In February 1989, Frank Bruno and Mike Tyson fought in Tokyo, in what was then billed as the biggest fight on the planet. Both were champions in their own respect , Tyson was the youngest boxing champion at the time and the most brutal thing the world has ever known  in the ring . Bruno who had a 32-2 record ,till that date lost that fight but went on to take the WBC heavyweight in 1995 title. Sadly for both, drugs and social circumstances became an issue and their careers ended   in controversy . Both fighters ultimately were diagnosed with bipolar disorder , a mental health disorder  with episodes of depression and manic states  requiring clinical management .
Sports and psychiatric issues stem deep. The pressure of performances in front of huge attendances, the pre – match anxiety ,  glorious wins and agonising defeats all are part and parcel of sport.  Mental health issues may not make the news until severe problems occur for example the recent cases  of  Marcus Trescothick and  Jonathan Trott which  became front and back page news.
Both have since described engaging with  support from mental health services .Unfortunately , some athletes aren’t so lucky and do not receive the kind of psychiatric support they probably require.

Sports psychiatry aims to address this issue and has been successful  helping various individuals  like snooker player Ronnie O Sullivan or  teams like British Olympic cycling team,  achieve success. Sports Psychiatrists employ a range of Pharmacological and Therapeutic strategies. As a pioneering example ,Dr Allan Johnston ,a Consultant Psychiatrist and UK Rugby League’s first  Sports Psychiatrist currently  with the Bradford Bulls describes the components of  his model:
There  are a number of important factors which have proven crucial to the success of the Sports Psychiatry model used at the Bradford Bulls RLFC. These can be summarised as:
1. Confidentiality
In Sports Psychiatry, confidentiality takes on an extra significance. The Sports Psychiatrist will likely work in a team of athletes, coaches, , managers and other support staff. The Sports Psychiatrist will often have a dual role of ensuring the wellbeing of the athlete and also enhancing their match day performance.. . A potential conflict of interest could arise where the athlete discloses a wellbeing issue which may impact on their individual performance, the performance of the team or their match selection. The Sports Psychiatrist should discuss in advance with the coaching team the importance of Confidentiality.
2. Clinical thresholds and Proactive engagement
The model developed by Dr Johnston at the Bradford Bulls RLFC has a proactive reach. An athletes focus is understandably on their own elite performance and they are often not well placed to assess when they need to access help with some notable exceptions such as the England Cricketer Jonathan Trott. In Dr Johnston’s Bradford Bulls model the players have open access to the wellbeing clinic which is located at the training ground alongside the players changing rooms. A weekly clinic occurs which players can self refer to in person, via telephone or SMS text message. The first hour of the clinic has an open access ‘drop in’ facility which the players often use for brief consultation. All players and staff can contact Dr Johnston in person or via Telephone, SMS  message, Email or Twitter. He is present each Friday at the training ground and at every match home and away, ensuring a high level of engagement.

3. Mental Health Stigma and Normalising the Psychiatrists role
The final factor essential to the success of the Sports Psychiatry role has been the ‘normalisation’ of sports psychiatry as a routine part of the players match preparation. The Friday routine of the Bradford Bulls players involves Physiotherapy, Massage, Gym, Well being support, indoor skills and field skills.  ‘Normalisation’ has been essential in de-stigmatising the role of the Sports Psychiatrist which has become just part of the Friday routine at the Bradford Bulls. Players can see Dr Johnston for well being issues, performance issues or any combination of the two. This, combined with strict confidentiality ensures that when a player requests a consultation this carries no stigma amongst his teammates and is frequently seen as a mark of professionalism in this demanding sport.

One measure of the success of this model is that 75% of all consultations with Dr Johnston have been requested by the players themselves with the remaining 25% a combination of requested by Dr Johnston, by the coaching staff or by a family member. This demonstrates the enthusiasm the players have for this key part of their match preparation both in terms of well being and elite performance.

Sports Psychiatry is a developing psychiatric field but as levels of competition increase in the world of sport, services will be required to ensure the mental well being in addition to physical  health of sportsmen.. If there is any doubt about its success, we only have to look back to the most decorated swimmer in history. Michael Phelps overcame childhood Attention deficit disorder to  win 22 Olympic medals, a living record.

Dr Allan Johnston is a consultant psychiatrist in Derbyshire Healthcare Foundation NHS trust who has  a special interest in sports psychiatry. Special thanks for his contribution .