocol, which, according to Dr Gervis, has returned positive results in the treatment and recovery of players.

Addressing how to improve football’s shortcomings in this field, Dr Gervis said: “A cultural shift of practice is needed by medics, physios and coaches.”