R M Cullen MD MSc MFM BA DipStats DipProfEthics

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april 2015

hayden butler These two fine young men both committed suicide at the start of the 2015 season regan grieve

preventing suicide in young elite sportsmen

Two years ago I wrote about suicide in young elite sportsmen. That piece followed the deaths of two young rugby league players, Mosese Fotuaika and Alex Elisala. This year, over the long weekend celebrating Australia day, another two young players, Hayden Butler and Regan Grieve killed themselves. Whatever the NRL did in 2013 is no longer effective.

What can professional clubs do to prevent suicide? The club I know best is the NZ Warriors. I have no involvement with club administration, but I do know a number of its junior players. In all cases, I have known these young men, sometimes as family doctor, sometimes as team sponsor, sometimes as employer, sometimes as amateur club administrator, since before their involvement with the Warriors. Much of what follows is a response to that club's current systems as I understand them to be.

Suicide prevention falls into three parts. First is the club systems which make suicide risk negligible. Second is the identification of at-risk club members. Third is the internal review to ensure that those at-risk are not falling between cracks in the systems.

club systems

Although it ticks the boxes and leaves clubs feeling they are doing something, having a third party come in and either lecture the players or 'train' staff has never been shown to have any effect on youth suicide. Prevention is much much more than having some well meaning person come in and say "if you feel depressed, ask for help", or "keep an eye out for these signs of depression."

The underlying problem in youth suicide is rarely depression. It is a combination of despair and isolation. A guy with lots of mates can be isolated.

The danger with professional clubs and young players is player perception that they are merely pieces of meat, to be thrown out if they are no longer to the coach's taste.

Shontayne Hape expressed the sentiment well in a NZ Herald article when he said "Players are just pieces of meat. When the meat gets too old and past its use-by date, the club just buys some more. You get meat that's bruised or damaged, the club goes and buys some more."

The sad fact is that this is often true. Once a player is cut from, or becomes too old for, the under 20 squad, contact with the club ceases.

Professional clubs do not appreciate enough that many of these young men have placed all their eggs in that one basket. They have devoted themselves to a career in professional sport, and when that door closes it is not always the case that the player can see another opening.

The first change to club culture is to introduce the idea that "there is no such thing as an ex-Warrior". Those young men who have played even one game for the under 20s are part of the club from that point forward.

There are many ways in which such an ethos can be realised. Simple, immediate ways such as those too old for the 20s, training with the new guys over summer and having a pre-season game against the "new" team. Roles for former players can be found at home games, as security personnel for example. Former players should be invited to club events. Former players should all be on the 'club member' mailing list. Making tickets available to home games is never a bad idea.

The second change is for the club to accept responsibility for its junior players having a career beyond rugby league. The current system of requiring players to have a job or to be in training is not good enough. The "training" acceptable to the club is often of low quality and does not lead to employment. Labouring is an acceptable job for a junior warrior, when this should not be the long term career of an elite sportsperson.

At a very basic level, a high proportion of junior warriors (for example) do not have a full driver licence. This is an easy thing for the club to organise.

Rugby league is a sport with many "tradesmen" supporters. Clubs could do a much better job of preparing their junior players for apprenticeships and then introducing them to potential employers.

Clubs should do much more than simply ticking a box ("has a job or is in a training programme") with their new players. An initial assessment, asking the player what he wants to do after football should be undertaken, and then a plan constructed to move the player towards that goal.

The third change is to utilise the increasing number of welfare officers and mental health support staff effectively. Suicide in young men is most often a response to triggers. The welfare officer should know what those triggers are, recognise them when they occur, and have a plan to reduce the number of triggers that do take place.

Here's a simple example. The fringe player who has had a previous season ending injury. Let's say it was a knee, an ACL. A second such injury may trigger suicide. Suicide prevention may be as simple as ensuring the athlete has a daily single leg balancing and hamstring regime. No recurrent ACL tear, no suicide.

identifying at-risk club members

There are obvious common features to these four suicides. Age 18-21. Never played a first grade game. Significant recent stressors - bad news, injury, career perceived as having stalled, or a move to a new city (North Queensland seems to be the suicide capital of the NRL). Timing -pre-season or early season.

In addition, there is the established risk factor of knowing someone who has recently committed suicide.

The minimum standard for a club is a system that identifies those players who are being cut from the Holden Cup (under 20) squad, perhaps because of age, and are not being invited to train with the reserve grade squad, or who are being cut from the reserve grade squad, or who are under 22 and not progressing to a first grade contract. Off season and pre-season injuries that are going to require more than four weeks on the sidelines also place a player at risk. Players who have moved to the club in the off-season are also at risk. A suicide event at another club is a red flag at NRL level. All clubs should be sent a list of the deceased players team mates over the previous five years.

internal review

It is the responsibility of the club CEO to ensure that the process used to identify at-risk players is identifying all those whom it should, and that those at-risk players are actively in the club's system.