In a survey conducted with 74 male current professional players, the majority of whom play in the top two English leagues, 22 per cent reported lifestyle issues which would usually lead to an occupational therapy referral. 

The poll also revealed that the older the football player, the more likely they are to require a referral.  

Occupational therapist and assistant professor Victoria Wilkinson, who conducted the survey as part of her PhD on footballers' wellbeing at the University of Bradford, said: “I was quite taken aback by the scores. It demonstrates the need for a more proactive approach rather than waiting for a crisis moment to happen."

The 74 players voluntarily took the same standard Occupational Self Assessment used by occupational therapists working with patients in hospitals and with people returning to work after illness or injury.  Occupational therapy covers not just a person’s job but how a person is managing everyday activities, such as personal care, as well as their involvement in leisure activities.  

Pictured above: Assistant professor Victoria Wilkinson

The assessment asks the person to determine their competence in 21 different lifestyle areas, such as taking care of themselves, managing their finances, expressing themselves and having a satisfying routine. They are then asked to rate how important each of those 21 areas are to them. 

If there is a large difference between the value the person places on an area and how well they consider their performance in this area, this would indicate the need for intervention by an occupational therapist, who would aim to improve the person’s satisfaction by enabling them to engage in a lifestyle which is meaningful to them.  

Ms Wilkinson said: “The results showed a large difference between the sort of lifestyle the players have in comparison to the type they would like to have."

Of those 74 players, 43 also completed the Short Warwick-Edinburgh Mental Wellbeing Scale, which showed lower than the average population norm in their wellbeing.

'Limited role identities' 

Ms Wilkinson said: “Participating in a balance of activities provides us with different roles and promotes our wellbeing. Unfortunately, professional footballers often have limited role identities because, from a young age, they spend most of their time playing football, starting out at an academy.

"While this limited role might not be a problem during their career, it can be detrimental when this role is taken away from them, for example if a player’s contract is not renewed or if an injury ends their career early. It is important to provide preventative interventions to prepare players for transitions. 

"Without other roles, there is a chance those players could end up replacing football with addictive behaviours such as gambling, or experience serious mental health difficulties and we have sadly seen examples of this with some high-profile players in the past."

Ms Wilkinson was inspired to research this area after conducting a 2019 study – Evaluating the role of Occupational Therapy in professional football - which was supported by the Royal College of Occupational Therapists and which received an award from the Institute of Social Psychiatry. While the subject of footballers' mental wellbeing has hit the headlines in the media, there is very little academic research on the issue. 

Ms Wilkinson, whose PhD focus is to develop Occupational Therapy Practice within professional football, is particularly interested in the effect on players when they fail to make the transition from academy to professional club and when they retire. 

Last month, Liverpool player Trent Alexander-Arnold spoke to the BBC about the devastating impact it can have on young players who fail to make the leap from academy to professional clubs and why he is launching ‘The After Academy’ with the Professional Footballers’ Association (PFA) to support former academy players.  

He said: “I’ve seen first-hand the struggles and difficulties players have when they’re released from football clubs and it’s gone on too long and now it’s time to change.”

Treat mental and physical health

The Premier League states that it's Elite Player Performance Plan, launched in 2012/2013, "works hard to educate, equip and empower boys to transition to successful careers beyond a playing career,"  including the majority of young people coming through the Academy system who do not make it as professional players. 

In addition, many academies are beginning to acknowledge their ‘assets’ as people first and athletes second. The League Football Education (LFE) offers all clubs personal development and life skills programmes. Topics include finance management, emotional well-being, equality, diversity and inclusion and sexual health awareness. The EPL (English Premier League), LFE and the Professional Football Association also partner with a variety of organisations that offer support services for their players. 

Ms Wilkinson said: "In recent years, English football organisations have placed considerable efforts in supporting the mental health of current and former players. However, our preliminary findings show there is also a need for a more client-centred approach as the participants identify various needs. Football clubs need to have a regulated system of health professionals.

"The representative body of professional players, FIFPRO. states: 'When it comes to mental health, every person and player is different, and there is no one-size-fits-all solution.'

"It is essential that mental health concerns can be treated with the same professional approach as physical injuries. As most of the current research relating to mental health and professional football players excludes those playing in  English football leagues, I believe the first step is to encourage primary research within English football."

Dr Rob Brooks, Associate Professor in Occupational Therapy at the University of Bradford, one of Ms Wilkinson's PhD supervisors, said: "Working with people in professional sports is an important and emerging area of practice for occupational therapists. Participating in a balance of meaningful daily activities is good for everyone’s health, particularly mental health.

"The professional focus of sports players means they can experience an imbalance of activities that could make them more prone to low mood, anxiety and other emotional difficulties. This innovative research is showing us what some of the daily life difficulties might be, where in a professional career they are most susceptible, and where sports players could benefit from occupational therapy."