Prevention and mental health promotion activities as well as regular mental health screening were identified as within the scope of the club doctor role. The participants strongly endorsed that club doctors should be aware of and engaged in whole-of-club mental health promotion activities, which should be evidence based, multidisciplinary and delivered by those with relevant expertise.
In line with these views, a comprehensive mental health framework has been proposed 3 for promotion of athlete mental health and well-being. This framework suggests that preventative components, such as mental health literacy training and screening tools are essential components within any elite or professional sporting context.
This standardised assessment tool is one example of an athlete specific screening tool that could be implemented in sporting programmes for early identification of mental health symptoms. Existing AFL concussion protocols mandate use of the SCAT5 17 which incorporates brief screening for psychological symptoms, and may be deemed sufficient. However, we also note emerging evidence of associations between concussion and mental health symptoms, 18 19 and this result may suggest a need for further training for club doctors in this area.
The participants strongly agreed that club doctors ultimately held the duty of care for player mental health; however, it was also agreed that within each club, a nominated health professional could be embedded to manage treatment coordination and ease administrative burdens on club doctors.
This nominated treatment coordinator would liaise closely with the club doctor, ensuring overall integrated management, while bringing relevant additional expertise. This view is consistent with recommendations 12 that appointed mental health officers could be a positive addition to multidisciplinary athlete support.
Regarding treatment, the participants agreed that if club doctors had relevant clinical expertise, they could conduct mental health assessments, manage pharmacotherapy and deliver initial evidence-based treatment. Club doctors who did not have relevant experience were still acknowledged to hold a duty of care and responsibility for oversight of treatment progress.
As such, club doctors would hold responsibility for treatment coordination, which could be delegated to a nominated club professional, while the club doctor maintained oversight.
Such an approach could facilitate the best use of professional expertise, while embedding consistent processes within the club and ideally contributing to an athlete-centred culture of care.
They also endorsed a recommendation that concurrent referrals to mental health professionals should be considered when the principal injury is physical, given significant overlap between injury and mental health decline. Such roles may create a conflict of interest for club doctors, 21 and could potentially jeopardise athlete-centred focus of care.
The participants endorsed standard protocols around patient confidentiality, following existing local legal and ethical protocols. There was also agreement for a focus on building mental health literacy for all club staff, particularly those in coaching roles or other direct player contact, to understand mental health disorders and encourage help seeking, as supported by other experts.
Lastly, with respect to illicit drug policies, the participants agreed that the only role of the club doctor was to coordinate evidence-based treatments for alcohol use disorders, whereas directly providing treatment for alcohol, gambling and substance use was beyond the scope of their role.
This last point highlighted the potential need for greater training in the management of gambling and substance use disorders for club doctors. To date, support for elite athlete mental health has focused on building mental health literacy and awareness 3 ; however, such an approach is insufficient without a comprehensive mental health system that can respond effectively to athlete needs, at the right time, the right place and with the right support.
Findings from this study provide a starting point for club doctors to address the varied mental health needs of professional team athletes which has been lacking in published literature, and supports existing calls to action. Investment in primary prevention and early intervention are an important part of stepped care approaches to mental health, and are an important part of a whole-of-club approach to ensure the club is capable of preventing athlete mental health disorders.
We note that while club doctors hold a duty of care, they cannot be solely responsible for player mental health and well-being. Within a stepped care approach, 22 23 engagement of expert tertiary resources is a valuable and efficient use of relevant expertise.
Within a given team or club, coaches, allied health staff, teammates and support staff, and external agencies such as the sport governing body, also have critical roles in management of player mental health within an integrated team.
To achieve this, a focus on professional clubs as mentally healthy workplaces, 24 where risk factors are identified and addressed, and protective factors maximised, requires input from all organisational levels. Such an approach includes a culture of mental health literacy and awareness, stigma reduction and increased capacity for individuals other than club doctors, such as teammates, coaches and other support staff, to intervene and promote early help seeking.
Therefore, specific and continuing mental health training should be a priority for club doctors in professional sporting contexts. While all medical practitioners receive mental health and psychiatry training during their medical degree, postgraduate training in mental health is limited. For sports and exercise registrars, the Australasian College of Sport and Exercise Physicians has recently developed a specific module, Sports Psychology for Sports Medicine , 27 in which non-trainees can also enrol.
However, regular, scheduled and ongoing professional mental health training for existing sports and exercise physicians may be helpful. A second noteworthy implication concerns the need for access to both internal and external mental health expertise.
Crucially, should an athlete require intervention due to emergent concerns, including deteriorating pre-existing mental health disorders, it is imperative that the club has a critical incident response plan for how to best assess the situation, bring together relevant and suitably qualified professionals especially in regard to lower prevalence conditions , formulate the planned strategy and implement a response, as per stepped care models.
Regardless of specific screening tools used, there was consensus on the importance of screening, as part of a comprehensive early identification and intervention model of care, 29 again consistent with recommended best practice in mental health management for Olympic and other elite athletes. This offers the opportunity to triage athletes into levels of mental health risk, and then ensure access to services and resources based on their current profile, enabling the earliest and most effective mental health management.
Lastly, issues of confidentiality within the professional club setting remain challenging for club doctors. To support this, education for coaching staff and developing a psychologically safe workplace within the club, are likely to create a climate in which athletes feel that such information can be safely shared. While our findings are of interest, we note some study limitations.
First, although the sample size was within recommended guidelines for a Delphi procedure, 15 it may not reflect the experiences and perspectives of all club doctors. In addition, participants were limited to club doctors and did not include primary mental health clinicians.
Although this privileges the opinion of club doctors, with varying levels of expertise in mental health, this research attempts to provide an initial consensus on the roles and responsibilities of the club doctor as determined by their own peer group. Further research is warranted to broaden the scope of opinion on the role of the club doctor through a multidisciplinary lens.
Third, participants surveyed work within a professional team sport operating in a single nation, in well-resourced clubs, where there are strong regulatory frameworks around mental health treatment provision.
As such, implications for other sports, or non-professional teams in less well-resourced environments, should be evaluated for applicability, as other professional team sports will have cultural-specific context and nuances.
Lastly, this study is based on consensus, which means that if new information becomes available, suggested domains may need to be amended accordingly. Ideally, future research will enable these questions to be further explored.
Our findings identify the important role that club doctors play in the management of athlete mental health in professional Australian Rules football teams. Our consensus recommendations outline the ways in which club doctors can effectively address the mental health needs of their athletes, while acknowledging their limitations.
A multidisciplinary team and a whole-of-club approach are needed to optimise prevention, early identification and treatment strategies to manage player mental health. The authors gratefully acknowledge the contributions and time of those club doctors who responded to and completed our surveys.
All authors have read and agreed to the submitted version of the manuscript. BW and TC are present and past medical doctors respectively at football clubs within the AFL competition, and have no other conflicts of interest to report. EMC and JB have no conflicts of interest to declare relevant to this paper. Provenance and peer review Not commissioned; externally peer reviewed.
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My car licence Driving is one of the riskiest daily activities that you'll do so preparing yourself and your vehicle is vital. My motorcycle licence Riding a motorcycle is enjoyed by people of all ages.
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Heavy vehicle inspections Heavy vehicle inspections required on change of ownership from Parents and supervisors Supervising a learner driver is a challenging experience. In addition, complex and troubling issues in the world have added urgency to the need for consideration of what knowledge, skills, and pedagogies schools should focus on in the curriculum into the future.
This article discusses views in the literature and research on how educators are grappling with the issues and tensions of internationalisation in Australian secondary schools. Education and Australian education. Curriculum and Curriculum and Pedagogy.
One of the greatest challenges that all teacher educators face is ensuring that our classes and programmes meet the learning needs of our students. We must prepare them to be effective teachers who can be responsive to current and future We must prepare them to be effective teachers who can be responsive to current and future educational concerns and issues. Australian national curriculum documents state that it is core work for schools to prepare students to function effectively in their personal and vocational lives in local and national settings, as well as in the wider global context.
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Examples are given of EFS programmes employing a whole-school approach in Australian schools, with special attention to programmes having a practical focus engaging students in real-world issues. The chapter concludes by reflecting on the experience of EFS and makes recommendations for the future stressing the qualities needed by young people to be honed by values and citizenship education in the context of a whole-school approach.
Environmental Education and Young People. Learning About Teaching more. Over the past three years we have been working together to develop and teach a third year subject Curriculum and Pedagogy in which intensive micro-teaching experiences are used to help student-teachers begin to learn about their own Over the past three years we have been working together to develop and teach a third year subject Curriculum and Pedagogy in which intensive micro-teaching experiences are used to help student-teachers begin to learn about their own teaching.
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This chapter therefore examines how we have come to see our practice differently and how framing and reframing is central to articulating a developing pedagogy of teacher education. Student-Teacher Relationships and Learning Outcome. In Australian schools, values education policies and programmes have existed in various forms in the past, but in recent years, the area has received renewed attention since the publication of the National Framework for Values Education In Australian schools, values education policies and programmes have existed in various forms in the past, but in recent years, the area has received renewed attention since the publication of the National Framework for Values Education in Australian Schools DEST by the Australian government.
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