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2015 Delivering the Mental Health First Aid (MHFA) Course within the National (NRL): Evaluation Report Jioji Ravulo University of Wollongong, [email protected]

Publication Details Ravulo, J. (2015). Delivering the Mental Health First Aid (MHFA) Course within the (NRL): Evaluation Report. Western Sydney University.

Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected] Delivering the Mental Health First Aid (MHFA) Course within the National Rugby League (NRL): Evaluation Report

Abstract Mental illness is a reality for many Australians. The aN tional Survey of Mental Health and Wellbeing, conducted in 2007 with people aged 16-85, revealed that one in five Australians, or 3.2 million people, had a 12-month mental disorder (a mental illness occurring 12 months before the survey took place) (ABS, 2007). The urs vey further revealed that 16 million Australians (45%) within this age bracket suffered with a mental illness at some point in their lives. While these findings are slowly becoming public knowledge, there is still a limited understanding amongst laypeople regarding the overt and more covert symptoms of mental illness, as well as appropriate methods of treatment and support for those that struggle with such challenges in their daily lives. Despite popular opinion, elite athletes are not exempt from these statistics. The pressures and expectations of clubs, coaches, fans and players themselves can reinforce feelings of isolation and loneliness (Storch and Ohslon, 2009), which discourage those experiencing mental illness to seek help. Compounding this sense of isolation are the physical, mental and emotional demands of elite athleticism partnered with the debilitating stigma that is rampart within the industry (Griffin, 2013).n I response to the needs of such an underserviced population, this report assesses the effectiveness of the Mental Health First Aid course, for stakeholders across the National Rugby League (NRL), and their responses to the course. This course is run over one or two days, depending on the availability of each cohort, and provides an overview of a range of mental illnesses, their symptoms, and how lay people can be better trained in assessing symptoms and referring those in need to mental health care professionals.

Keywords first, evaluation, health, mental, delivering, (nrl):, league, rugby, national, within, course, (mhfa), aid, report

Disciplines Education | Social and Behavioral Sciences

Publication Details Ravulo, J. (2015). Delivering the Mental Health First Aid (MHFA) Course within the National Rugby League (NRL): Evaluation Report. Western Sydney University.

This report is available at Research Online: https://ro.uow.edu.au/sspapers/3890 DELIVERING THE MENTAL HEALTH FIRST AID (MHFA) COURSE WITHIN THE NATIONAL RUGBY LEAGUE (NRL): Evaluation Report

November 2015 ACKNOWLEDGEMENTS

Evaluation Manager: Dr. Jioji Ravulo Evaluation Support: Shannon Said School of Social Sciences & Psychology WESTERN SYDNEY UNIVERSITY

Welfare & Education National Manager: Paul Heptonstall NATIONAL RUGBY LEAGUE

© Jioji Ravulo 2015 Western Sydney University ISBN: 978-1-74108-380-4 Introduction

Mental illness is a reality for many Australians. fans and players themselves can reinforce The National Survey of Mental Health feelings of isolation and loneliness (Storch and Wellbeing, conducted in 2007 with and Ohslon, 2009), which discourage those people aged 16-85, revealed that one in experiencing mental illness to seek help. five Australians, or 3.2 million people, had a Compounding this sense of isolation are the 12-month mental disorder (a mental illness physical, mental and emotional demands occurring 12 months before the survey took of elite athleticism partnered with the place) (ABS, 2007). The survey further debilitating stigma that is rampart within the revealed that 16 million Australians (45%) sports industry (Griffin, 2013). In response within this age bracket suffered with a to the needs of such an underserviced mental illness at some point in their lives. population, this report assesses the While these findings are slowly becoming effectiveness of the Mental Health First Aid public knowledge, there is still a limited course, for stakeholders across the National understanding amongst laypeople regarding Rugby League (NRL), and their responses to the overt and more covert symptoms of the course. This course is run over one or two mental illness, as well as appropriate methods days, depending on the availability of each of treatment and support for those that cohort, and provides an overview of a range struggle with such challenges in their daily of mental illnesses, their symptoms, and how lives. Despite popular opinion, elite athletes lay people can be better trained in assessing are not exempt from these statistics. The symptoms and referring those in need to pressures and expectations of clubs, coaches, mental health care professionals1.

1 More information about the course can be accessed from https://mhfa.com.au/.

DELIVERING THE MENTAL HEALTH FIRST AID (MHFA) COURSE WITHIN THE NATIONAL RUGBY LEAGUE (NRL): EVALUATION REPORT 3 Literature Review

TRENDS IN MENTAL HEALTH IN AUSTRALIA disadvantage, poor housing, lack of social 258). Of the mental illness symptoms cited, support and the level of access to, and use depression was noted as the most prevalent Trends within Australia’s general population of, health services” (ibid, no page numbers). (27.2%), followed by eating disorders (22.8%), reveal that one in five will be diagnosed with Once again, there appears a link between General Psychological Distress, (16.5%), social a mental illness at some point in their lives social services and the health of the general anxiety (14.7%), Generalised Anxiety Disorder, (ABS, 2007). The National Survey further population. 26% of those with a 12-month or GAD (7.1%) and Panic Disorder (4.5%). showed that anxiety disorders1, affective mental disorder stated that they felt “their disorders2 and substance abuse disorders3 are need for counselling [was not] met or only The presence of mental illnesses is further the most prevalent 12-month illnesses (those had their need partially met. A slightly higher reinforced by the fact that elite athletes recorded as happening within the 12 months proportion, 29% did not have their need experience “a heightened sense of social prior to the Survey) (ibid). These conditions for information met or only had their need and public evaluation” (Gulliver, Griffiths, are implicated by a range of population partially met”. Crampton (2014) further Mackinnon, Batterham, and Stanimirovic 2015, characteristics, such as one’s employment reiterates this concept in the case of elite- p.259), which could be a trigger to some of status, living arrangements, life experiences athletes performing at the 2000 Olympics, the aforementioned social mental disorders (homelessness, incarceration), and contact where support services were effective around (GAD, as well as social anxiety disorder). It with family and friends. One’s smoker status, the lead-up to the event, but did not sustain is suggested that young athletes be shown alcohol consumption, misuse of drugs, general afterwards. He argues that “organisations how to “perform their sporting-related roles levels of psychological distress, suicidal must show genuine concern for each effectively” (ibid), which could potentially behaviour, and disability status also have individual’s wellbeing by providing support bolster their resilience against these illnesses. bearing upon mental health. throughout a performer’s career” (p. 52, These conditions are not simply a part Comorbidity, or the occurrence of more emphasis original), and not wait until the point of athletes’ lives during their sporting than one disease or disorder, alongside the of personal crises and consequent debilitation careers, but can pervade later life, making use of support services for these mental before these services are utilised (p.46). it imperative for sporting institutions to health challenges, are also issues of concern. Considering the prevalence of mental health adhere to more diligent standards to ensure Of particular significance to this report is issues in the community at large, it seems that the health and prosperity of their players’ the reality that “More than a quarter (26%) significant promotion and development of wellbeing and personal longevity. Kerr, of people aged 16-24 years and a similar services is required so that consumers receive DeFreese and Marshall (2014) analyse data proportion (25%) of people aged 25-34 years the help they need. from 797 retired American sportspeople had a 12-month mental disorder compared via online surveys, which revealed trends with 5.9% of those aged 75-85 years” (ABS, MENTAL HEALTH AND ELITE ATHLETES that are consistent with the general U.S. 2007, no page numbers). As this is the prime Whilst there is a perception that elite population. For retired American Football age for NRL players to be at the peak of their athletes do not suffer from these conditions, players, these included “higher prevalences careers, it is incumbent upon clubs and other surveys completed with this population and earlier onset of Alzhemier’s disease and support services to know how to aid players suggest otherwise. Gulliver, Griffiths, osteoarthritis” (p.1), “significant memory that struggle in their mental health. This age Mackinnon, Batterham, and Stanimirovic problems, bodily pain, clinical diagnoses of group is also most susceptible to substance (2015) conducted an internet self-report mild cognitive impairment and depression” abuse: “Among all age groups…younger age survey of 244 Australian athletes from (p.7), lower recorded scores of “physical groups had higher prevalence of 12-month the Australian Institute of (AIS) and function, depression, fatigue, sleep and Substance Use disorders…Of the 2.5 million Australian sporting organisations funded by pain interference” (pp.2, 6-7), uncontrolled people aged 16-24 years, 13% (323,500) had the Australian Sports Commission, with an eating and alcohol dependence (p.5), and the a 12-month Substance Use disorder” (ABS, average age of 24.91 years (p.256, p.258). presence of injury as an important factor “in 2007, no page numbers). The survey asked questions around a range an athlete’s psychological response to career of demographic variables and mental transition” (p.7). For those athletes heading It has also been noted that there are “multiple health symptoms (ibid). The general results towards retirement, no social services exist to and integrating social, psychological, and highlighted that 46.4% of athletes experienced aid them in transitioning into this stage of life biological factors” (ABS, 2007, no page symptoms of at least one mental illness, which (pp.7-8). numbers) that impact upon the development were consistent when compared with similar of these conditions. These include “individual studies from other countries (i.e. France, p. or societal factors, including economic

2 These are: panic disorder, agoraphobia, social phobia, generalised anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. 3 These are: depressive episode (severe, moderate or mild), dysthymia, and bipolar affective disorder. 4 These are: alcohol harmful use, alcohol dependence, and drug use disorders.

4 WESTERN SYDNEY UNIVERSITY INJURY AND DEPRESSION temporary, which prompts the athlete to p.105). When athletes do resume training assume the pain was imaginary, only to after such an occurrence, they usually do so Despite evidence that high levels of physical have it resurface more violently at a later “just below the pain threshold” (p.108), which activity correlate with positive mental health time due to a lack of proper treatment (ibid, is a “short-term solution” that can “create (Gulliver, Griffiths, Mackinnon Batterham, p.105). Another reality that distorts the long-term problems” (p.109), and “[these] and Stanimirovic, 2015, p.255), many true picture of mental health in elite athlete athletes [are] risking further injury, [and] athletes suffer from depression amongst is the fact that they tend to “minimise the the psychological manifestations of training other ailments as a result of injury (Dietrich apparent signs of weakness…[and] sometimes under these conditions exacerbate the initial and Shuer, 1997), especially in relation to [athletes] resemble symptoms of mental distress” (Dietrich and Shuer, 1997, p.109). performance and failure-based depression disorders (e.g. meticulous attention to diet, This can result in protecting the injured part (Hammond, Gialloreto, Kubas and Davis, relative hyperactivity) thereby confounding of the body and consequently overtraining 2013). In an industry where performance recognition of illness” (Factor and Reardon, surrounding areas to compensate (ibid). is closely tied to one’s sense of worth and 2009, p.962). While the rate of diagnosis is As injury and the mental health of athletes identity, the personal significance of failure similar to that of the general population, “the are indelibly linked, serving one part of the is enhanced for elite athletes (Hammond, impact of the symptoms [are] exacerbated by athlete’s condition without the other only Gialloreto, Kubas and Davis, 2013, pp.276- high levels of pain” (p.964) that are a usual promotes a continued sense of “cognitive 277), and thus merits serious consideration part of an athlete’s training. dissonance” (ibid p.107). around the kinds of supports offered. Athletes are more susceptible to other challenges in These attitudes and practices encourage their mental health, such as a “heightened risk SEEKING HELP athletes to ignore and press through pain for suicide, citing possible risk factors such rather than seeking appropriate medical Elite athletes have stated several factors as injury, pressure to win, substance abuse, help. What starts as physical ailments can which inhibit them from seeking help from a and a comparatively early retirement from often lead to emotional and / or mental mental health professional: a lack of mental their professional career” (Gulliver, Griffiths, health problems. Minor injuries are similarly health literacy, negative past experiences of Mackinnon Batterham, and Stanimirovic ignored, until they affect the athlete “to help-seeking, and the overwhelming sense 2015, p.256). While these realities are well such a degree that is it apparent to coaches of stigma associated with accessing these understood by athletes and their coaches, and teammates alike” (Dietrich and Shuer, resources (Gulliver, Griffiths and Christensen, families and friends, there is little support 1997, p. 104). Rather than seeking assistance 2012; Yang, Peek-Asa, Corlette, Cheng, Foster for mental health awareness and treatment. at the first sign of symptoms, which could and Albright, 2007). Other barriers to seeking Dietrich and Shuer (1997) highlight that the prevent further difficulty, athletes tend to help are athletes not recognising they have “emotional distress experienced by athletes supress these, proving that the very culture a problem, which may result from a failure to with chronic injuries” (p.104) is not removed that ought to encourage peak performance discern emotions from symptoms of mental from the “constant state of pain and injury” actually hinders it in the case of dealing illness, not knowing when to seek help, and (ibid), and some athletes’ levels of trauma effectively with injury. “The numerous concern for expectations of others, namely have been recorded as comparable to the psychosocial ramifications of injury, including coaches, family and friends (Griffiths and trauma felt from experiencing a natural the disruption of social support networks, a Chistensen, 2012, pp.9-10). Conversely, having disaster (via a self-report battery called compromised relationship with coaches, and a working relationship with a health service the Impact of Scale Event, p.105). Many a possible change in playing position and professional, alongside a positive attitude athletes with constant injury avoid dealing team hierarchy, weigh heavily on the minds towards seeking help from family, friends and with it effectively, embodying the ethos of of injured athletes” (Dietrich and Shuer, 1997, coaches helps to facilitate help-seeking (ibid adages such as “no pain, no gain” and “hurt p. 104). Added to this, there is no real sense pp.167-168). is temporary, pride is forever” (Dietrich and of clear rehabilitation for mental / psychiatric Shuer, 1997, p. 104) reinforcing stereotypes issues: “Although modern technology has that athletes are “superheroes” whose increased the speed of physiological recovery, audiences rarely see the “emotional pain no equivalent inroads have been made in associated with injury and vulnerability” the psychological or psychiatric treatment (p.108). In the course of a training session, to facilitate mental health recovery” (ibid, the symptoms of a mental illness may retreat

DELIVERING THE MENTAL HEALTH FIRST AID (MHFA) COURSE WITHIN THE NATIONAL RUGBY LEAGUE (NRL): EVALUATION REPORT 5 Mental Health First Aid and The National Rughy League (NRL)

This report reflects upon the impacts of ≥≥Skills in how to recognise the signs and from a number of clubs: Sydney Roosters, teaching the Mental Health First Aid (MHFA) symptoms of mental health problems; Wests Tigers, St George Dragons, Mackay course to NRL players and NRL staff between ≥≥Knowledge of the possible causes or risk Cutters, Parramatta Eels, Melbourne Storm, November 2013 and July 2015, where a factors for these mental health problems; Vodafone Warriors, Manly total of eight courses were conducted over Sea Eagles, Bay Roskill Rugby League, ≥ Awareness of the evidenced based medical, a duration of 1 or 2 days, depending on the ≥ and Rugby League. The first five psychological and alternative treatments availability of the participating cohort. A total questions were measured on a scale of 1 available; of 120 responses were collected, reflecting (lowest score) to 10 (highest score). The attitudes and the experiences of players and ≥≥Skills in how to give appropriate initial following questions were asked: staff as a result of completing the course. A help and support someone experiencing a general overview of the course is given below, mental health problem; 1. How new was this material to you? followed by data analysis based on feedback ≥≥Skills in how to take appropriate action if 2. How easy was it to understand? forms that were completed by participants a crisis situation arises involving suicidal 3. How well was it presented? after course completion5. behaviour, panic attack, stress reaction to How relevant was the content for you? trauma, overdose or threatening psychotic 4. The MHFA Course behaviour. 5. How suitable was the venue? The MHFA course was developed by Betty Kitchener AM and Professor Tony Jorm in 2001 Over the years, the Standard MHFA course The second set of five questions asked for through Mental Health First Aid Australia, a has been the platform to create other personal reflections from participants. The national not-for-profit organisation focused specialised courses, including Youth MHFA, number of responses varied. The following on mental health training and research6. The Aboriginal and Torres Strait Islander MHFA questions were asked: MHFA course teaches strategies to members and Vietnamese MHFA9. MHFA Australia of the general public and specific population continues to work towards creating 1. What is your overall response to this groups, including Vietnamese, Indigenous sustainable opportunities to enhance course? (120 responses) Australian, Nursing students and those professional sectors to respond proactively 2. What do you consider to be the strengths of with an intellectual disability7. Courses are to mental health concerns by also creating the course? (120 responses) conducted by an accredited MHFA Instructor, adaptation of the material suited for a 3. What do you consider to be the weaknesses who is independent from the organisation particular sector, including Nursing and of the course? (108 responses) and delivers the programs to the general Medical Students, and Financial Counsellors. 4. Are there any other issues which you think public, or specific workplace where they are With the success of the course nationally, should be included in this course? employed. Several empirical studies have MHFA has also expanded to be delivered (101 responses) been undertaken on the effectiveness of the and adapted in over 20 countries around the MHFA with various stakeholder groups with world, including China, USA and South Africa. 5. How did you hear about this course? (114 most key finding suggested a positive impact responses) and affect on participants ability to assist In 2013, the NRL Welfare and Education people experience mental health issues8. National Manager, decided to introduce the Participants’ responses are presented below. Standard MHFA course as a means to bolster Questions 1 - 5 are presented in graphs. What do MHFA Course Participants Learn? mental health literacies across the game, and Reflection questions 6 – 9, which required MHFA courses teach mental health first aid to further promote organisational capacity in an open response from participants, is strategies to members of the public. Mental dealing effectively with mental health issues. A presented in the findings below as key ideas health first aid is the help provided to a designated Mental Health First Aid Instructor that were shared across the feedback forms. person who is developing a mental health was assigned with the task to subsequently That is, themes gained from the responses problem, or in a mental health-related crisis, implement the MHFA course across the given by participants are weaved into the until appropriate professional treatment is game; with an initial focus to have Welfare & first 5 questions, supporting the respective received or the crisis resolves. Course content Education and Career Coaching staff trained, weighted average provided under each graph. is derived from a number of consensus studies followed by Player Ambassadors and other key Question 10 is presented as a graph. Question incorporating the expertise of hundreds staff and players across the NRL. 5, “How suitable was the venue”, was not of researchers, clinicians, mental health present on the 2013 course feedback form, consumer advocates and carer advocates so this question had a total of 83 responses DATA ANALYSIS / DISCUSSION across the world. (compared to 120 for all other questions). Each survey consisted of ten questions taken Where number scores did not have any entries MHFA courses can provide members of the directly from the MHFA Course Evaluation (for example no participants entered 1 for community with: form to gauge participants’ responses to the newness of material in Question 1), they are course. In total, 120 responses were collated not included in the respective graphs.

5 Data was collated from the following feedback forms https://www.surveymonkey.com/r/NRLMHFAFeedback 6 Information from this and the next section taken from https://mhfa.com.au/about/our-activities/what-we-do-mental-health-first-aid 7 See https://mhfa.com.au/courses/public for the list of tailored versions of the course. 8 For a detailed reference list of such studies, including impact, visit https://mhfa.com.au/our-impact/our-global-impact 9 See https://mhfa.com.au/resources/mental-health-first-aid-downloads for the different formats of the MHFA course.

6 WESTERN SYDNEY UNIVERSITY Please see figure 1 (below). knowledge I now have” and “new tools to apply “Presenter made it easy to understand and share with my club and family and friends”, and broke down into everyday Given that 67.5% (81) respondents scored as well as having more confidence “to respond language.” 8-10 for the newness of material (Figure 1), appropriately”, especially in “situations I have not the MHFA course is filling a much needed yet encountered”. One participant found that “MHFA Instructor presented the void in mental health literacy within the NRL the course “gave a new clarity on the connection content in an easy to understand and community. This is reflected in participants’ between social pressure and mental illness”, practical manner, gave it relevance.” responses: showing that the course is not only providing “The delivery of content [was “Excellent course with a new more information, but is empowering those considered a strength] which can perspective on mental health. Need involved to understand less obvious issues that be mundane but because of the more courses available in this space.” impact upon mental health issues. Instructor’s approach…very well done.” “I found the content very interesting Please see figure 2 and 3 (below). and dispelled many myths about Given the stigma and general lack of As a result of the course content being mental health / illness. Gives me some understanding that surround mental health presented in a clear manner (Figure 3), some great tools to use going forward.” issues, and the fact that the course covers participants found that the information was a lot of information in a short time, it is vital “easy to absorb”, and “the instructor kept my “I found that mental health is a growing that presenters offer information in a clear, attention”. The manner of delivery was also issue in our community. Overall I’m concise and digestible manner (Figure 2). helpful in “making people feel comfortable empowered with the knowledge I now The presentation of content impacts on how ground” which was understood to “assist have on mental health.” well it is received, a concept reinforced by people discuss [a] difficult cultural topic”. participants’ experience: Other participants stated that completing the Participants found the diversity of delivery course was an “eye-opener” and “improved “I thoroughly enjoyed this course and modes (videos, role plays, and lecture- awareness and understanding”. As a result learnt quite a lot. There was a lot of style sharing) helpful and engaging, which of gaining more insight into these issues, information delivered exceptionally encouraged positive responses to the participants left feeling “empowered with the well.”

FIGURE 1: Newness of Material FIGURE 3: Presentation Quality

Weighted average: 7.87 Weighted Average: 9.74

FIGURE 2: Ease of Understanding

Weighted Average: 9.05

DELIVERING THE MENTAL HEALTH FIRST AID (MHFA) COURSE WITHIN THE NATIONAL RUGBY LEAGUE (NRL): EVALUATION REPORT 7 information being presented. Many stated that One of the most powerful quotes comes from the course, and spaces that facilitate role-plays the modes of presentation were “practical”, a participant who could identify deeply with and interactive participation from audiences. “engaging” and made use of “relevant the material that was presented: examples”. Another important element was Please see figure 5 (below). “Having lived with mental illness for the “presenter’s real life experience” and Most participants heard about the course the past 16 years, the MHFA Instructor that he “was really knowledgeable” and through their local NRL club (Figure 6). It is has shed a lot more light on my had a “professional manner”. The quality of probable that ‘work’ here indicates the NRL problems I face on a daily basis.” presentation therefore impacted upon the club which employs them at some capacity. ability of participants to engage with and The NRL Clubs that were mentioned are the This quote highlights the need to have assimilate the information offered, which is Sydney Roosters, West Tigers, St George meaningful forums such as the MHFA course, attested to by the weighted average of 9.74, Dragons, Parramatta Eels, Melbourne Storm, but further, for all those involved in NRL clubs, the highest of all score averages. Manly Sea Eagles, New Zealand Vodafone be they players, support staff, coaches, and Warriors, Bay Roskill Rugby League, Please see figure 4 (below). even family and friends of players, to do their Queensland Rugby League, Mackay Cutters part in facilitating healthy conversations Many respondents felt “empowered” by what and . The NRL RLPA around this often neglected topic; and they had learned, and now possessed “a (Rugby League Players’ Association10) and develop a working knowledge of how to better understanding of what may be relevant NRL HQ11 were also listed. Some participants respond appropriately to those in need. reasons why people do specific things”. The highlighted individual members from these data shows that mental health is an issue Please see figure 5 (below). clubs who invited them to take part in this that NRL players and staff considered very course. Their roles were listed as welfare and relevant to their context, as almost 95% Although the choice of venue may appear education officers, development officers, scored 8-10 for this question. Understanding a trivial concern, the course presents a vast HR managers, accreditation managers and the relevance of such information (Figure amount of information in a relatively short bosses and managers. Other comprised of ‘nil’ 4), combined with effective delivery, are key amount of time (1 or 2 days, depending on (unknown meaning) and email correspondence elements in improving mental health literacy the availability of the participating cohort). advertising the course. The work of the amongst such groups, empowering them to Effective learning spaces are more conducive NRL in promoting this program is kindly make a difference in their communities and to effective learning, so this ought to be acknowledged, and it is seen as beneficial for clubs, and shifting mindsets and challenging considered by those offering the course (Figure more stakeholders across the organisation to stigmas that disable conversations around 5). Useful features of such learning spaces do the same in seeking to equip their players, mental health. include access to projector screens to show staff and communities with the MHFA course. demonstration film clips, which make up part of

FIGURE 4: Relevance of Materiall FIGURE 6: Recruitment into course

Weighted Average: 9.17

FIGURE 5: Suitability of Venue

Weighted Average: 9.02

10 More information available from http://www.rlpa.com.au/ 11 More information available from http://www.smh.com.au/rugby-league

8 WESTERN SYDNEY UNIVERSITY Recommendations

On further reviewing responses from ≥≥More focus on depression, and the role of Questions 8 & 9 of the MHFA evaluation substance abuse in depression and suicide form (areas of development and possible inclusions), some participants mentioned that ≥≥Mental health in 16 - 30 year olds, and they would like to find out more information formulating this program for Junior Rugby about mental health, and requested a follow- League up course be developed. Others stated that they would like to see more attention given to ≥≥The relationship between mental illness and the following areas: sporting injuries

≥≥More national and international examples ≥≥The relationship between body image, food, and eating disorders ≥≥More effective breakdown “with engagement tools” ≥≥The impact of bullying and peer pressure.

≥≥Use of more specific case studies from a Implementing these recommendations into Rugby League context future delivery of the course would be fruitful for NRL communities, as they deal with the ≥≥More focus on cultural / linguistic / above issues on a regular basis. While the religious difference and sensitivity, and the information that was presented has been application of this Western mental first aid shown to be helpful in raising awareness and within these diverse perspectives helping to shift mindsets and club culture, addressing the above issues will do even more ≥≥Further information on the use of to provide support and a firm knowledge prescription drugs and their effect on base for players, staff and those who support mental health them. This, in turn, will promote healthy and professional conversations around mental ≥≥The relationship between gambling and health and wellbeing within and across these mental health communities.

≥≥Other addictions (including tobacco), and how their psychological, biological and behavioural implications

DELIVERING THE MENTAL HEALTH FIRST AID (MHFA) COURSE WITHIN THE NATIONAL RUGBY LEAGUE (NRL): EVALUATION REPORT 9 Conclusion

The literature explored in this report highlights culture and mindsets around mental health the prevalence of mental health issues and encourage dialogue around a topic that within the general population alongside the has for too long been considered taboo need of mental health literacy within the and a source of confusion and shame. NRL general population. As a result of this lack players are, on the whole, considered to be of accurate information, stigmas emerge role models within the community, especially that shape perceptions of and interactions in the eyes of aspiring football players and with mental health, especially in elite sports fans. If these players are able to show the like Rugby League. It is therefore important acceptability and normalcy of being able to for organisations like the NRL and others to speak out on issues around mental health, equip their staff members and players with this can have a considerable effect on sound knowledge around mental health, breaking down stigmas and engaging with and provide support to players who face the community at large, encouraging more mental health challenges, as well as to their deliberate and informed conversations around colleagues, to ensure that there is consistent this often misunderstood reality. Ongoing and professional support at hand at all times public initiatives like the NRL State of Mind12 for all community members seeking advice campaign continue to support such efforts, or professional assistance. The MHFA course and further reiterate the importance of having is a vital tool in promoting and providing a shared vision on responding effectively to support networks for NRL clubs. This course mental health issues through innovative and has the potential to shift organisational engaging resources.

12 More information on this campaign can be found via their website: http://www.nrlstateofmind.com.au

10 WESTERN SYDNEY UNIVERSITY References

Australian Bureau of Statistics (ABS) 2007, Hammond, T., Gialloreto, C., & Kubas, H. National Survey of Mental Health and (2013). The Prevalence of Failure-Based Wellbeing: Summary of Results, Cat. no. Depression Among Elite Athletes. Clinical 4326.0, ABS, Canberra. Retrieved from http:// Journal of Sports Medicine, 23, 273–277. www.abs.gov.au/ Jingzhen, Y., Corinne, P.-A., Corlette, J. D., Crampton, J. (2014). Depression in elite Cheng, G., Foster, D. T., & Albright, J. (2007). athletes : are we doing enough ? Sport Prevalence of and Risk Factors Associated Psychologist, 32(3), 45–53. with Symptoms of Depression in Competitive Collegiate Student Athletes. Clinical Journal of Dietrich, M., & Shuer, M. (1997). Psychological Sports Medicine, 17(6), 481–487. effects of chronic injury in elite athletes, 2 (March 1996), 104–111. Kerr, Z. Y., DeFreese, J. D., & Marshall, S. W. (2014). Current Physical and Mental Health Factor, R. M., & Reardon, C. L. (2009). Sport of Former Collegiate Athletes. Orthopaedic psychiatry: a systematic review of diagnosis Journal of Sports Medicine, 2(8), 1–9. http:// and medical treatment of mental illness in doi.org/10.1177/2325967114544107 athletes. Sports Medicine, 11 (40), p961 – 980. Storch, J., & Ohlson, M. (2009). Student Gulliver, A., Griffiths, K. M., & Christensen, Services and Student Athletes in Community H. (2012). Barriers and facilitators to mental Colleges. New Directions for Community health help-seeking for young elite athletes: a Colleges, (147), 75–84. http://doi.org/10.1002/ qualitative study. BMC Psychiatry, 12(1), 157– cc 170. http://doi.org/10.1186/1471-244X-12-157

Gulliver, A., Griffiths, K. M., Mackinnon, A., Batterham, P. J., & Stanimirovic, R. (2014). The mental health of Australian elite athletes. Journal of Science and Medicine in Sport, 18(3), 255–261. http://doi.org/10.1016/j. jsams.2014.04.006

DELIVERING THE MENTAL HEALTH FIRST AID (MHFA) COURSE WITHIN THE NATIONAL RUGBY LEAGUE (NRL): EVALUATION REPORT 11 Contact information Dr Jioji Ravulo +61 2 9772 6482 [email protected]

Western Sydney University Locked Bag 1797 Penrith NSW 2751 Australia

WESTERNSYDNEY.EDU.AU