R M Cullen MD MSc MFM BA DipStats DipProfEthics

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may 2013

suicide in young elite sportsmen

mosese fotuaika These two fine young men both committed suicide at the start of the 2013 season alex elisala

In the last few months two young elite rugby league players have committed suicide in Australia. Both were aged 20, and although neither had played a first grade game, both were members of their club’s first grade squad.

It seems from the response of the clubs and that of National Rugby League, that both deaths are going to be attributed, wrongly, to undiagnosed depression. The media coverage of one case, Mosese Fotuaika has included interviews with his family and partner, as well as with West Tigers personnel who had contact with him on the day. Mosese’s death was avoidable.

Suicide in young men is sometimes an irrational act, a consequence of the mental illness ‘depression’. In these cases medication helps by restoring rationality. However, suicide in young men is more often both an impulsive and an emotional act. It is a way out of a situation that appears intolerable right now. Mosese was overwhelmed by his emotions, by a bout of despair, but this would have passed if the club could have kept him alive until his girlfriend got home from work. Genuine emotions have a lifespan of hours, and are something quite different from depression, a disorder of mood which will persist for months if untreated.

Jane Cadzow, feature writer for the Sydney Morning Herald wrote an excellent piece on Mosese I have relied on this for the factual background.

This young man was under pressure, but nothing extraordinary. He was living in Sydney with his partner, away from his Gold Coast based family. He was in the first grade squad, but not the team. He had been told by the coach he needed to improve his on-field communication. There was an unplanned baby on the way. He was supporting his family financially.

Then, in the club gym he tears a pectoral during weight training.

The diagnosis was made at the time by the club physiotherapist who was surprised that Mosese began to weep. “It was strange. It was really strange”. The physio went on to fit a sling and make an appointment for the following morning. He missed the life threatening acute mental injury.

The coach heard about the injury, ‘poked his head out’ of his office, saw the physio was involved, and chose not to go over.

In the car on the ride home Mosese asked his best mate if they could go for a beer. The mate knew Mosese was really upset, but said no, and dropped him off home to have a shower. They were supposed to attend a team cricket match that afternoon. When the mate returned to pick him up Mosese didn’t answer the door or his phone. The coach was phoned and said ‘it’s not your job to find him'.

This tragedy indicates four problems common to many clubs.

• A. Player welfare is seen as the welfare officer’s job. This silo mentality is life threatening. Many modern companies see every employee as part of the sales team, and some companies even see their customers as part of the sales team. Everyone in the club shares the responsibility for player welfare. This communal responsibility is meaningless unless fear is replaced with the authority to fix a problem. The mate knew something was very wrong. But he put the directive to attend the social cricket game ahead of Mosese’s welfare. The physio knew something was wrong, but didn’t know what to do. The coach put off intervening and then gave a standard ‘you’re not responsible for him’ direction. Chances to save a life were missed.
• B. The club didn’t know the right things about Mosese. Forget mental health risk assessment tools. The background risk factors are unimportant in the ‘right now’. The presence of suicide triggers is what counts. What are the potential problem areas? What sort of things can reduce a first grade prop to tears? How do we help when a player asks for help (as Mosese asked his mate)?
• C. The person most able to help Mosese get through this was his partner. Yet nobody thought to phone her, when if he had been taken to hospital with a broken arm this would probably have happened automatically.
• D. The professional sports club which recruits young players from far away has parenting and mentoring responsibilities. This is not about player education. It is about looking after players. Mosese had all his career eggs in one basket and was betrayed by a body which couldn’t cope with the excessive training demands he made of it. Why weren’t these problems solved for him? They were far too big for the young man to work through alone. The problem here is with the gap created between a club and its players when, to a large extent, the club is the players.

Mosese’s death also indicates two problems at NRL level.

The first is with the training that clubs receive about player suicide. It is disappointing that ‘depression’ was what the media heard, and reported, from various club welfare officers. The cause of death here was despair, probably preceded by anger (at betrayal by his own body).

The second is with the rookie camps where young men are told all about the problems that might come, including the probability that they won’t have a professional career at all, and if they do, that their career will probably only last one or two years. This is an unhelpfully negative approach.

These boys are in a great position and that’s what they should be told at rookie camp. They are entering their learning years, not their earning years.