Examining sports coaches’ mental health literacy: evidence from UK athletics

ABSTRACT

There is increasing interest in the role sports coaches are expected to play in supporting the mental health of elite and sub-elite athletes. This paper presents the first single-sport, mixed-methods, study of UK athletics coaches’ mental health literacy (MHL). We extend previous quantitative survey-based UK studies by incorporating the qualitative lived experiences of coaches into the analysis. We explore coaches’ knowledge of mental health and illness, experience of mental health training, and willingness to support athletes with mental illness. An online survey of 184 UK athletics coaches revealed that MHL was highest among women, younger coaches, and coaches with less experience. No statistical differences were found between MHL score and disability, sexuality or region in which coaches worked. Interviews held with a sub-sample of 25 survey respondents revealed a lack of clear consensus about what constitutes mental health and mental illness, and that coaches’ everyday views of these did not always correspond with formal definitions or conceptualisations. Coaches’ views were instead typically characterised by dominant psychological and psychiatric understandings of mental health and illness, while the significance of social relations and inequalities were often overlooked. There was a general willingness among coaches to support athlete mental health as an aspect of their duty of care, but most lacked the relevant training and understanding to do so effectively because such training was not implemented systematically within their organisational practice. Coaches’ call for mandatory athletics-specific mental health training was one strategy thought to better enhance coaches’ skills, knowledge and intentions to provide and seek mental health support. Important though MHL training and other sources of support is, we conclude that this is likely insufficient on its own and that there is a parallel need for multi-level, systems-wide, approaches in sport and wider society to better support the mental health of everyone.

KEYWORDS:

• Athletics
• coaching
• education
• mental health
• mental illness

Introduction

Set in the context of global concern about the mental health of individuals, communities, and whole populations (WHO, 2020), there is increasing interest in the role sports coaches are expected to play in supporting the mental health of elite, and to a much lesser extent, sub-elite, athletes (Smith et al., 2020; Smith & Greenough, 2023; Vella, Schweickle, Sutcliffe, et al., 2021; Vella, Swann, and Tamminen, 2021). The importance of coaches’ role in supporting athlete mental health (typically at elite level) has been articulated in various international consensus statements and position stands (see Breslin et al., 2019; Smith & Greenough, 2023; Vella, Schweickle, Sutcliffe, et al., 2021). Mental health literacy (MHL) programmes intended to support coaches to fulfil this role have also been developed, with much of the existing research (reviewed below) being conducted in Australia (e.g. Ferguson et al., 2019; Gulliver et al., 2012; Mazzer & Rickwood, 2015a, 2015b; Vella, Schweickle, Sutcliffe, et al., 2021; Vella, Swann, Batterham, et al., 2021). In contrast, very little is currently known about coaches’ MHL in the United Kingdom (UK) where the limited research has been survey-based and multi-sport-focused (Duffy et al., 2021; Gorczynski et al., 2020; Smith et al., 2020).

In this paper, we extend existing UK-based studies by undertaking the first single-sport, mixed-methods, examination of UK athletics coaches’ MHL. Specifically, we explore coaches’ knowledge of mental health and illness, experience of mental health training, and willingness to support athletes with mental illness. We also discuss the practical implications of our findings, which will be important given the absence of substantial mental health content in athletics and many other UK coach education and development programmes (Smith & Greenough, 2023). Our findings are also important given continued coach-related duty of care concerns in sport, including in relation to: cultures of abuse and athlete maltreatment (McMahon et al., 2018; McMahon & McGannon, 2021); athlete experiences of mental illness, self-injury and suicidality (McMahon & McGannon, 2021; Smith, 2019); and coach-athlete relationships and body shaming (McMahon et al., 2022).

Before we examine these issues, however, it is important to understand that mental health is an ‘embedded aspect of social relations, organizations, identities and structures’ (Brossard & Chandler, 2022, p. 8; original emphasis). It is typically defined as ‘a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’ (WHO, 2014). Conceptualising mental health also requires an appreciation of the relationship between wellbeing (e.g. quality of life, social and emotional functioning) and mental illness (i.e. any health condition involving changes or alterations in thinking, mood or behaviour, or any combination of these, which can result from stressful experiences but also occur in the absence of them, WHO, 2014). An understanding of this two-continua model of mental health is essential if we are to adequately understand coaches’ MHL and the role they are expected to play in supporting athlete mental health.

Sports coaches’ mental health literacy and training

As Jorm (2012) has noted, MHL refers to knowledge, beliefs and attitudes about mental health and mental illness, and the potential actions needed to support one’s own and others’ mental health through symptom recognition, management and prevention. In a coaching context, brief MHL training (including Mental Health First Aid) focusing on knowledge and action (Jorm, 2012; Kitchener & Jorm, 2008) has been promoted as a potentially effective way of increasing coaches’ knowledge of the signs and symptoms of mental illness (e.g. depression, anxiety) and how mental illness and wellbeing are distinct components of mental health (Keyes, 2002; Westerhof & Keyes, 2010). Improving MHL has also been shown to be important for increasing coaches’ confidence to provide mental health support to others (Mazzer & Rickwood, 2009, 2015a, p. 2015b; Ferguson et al., 2019; Vella et al., 2022).

Although evidence-based, appropriately resourced and supported, coach-specific MHL training has several benefits for coaches, coach MHL has been rarely acknowledged as important, or implemented systematically, by organisations (Breslin et al., 2017; Breslin et al., 2022; Gorczynski et al., 2020; Smith & Greenough, 2023; Swann et al., 2018; Vella et al., 2022). This is despite evidence suggesting that many coaches recognise they have a role to play in the identification, referral and prevention of athlete mental health problems, in the facilitation of athlete wellbeing, and in fostering good mental health through positive coach-athlete relationships where symptoms can be discussed directly with athletes (Ferguson et al., 2019; Gulliver et al., 2012; Mazzer & Rickwood, 2015a, 2015b; Purcell et al., 2022; Vella et al., 2022). In Australia, for example, alongside parents and family, coaches have also been shown to be important mental health supports for young people, especially to those who perceive their coach to be knowledgeable, trustworthy, and supportive (Ferguson et al., 2019; Mazzer & Rickwood, 2015a, 2015b; Swann et al., 2018). A study of the MHL of Gaelic games coaches of young people in Ireland also reported significant indirect effects of improved MHL for coaches’ engagement in mental health promotion, prevention and early intervention via role breadth (i.e. increasing coaches’ acceptance that athlete mental health support is part of their role) and role efficacy (i.e. perceived competence in providing mental health support (Duffy et al., 2021)). Since coaches provided an important alternative source of initial mental health support for young people, it was concluded that improving MHL will better prepare coaches to identify the early signs and symptoms of mental illness among young people and signpost them to appropriately qualified mental health professionals (Duffy et al., 2021).

A survey of the MHL of 103 UK coaches concluded that women had higher MHL than men, but no statistically significant differences were found between MHL and age, ethnicity, and sexuality (Gorczynski et al., 2020). In addition, MHL was not associated with seeking help from others, distress, or wellbeing, but heterosexual coaches had lower distress scores than bisexual or gay coaches (Gorczynski et al., 2020). More gender-sensitive MHL training programmes which focus on the knowledge, attitudes and actions of diverse groups of men and women, were thus recommended (Gorczynski et al., 2020).

However, a vital pre-requisite for the development and implementation of ‘holistic evidence-based, context-specific mental health programmes for coaches which are accessible, practical and proportionate to the mental health needs of participants’ (Smith & Greenough, 2023, p. 188), is an adequate understanding of coaches’ current MHL. As we noted above, however, very little is currently known about UK coaches’ MHL and no studies have so far explored the MHL of UK coaches working in athletics. This is perhaps surprising since athletics has been among the more progressive national governing body (NGB) sports which has recently endeavoured to promote mental health in the UK, including through the #RunAndTalk programme and the Mental Health Champions scheme led by England Athletics. However, there is currently no mandatory training for athletics coaches at any level in the UK, and only one voluntary course available (an online safeguarding and duty of care course provided by EduCare for Sport and endorsed by UK Athletics), which coaches must self-fund (England Athletics, 2018). It was thus anticipated at the outset of our study that athletics coaches were likely to have diverse experiences (if any) of mental health training and work across different participation levels (community/grassroots to elite) which might shape their MHL. An outline of how we conducted the study is provided next.

Research methods

Measures

This study adopted a mixed-methods approach to the study of coaches’ MHL and incorporated an online quantitative survey and follow-up qualitative semi-structured interviews with a sub-sample of survey respondents.

Mental health literacy scale (MHLS)

Participants were invited to complete the validated Mental Health Literacy Scale (MHLS), a 35-item measure of MHL (O’Connor & Casey, 2015) assessing disorder recognition, knowledge of help-seeking information, knowledge of risk factors and causes, knowledge of professional treatments, and attitudes towards promoting mental health and help-seeking behaviours. The MHLS scores range from 35 to 160, with higher scores indicating higher MHL. The MHLS has good internal consistency (α = .87) and test-retest reliability (r = 0.797, p < 0.001) (O’Connor & Casey, 2015). Alterations were made to questions 9 and 10 to reflect the study context, where ‘Australia’ was substituted with ‘UK’, as Gorczynski et al. (2020) have also done previously.

To capture additional demographic information from coaches, survey respondents were asked to provide separate information on age, gender, sexuality, disability, years of coaching experience, coaching level (i.e. beginner, county level, national or international), and the country (England, Northern Ireland, Scotland, Wales) in which they coach. They were also asked whether they were willing to coach a new athlete with a known mental illness, or a current athlete who subsequently experiences a mental illness, to help contextualise the MHL scores. The survey could only be completed once and each respondent was allocated a unique anonymous identifier to help analyse the data.

Semi-structured interviews

At the end of the online survey, participants were given the option to indicate their willingness to take part in a short audio-recorded semi-structured interview by including their name and email address, thus waiving their right to anonymity. The interviews were intended to incorporate coaches’ lived qualitative experiences into our quantitative analyses of their MHL. They explored participants’ survey responses as well as their knowledge of the two-continua model of mental health and illness, their social relations with others, experience of mental health training, and willingness to support athletes with mental illness.

Participants

Overall, 184 coaches aged 19-79-years-old (50.08 ± 14.44 yrs) completed an online MHL survey. Approximately two-thirds of respondents self-identified as male (n = 116), heterosexual (n = 173), not disabled (n = 173), and coached in England (n = 156) (Table 1). Similar proportions of respondents had been coaching for 0–5 years (n = 54), 6–10 years (n = 48), or more than 20 years (n = 50), while one-third of respondents coached at County (n = 61) and National (n = 57) levels, respectively. Most respondents (92%) stated that they would be definitely willing (n = 94) or willing (n = 76) to start coaching an athlete with a known pre-existing mental illness. Respondents also stated they would be definitely willing (n = 119) or willing (n = 56) to continue coaching an athlete they currently coach if they subsequently developed a mental illness (Table 2).

Table 1. Biographical details of survey respondents.

	N	%^a
Gender
Male	116	63
Female	66	36
Prefer not to say	2	1
Sexuality
Heterosexual	173	94
Gay/Homosexual	2	1
Bisexual	2	1
Asexual	1	0.5
Did not answer	6	3
Disability
Disabled	10	5
Not Disabled	173	94
Did not answer	1	0.5
Years coaching
0–5 years	54	29
6–10 years	48	26
11–15 years	17	9
16–20 years	15	8
>20 years	50	27
Coaching level Beginner	30	16
County	61	33
National	57	31
International	36	20
Country
England	156	85
Scotland	13	7
Wales	12	7
Northern Ireland	3	1
TOTAL	184

^a Totals may not equal 100 due to rounding.

Table 2. Coaches’ willingness to coach athletes with a mental illness.

		N	%
How willing would you be to start coaching an athlete with a pre-existing mental illness?	Definitely Willing	94	51
	Willing	76	41
	Neither Willing or Unwilling	13	7
	Unwilling	1	1
	Definitely Unwilling	0	0
How willing would you be to continue coaching an athlete if they developed a mental illness?	Definitely Willing	119	65
	Willing	56	30
	Neither Willing or Unwilling	8	4
	Unwilling	1	1
	Definitely Unwilling	0	0
	Overall	184	100

The sub-sample of survey respondents (n = 10 women, n = 15 men) aged between 22 and 72 years old (48.8 ± 16.1 yrs) also completed semi-structured interviews (Table 3). Most self-reported as heterosexual and non-disabled, while just over one-third had been coaching for 0–5 years and one-quarter had been coaching for more than 20 years. Similar proportions of interviewees coached at Beginner, County, National, and International level, and most coached in England (80%) (Table 3). Individual-level biographical details are presented in Table 4.

Table 3. Overall sample of interviewees.

	N	%^a
Gender
Male	15	60
Female	15	60
Sexuality	10	40
Heterosexual	23	92
Gay/Homosexual	1	4
Asexual disability	1	4
Disabled	2	8
Not Disabled	23	92
Years coaching
0-5 years	9	36
6–10 years	5	20
11–15 years	1	4
16–20 years	4	16
>20 years	6	24
Coaching level
Beginner	5	20
County	6	24
National	7	28
International	7	28
Country
England	20	80
Scotland	3	12
Wales	1	4
Northern Ireland	1	4
Total	25

^a Totals may not equal 100 due to rounding.

Table 4. Biographical details of interviewees.

Pseudonym	Age	Gender	Sexuality	Disability	Time coaching (years)	Coaching level	Region
Aaron	22	Male	Heterosexual	No	0–5	National	England
Bethany	29	Female	Heterosexual	No	0–5	County	Scotland
Colin	33	Male	Heterosexual	Yes	11–15	International	England
David	72	Male	Heterosexual	No	>20	International	Wales
Eeric	70	Male	Heterosexual	No	>20	International	England
Fatima	54	Female	Heterosexual	No	6–10	Beginner	England
Grace	52	Female	Heterosexual	No	6–10	International	N. Ireland
Harvey	71	Male	Heterosexual	No	>20	International	England
Ian	22	Male	Heterosexual	No	0–5	National	England
Jackson	25	Male	Heterosexual	No	0–5	County	England
Kate	50	Female	Heterosexual	No	6–10	Beginner	England
Liam	63	Male	Heterosexual	No	>20	County	England
Maria	55	Female	Heterosexual	No	0–5	National	England
Nadia	24	Female	Heterosexual	No	0–5	Beginner	Scotland
Oscar	70	Male	Heterosexual	No	16–20	National	England
Phillip	52	Male	Gay	No	>20	National	England
Liz	53	Female	Heterosexual	No	6–10	National	Scotland
Ruth	43	Female	Asexual	No	0–5	Beginner	England
Stephen	61	Male	Heterosexual	Yes	6–10	National	England
Toby	58	Male	Heterosexual	No	16–20	County	England
Paul	51	Male	Heterosexual	No	16–20	International	England
Vince	46	Male	Heterosexual	No	0–5	County	England
William	39	Male	Heterosexual	No	16–20	International	England
Seb	57	Male	Heterosexual	No	0–5	Beginner	England
Yasmin	48	Female	Heterosexual	No	>20	County	England

Procedures

Following receipt of institutional ethical approval, a non-probability purposive sampling strategy was used to recruit qualified UK athletics coaches via an online survey which was distributed between mid-October and mid-November 2020. Known track and field athletics coaches or clubs were encouraged to complete the survey via email or direct message on social media, while other coaches were invited to participate via social media advertisements. The survey was available for completion for four weeks and coaches were invited to participate if they met the inclusion criteria, namely: being aged 18-years-old or above and a qualified UK athletics coach. The survey was administered through SoGoSurvey software, no time limits were imposed on the participants to complete the survey, and no incentives were offered. Coaches’ consent was obtained by the return of their completed survey responses.

The survey respondents who were willing to be interviewed (n = 115) were divided into three groups of coaches using the calculated MHLS scores: (i) below 115; (ii) between 123 and 131 (the average MHL score reported by Gorczynski et al., 2020 and Sullivan et al., 2019); or (iii) over 140. To equally represent coaches in each of the three groups, 30 of the 115 respondents (n = 10 per group) who agreed to be interviewed were purposively sampled. Of these coaches, 25 participated, having provided written and verbal consent. The remaining five respondents withdrew consent or did not reply to follow-up requests. All interviews were audio-recorded, held virtually during November and December 2020 via Zoom, Facetime or Microsoft Teams, and each lasted up to 35 min.

Quantitative results: coaches’ mental health literacy

Differences in MHL scores according to gender, disability, sexuality, coaching experience, coaching level and region were calculated with SPSS (v26.0) using Kruskal–Wallis H (to assess differences in scores between groups) and Jonckheere-Terpstra (used to determine the significance of a trend in the data, e.g. whether MHL declines as years of coaching experience increase) tests and an alpha level of 0.05. The assumptions for both were met and the data were observed as non-parametric. Other descriptive statistics were calculated and are presented in Table 5.

Table 5. Survey respondents’ mental health literacy scores.

	M	SD	%^a
Gender
Male	128.1	11.7	63
Female	132.2	11.6	36
Sexuality
Heterosexual	129.7	11.8	94
Gay/Homosexual	130.5	17.7	1
Bisexual	124.5	7.8	1
Asexual	145.0	0	1
Disability
Disabled	130.0	11.8	5
Not Disabled	129.5	11.8	94
Years coaching
0–5 years	131.3	12.3	29
6–10 years	129.6	12.8	26
11–15 years	130.3	9.1	9
16–20 years	128.5	12.1	8
>20 years	127.4	10.9	27
Coaching level
Beginners	132.6	12.2	16
County	131.7	11.9	33
National	127.1	11.4	31
International	126.8	10.9	20
Country
England	128.9	11.9	85
Scotland	133.2	11.9	7
Wales	131.8	8.3	7
Northern Ireland	131.0	18.6	2
Total	129.5	11.8	184

^a Totals may not equal 100 due to rounding.

The average MHL score for all UK athletics coaches was 129.5 ± 11.8 (range = 98 –154, 95% CI = 127.8-131.2), which is notably higher than that for the UK coaches in Gorczynski et al.’s (2020) sample (123.1), but lower than those reported in other coaching studies (131.2) (Sullivan et al., 2019). Excluding the two respondents who did not indicate their gender, there was a significant difference between males’ and females’ MHL scores, with females scoring significantly higher (132.2 ± 11.57) than men (128.1 ± 11.73) (x2(2) = 4.608, p = .032). A statistically significant negative pattern was also observed between coaching level and MHL score, where a higher coaching level was typically associated with a lower MHL score (x2(3) = 7.838, p = 0.49; TJT = 2.671, p = .008). These findings for gender, and coaching level, are consistent with earlier studies (Gorczynski et al., 2020; Sullivan et al., 2019) which suggests that while the cultural contexts of individual sports such as athletics might be important, gender and coaching level appear to play a relatively independent role in shaping coaches’ MHL.

Indeed, our data suggest that gender was related to coaches’ MHL, irrespective of coaching experience. Although non-significant, when grouped by coaching experience, it was notable that there was a general decline in MHL score as the years of coaching experience increased (TJT = 1.613, p = .107). Females, however, reported higher MHL than males for those with 0-5, 6-11, and 11–15 years’ coaching experience, but no differences were apparent between males and females for coaches with >16 years’ experience (127.8 ± 11.9 vs. 127.6 ± 7.9, respectively). Based on our trend analysis, a negligible correlation between age and MHL score (r = −0.15, p = .038) was revealed (Figure 1), but no statistical differences in MHL score and disability (x2(1) = .074, p = .786), sexuality (x2(4) = 2.425, p = .489) or region (x2(3) = 1.829, p = .609) were observed. Finally, over nine-in-ten survey respondents indicated that they would be ‘definitely willing’ or ‘willing’ to start coaching or continue coaching an athlete with mental illness.

Figure 1. Relationship between mental health literacy score and age.

Qualitative results and discussion

Once completed, all semi-structured interviews were transcribed verbatim using Otter.ai software, and respondents assigned pseudonyms to ensure anonymity. Transcripts were analysed using reflexive thematic analysis (Braun & Clarke, 2019, 2022) to identify shared meaning and patterns of experience from the participants’ perspective. Informed by the literature reviewed above and the two-continua model of mental health, the transcripts were read and re-read, and then initial coding labels (e.g. ‘stress’, ‘wellbeing’, ‘confidence’, ‘signposting’) were identified in the margins before being revised over time. Once coding was complete, the first author identified larger patterns of shared meaning or experience across the transcripts to develop candidate themes (e.g. ‘duty of care and responsibilities’, ‘managing winning and welfare concerns’, ‘mandatory training and CPD’) illustrated by interviewee quotations (Braun & Clarke, 2019, 2022). The initial codes and candidate themes were reviewed by the last author and the first and last author then discussed how these could be refined further so that the final themes, and related participant quotations, could be constructed (Braun & Clarke, 2019, 2022). The final three themes, discussed next, were: (i) Healthy minds, cognitive wellbeing and clinical diagnoses; (ii) Mandatory training, empathetic understanding and the practical enactment of mental health literacy; and (iii) Negotiating boundaries, enacting responsibilities and duty of care for all athletes.

Healthy minds, cognitive wellbeing and clinical diagnoses

To adequately understand coaches’ ability to fulfil the roles they are often expected to play in supporting athlete mental health, and their MHL more widely, it is necessary to go beyond quantitative survey data and explore their complex understandings of mental health and illness (Brossard & Chandler, 2022; Keyes, 2002; Westerhof & Keyes, 2010). When asked to differentiate ‘mental health’ and ‘mental illness’, few coaches were able to articulate traditional often-cited definitions of these (WHO, 2014, 2020), or recognised, like Bethany, that ‘there’s a difference between mental illness and mental health and that we all have mental health’. For some coaches, mental health was conceptualised as lying along a spectrum, as Nadia suggested:

Mental health to me is a spectrum … you can be well or you can be unwell. And at any point, you will be somewhere along this spectrum … it's the same as physical health, basically, but in terms of emotional, mental states.

In emphasising the wellbeing dimension of mental health and how this related to everyday functioning, Kate, for example, also described mental health as:

a person’s sense of well-being, and whether they’re sort of, you know, you’ve got good mental health, you’re able to feel positive about life and function normally, and go to work and function socially. You know, in all different aspects of life.

More commonly, coaches often pointed towards the significance of cognitive functioning and the wellbeing of the mind before juxtaposing this with mental illness which was regarded as resulting largely from problems occurring in the brain. As Colin remarked:

Mental health is effectively the wellbeing of the mind … a healthy mind, but it [mental illness] tends to spring up when perhaps the mental health isn’t quite in balance. It's effectively when there’s a problem that the brain isn't currently coping with correctly. And that can come out in, in things like depression and anxiety or some sort of a side effect … when the brain is unable to cope with some sort of stimulus, whether that stimulus be stress or trauma. And that results in … the human behaviours being negative in some way, perhaps even destructive.

The lack of cognitive functioning thought to be associated with mental illness frequently led coaches to perceive mental illness as one which has necessarily been clinically diagnosed by a medical professional, as in the following extract taken from an interview with Vince:

Mental illness is perhaps when it’s had some sort of clinical definition … you’re clinically depressed or you have an eating disorder or something along those lines. And I think mental health is something that's with us all the time. But I think perhaps sometimes mental illness is more linked to some sort of medical or clinical diagnosis.

The emphasis coaches typically placed upon the formal diagnosis and medical treatment of mental illness was further captured by Maria, who stated:

To say that somebody had a mental illness, for me, would mean that they had sought professional help, got a diagnosis and were under some kind of treatment plan … I think that’s how I would differentiate between that and just mental health.

In contrast, very few coaches recognised that people could experience subclinical depression and anxiety, for example, and that for various reasons (including stigma and access to medical professionals) this might not necessarily be identified through a formal professional diagnosis which results in the prescription of medication, treatment plans or other forms of psychiatric support. In this regard, Ruth, who had previously been trained in Mental Health First Aid, explained how mental illness can refer to potentially diagnosable conditions like depression and anxiety:

[Mental illness] is where you’ve got a diagnosable condition … something like anxiety and depression … or it's something that's a passing thing like postpartum problems, or long-term condition … where a doctor or psychologist or psychiatrist has actually said you have a diagnosable illness.

Overall, it was clear that there was a lack of consensus among coaches about what constitutes mental health and mental illness, and that their everyday views of these did not always correspond with formal definitions or conceptualisations, perhaps because of variations in their MHL (Keyes, 2002; Westerhof & Keyes, 2010; WHO, 2014, 2020). Coaches’ views were instead typically characterised by dominant psychological and psychiatric understandings of mental health and illness, while the significance of social relations and inequalities for our experience of these were overlooked (Brossard & Chandler, 2022). This lack of clarity in coaches’ understanding emphasises the need for them to be provided with context-specific, evidence-based, appropriately resourced and supported, mental health training which better equip coaches with the necessary knowledge needed to optimise wellbeing and mental health in athletics (Ferguson et al., 2019; Mazzer & Rickwood, 2015a, 2015b; Smith & Greenough, 2023).

Mandatory training, empathetic understanding and the practical enactment of mental health literacy

As we noted earlier, in the UK there is currently no mandatory mental health training for athletics coaches at any level, though they can self-fund their engagement in an online safeguarding and duty of care course, which three interviewees had completed (England Athletics, 2018). Fourteen interviewees had also completed some form of self-sought mental health education (e.g. Mental Health First Aid). When asked about the mental health training and education available to support them, many of the coaches suggested it was too basic, superficial, and insufficiently related to the athletics context. Stephen, for example, described the EduCare course he attended as ‘Quite superficial, to say the least’ and that it contained ‘nothing specific to me [and had] no [face-to-face] contact in it, which I think that should be on that subject.’ Others, including Ruth, raised concerns about the disproportionate focus on, and preference for, training on the technical demands of athletics by many ‘in the coaching community [where] … we've got a lot of old men’ who were not perceived to be confident in addressing mental health. David also questioned whether the optional nature of mental health training would prove attractive compared to the focus on technical elements of coaching:

We’re starting to see more webinars are about mental health from the national government bodies than you did even a year ago. It’d all be technical … but now there’s also mental health. I just wonder how many coaches would look at five webinars, and two of them are mental health and go, ‘Ooh, those look good!’

Liz similarly argued that:

It’s all about listening to the athlete, but you never go through anything from a mental health side of things. It’s all about your … athletes … from a running, or sport point of view … So it may be worth then trying to incorporate something [on mental health] into the qualification … because it is a big part of sport.

In this regard, many coaches agreed with Ian who felt that there ‘should be mandatory modules on mental health … in athletics as part of every coaching qualification’, and that supporting athlete mental health was a more-or-less expected occupational demand (Ferguson et al., 2019; Mazzer & Rickwood, 2015a, 2015b). That mental health should also form a compulsory part of coaches’ continuing professional accreditation was also emphasised, including by Oscar who suggested:

They could make it mandatory … We all have to renew our coaching licence every three years. As part of that renewal, they could make it mandatory that we undertake some kind of … awareness test of mental health issues.

Echoing the findings of other studies (Smith et al., 2020; Vella, Schweickle, Sutcliffe, et al., 2021; Vella, Swann, & Tamminen, 2021 Vella, Swann, Batterham, et al., 2021;), our interviewees felt that the provision of more practical context-specific and evidence-based guidance was needed to better enable coaches to support the mental health of athletes and make appropriate referrals to specialist services and other support. Maria, for example, commented:

There's a whole set of guidelines … if you suspect that a child is being physically abused or mentally abused by somebody … I think if the governing body want coaches to do that for mental health as well then there needs to be some guidelines as to when it is appropriate to step in and what is appropriate to say to athletes, and when and what makes it appropriate that a coach … would pass that up the chain. At what point do you do more than suggest that an athlete seeks help? What point do you step up around the athlete and contact a professional to take over?

The provision of easily accessible web-based resources which enable coaches to signpost athletes to relevant support, and guidance on how coaches should manage mental health problems presented by athletes, was identified by other interviewees. These included Ian who personally experienced depression and who felt there should be:

some sort of really simple … flowcharts to go through [for when] … an athlete presented you with a problem … [There] should be a first step, second step, third step, and then knowing where to signpost them … They'd be kind of really helpful and good resources to have. And then … some sort of general kind of training on how to speak to someone as well … I know, when I'm feeling sort of in a depressive state, what helps me and what doesn't help me … you're always treading on eggshells that you could set them off by saying the wrong thing.

The provision of this type of mandatory and practical support, it was claimed, would help increase coaches’ MHL, confidence and general willingness to support others’ mental health as part of their role. This was a view expressed by Jackson who suggested:

I don’t think it's that coaches don't want to help … I think it’s a lack of confidence that a lot of coaches have, because … a lot of people wouldn't have … some mental health training … it’s as if you’re with the luck of the draw that you've got a coach who just on their own personal note cares a bit about it, and has a personal interest … But if [the coach] … doesn’t have that much of an interest, I think they're gonna completely lack confidence to step in for fear of making it worse.

In this regard, in the absence of any mandatory mental health training, many of the coaches in our sample were ‘unsure of what help was necessary and unsure of how to provide that help’ (Ferguson et al., 2019, p. 247; original emphases). For other coaches, personal experience of mental illness encouraged them to undertake training, including Mental Health First Aid, which helps increase coaches’ MHL and willingness to support others’ mental health (Ferguson et al., 2019; Mazzer & Rickwood, 2015a, 2015b). Bethany, for example, explained:

I’ve got my own personal experience … a lot of people … we interact with on a daily basis, whether that's through coaching or through your work, or family and friends, might be in need of a bit of support at times … I thought that the Mental Health First Aid training might be a good way to make myself a bit more prepared for those types of conversations and things that might crop up.

Ruth, who had been diagnosed with depression and anxiety, similarly outlined how her training and the mental health benefits of running underpinned her MHL as a coach:

I’m a mental health champion with England Athletics … I’ve done the Mental Health First Aid, the two-day course. And then I've … done the facilitator course [provided by Mind and Sport England] to teach people about mental health awareness for sport and physical activity … I’ve had some mental health challenges myself. I’ve been diagnosed with anxiety and depression after having my children … for me running is part of my coping strategy.

It is important to note, however, that the provision of mental health training was thought to benefit not just athletes, but coaches themselves, a point which is becoming increasingly recognised (Purcell et al., 2022; Smith et al., 2020; Smith & Greenough, 2023; Vella et al., 2022). Aaron emphasised the importance of supporting coach mental health through mandatory training provided by the NGB as follows:

If they [British Athletics] ever did mental health … I don’t want them to just look at the mental health of the athletes. I want them to look at the mental health of the coaches as well. Because … some of these coaches may be dealing with the same similar thing only at the stress of being a coach … Don’t ever just think about the athletes. There are always two people to think about as a coach, yourself and the athletes.

Overall, it was clear that among the coaches in our study there was a general willingness to engage with athlete mental health, but most of them lacked the relevant training and understanding to do so effectively because such training was not implemented systematically in organisational practice (Breslin et al., 2022; Gorczynski et al., 2020; Smith & Greenough, 2023; Swann et al., 2018; Vella et al., 2022). Coaches’ call for mandatory athletics-specific mental health training, as an aspect of their initial registration and CPD, was one strategy thought to better enhance coaches’ skills, knowledge and intentions to provide and seek mental health support (Ferguson et al., 2019; Purcell et al., 2022; Vella et al., 2022; Vella, Swann, Batterham, et al., 2021).

Negotiating boundaries, enacting responsibilities and duty of care for all athletes

Consistent with the findings of other studies (Duffy et al., 2021; Ferguson et al., 2019; Gulliver et al., 2012; Mazzer & Rickwood, 2015a, 2015b; Swann et al., 2018), the athletics coaches in our study accepted that supporting athlete mental health was perceived to be part of their role and duty of care responsibilities. Bethany, for example, explained that:

It's a kind of responsibility that we have to look out for each other … and to look out for athletes that we coach … our duty of care to them is that we provide an environment that's happy and that they feel safe, and that they can be themselves and not have any fear of judgement or anything like that. And I guess if things do come up where we're concerned about them … we have a plan and procedures in place.

The duty of care coaches felt they had to support athlete mental health was further discussed by Colin who said:

If I think there’s a [mental] health concern … I have a duty of care to potentially refer it to club welfare officers, potentially even social services if I think something’s very serious, to the police … If an athlete has a mental health issue it’s not my duty to treat it, but if there's anything I can do to help them with the situation [I will].

The importance of working within their professional boundaries, rather than as ‘mental health professionals’, was frequently emphasised by coaches, including Ruth who suggested:

If there was something where I was like, ‘Wow, you're at risk’, then I would be asking some hard questions about, you know, whether they've thought about harming themselves and that kind of stuff … There's kind of two angles I take. So, one will be listening, and just letting them talk and letting them sort of find their own path. And then I think the other one is signposting … because, you know, I'm not a mental health professional.

Other coaches expressed concern about how and who to refer athletes for support and about exacerbating their mental health problems. Grace summarised her concerns thus:

I’m sure I would panic and not know what to do for the best … that would be a common reaction … because you wouldn't want to make it worse. And you might think, ‘What do I actually say? And how do I signpost them?’.

Aaron similarly replied:

It’s one of those things that you don’t know how to react [to the athlete’s mental health problem] … even though there might be steps that are recommended to take. I will never know without the training. I may be doing the best for what I think, but is it actually the best route for the athlete?

Although they frequently recognised the duty of care they are expected to exercise in relation to individual athletes’ mental health (Smith, 2019; Smith & Greenough, 2023), several coaches were cognisant of the potential impact this might have on athletes’ teammates. As Toby said: ‘it's really difficult to focus on just one athlete, especially when it’s [mental illness] kind of non-athletic’, while Colin explained how ‘It depends on the mental health issue … what's causing that mental health issue … [and] if I felt it was going to pose a risk to the rest of the training group, or myself’. Stephen similarly outlined his approach thus:

I wouldn’t be against taking someone on, but I would have to consider … their difficulties, how I could help them if I could, and if the rest of the group could help them … and … whether or not that person's issues would burden the … health and welfare of the rest of the group. It depends what their problems are, how they're handling them, and where they're at.

Finally, the age of coaches was often cited as an important component of their MHL, with ‘younger’ more ‘modern’ coaches typically regarded as being most likely to be willing to support athlete mental health. David, aged 72, claimed:

The modern coach, the younger coach now who's coming through, will be far more open to … educate themselves better … the national coach or the top coach or any coach, in 10 years’ time, I hope, will be a far more well-informed individual than they are now. But what I see around me right now … is there's a tremendous level of ignorance. And, you know, the attitude would be ‘well, you're just too difficult’.

This was a view shared by Toby, aged 58, who felt his experience of working in mental health enabled him to better support athletes compared to other coaches who, in his view, find it more difficult to have mental health conversations:

Younger coaches are much more open to those sorts of issues, dealing with them. Older coaches tend not to be … I mean, I'm an older coach. I'm nearly 60 but because I'm in the mental health as a job, I just find it natural to talk about these sorts of things, whereas a lot of them don't. They just want to work on their training schedule.

The significance of coaches’ age, as articulated by coaches and reflected in our survey data, support the findings of previous studies which pointed to the significant (albeit weak) negative relationship between age and MHL (Sullivan et al., 2019), and between years of coaching experience and MHL (Gorczynski et al., 2020; Sullivan et al., 2019). It appeared that younger coaches, with fewer years of coaching experience, were more literate in mental health than older, more experienced, coaches and may have had more positive knowledge about, and attitudes towards, providing and seeking mental health support (Sullivan et al., 2019). As Gorczynski et al. (2020, p. 722) have noted, this may suggest that

new coaches may simply be more aware of poor mental health and may be less impacted by cultural aspects of sport (i.e. the development of bad habits), the impact of which may accrue over time, which may result in dismissing either the causes … of poor mental health or the symptoms of poor mental health.

Conclusions

In this paper we have provided the first single-sport, mixed-methods, examination of UK athletics coaches’ MHL and extended previous quantitative survey-based UK studies by incorporating the lived qualitative experiences of coaches into our analyses. Conducting semi-structured interviews alongside the validated MHLS has helped reveal coaches’ complex, and nuanced, experiences which underpin their MHL. In this regard, particular attention was drawn to the individual and collective significance of gender and coaching level, where MHL was highest among women, younger coaches, and coaches with fewer years of experience (Gorczynski et al., 2020; Sullivan et al., 2019). There is a clear need to ensure these groups retain their high levels of MHL while also supporting men, especially older men, to improve their MHL so they are better able to support others and themselves (Gorczynski et al., 2020). If coaches are to assume an expanded role which includes supporting athlete mental health, it is important that relevant, evidence-based, accessible resources and support are provided to enable them to fulfil this role as part of developmentally, socially and culturally appropriate mandatory training (Ferguson et al., 2019; Gorczynski et al., 2020; Purcell et al., 2022; Vella et al., 2022). Indeed, as Purcell et al. (2022, p. 8) have noted, participation in ‘psychoeducation about mental health should be a minimum compliance requirement that will convey the organization’s commitment to creating a cohesive understanding of mental wellbeing within the sporting environment.’

The provision of such MHL training might be a necessary condition for optimising athlete mental health and performance, supporting coaches’ mental health, and enabling NGBs and other organisations to achieve their objectives in these areas (Breslin et al., 2017; Breslin et al., 2022; Ferguson et al., 2019; Gorczynski et al., 2020; Purcell et al., 2022; Smith & Greenough, 2023; Vella et al., 2022). It is also important for coach developers and educators given the central role these groups play in the support, education, and development of coaches at all levels, including in relation to mental health (Smith & Greenough, 2023). Improving MHL through training and other sources of support clearly is, however, likely insufficient on its own (Gorczynski et al., 2020; Purcell et al., 2022; Smith & Greenough, 2023; Vella et al., 2022). It has been argued that there is a parallel need for multi-level, systems-wide, cultural change in sport to better prioritise and support mental health of all involved (Breslin et al., 2022; Gorczynski et al., 2020; Purcell et al., 2022; Vella et al., 2022). Adopting a systems approach means that MHL training should necessarily become embedded into the person-centred policies, programmes and practices of clubs and organisations, rather than focusing solely on the knowledge, actions and behaviours of individual coaches (Purcell et al., 2022; Vella et al., 2022).

Finally, it should be noted that sport-specific and systems-wide cultural change cannot be seen or occur effectively in isolation from the cultural changes needed in wider society where ‘mental health concerns inequalities, identities, cultural imaginaries, discriminations, politics, categorizations, capitalism and emotions, among many other things’ (Brossard & Chandler, 2022, p. 132). This is important for, as our data indicate, there exists among many athletics coaches a tendency to conceptualise mental health in largely psychological and psychiatric terms whilst often downplaying the significance of social relations and inequalities. The introduction of systems-wide approaches which include MHL training to enable coaches to optimise athlete wellbeing and prevent mental illness in sport, whilst simultaneously supporting positive mental health promotion and literacy in the wider society, is an important first step in addressing the deep-seated mental health inequalities and increasing prevalence of mental illness currently being witnessed in many countries across the world (WHO, 2020).

Disclosure statement

No potential conflict of interest was reported by the author(s).