The AFL Player’s Association (AFLPA) consider themselves leaders in the Australian sporting industry as a representative body for professional AFL players, whether they are male or female, currently playing or formerly played. Over the past 44 years the AFLPA has strongly advocated for AFL players and the broader community, contributing to many key milestones, like negotiating Collective Bargaining Agreements, and officially representing female AFL players ahead of the inaugural AFL women’s competition in 2016. Their contributions to the development of the game are significant, but it is their work on mental health and general wellbeing which elevates them to what many perceive as a leader among player associations.

There is a misconception that athletes are less susceptible to mental illness because they are seen as resilient and strong in their professional lives, or because of the wealthy, celebrity lifestyle that is assumed to come with being an athlete. However, a 2015 study of 224 Australian athletes found that the prevalence of common mental health disorders among them was comparable to the Australian public, with approximately one in four athletes considered to have a mental illness. Thus, it is important for the AFLPA to consider the mental health and wellbeing of their members as part of player welfare.

The AFLPA has a comprehensive range of services available for current and former players. They oversee an independent and confidential network of mental health clinicians and wellbeing practitioners that is readily accessible. They also work closely with AFL clubs who have their own internal resources – club doctors, player development managers, and in most instances their own club psychologist, to ensure the wellbeing of players are taken care of.

AFLPA also focuses on transitioning retiring AFL players into the wider world. Athletes often struggle with life after sport as they lose the sense of identity they significantly invested in for the first 20 to 30 years of their lives.

Despite the comprehensive offering AFLPA provides for players, there is only so much they can do. Mental health and wellbeing are often ignored by players themselves due to the perceived stigma of mental illness, and their fears about the potential impact on their job security if disclosed. As a result, these services are often underutilised.

“Players are not always willing or ready to make use of these services, and that’s the challenge we [AFLPA] face.” Brent Hedley, AFLPA Mental Health and Wellbeing Manager, said.

“We try to focus on educating players and providing preventative services, but often players are coming to us on the reactive end of things. We’re trying to change the conversation in getting guys to engage in it on a more proactive level.”

The AFLPA are working towards improving the mental health literacy of players, highlighting the benefits of being open and supporting help-seeking behaviours. With some of most celebrated players sharing their mental health struggles, such as Lance Franklin in 2015, the conversation about mental health is gradually changing for the better.  AFL is one of the biggest sports in Australia, so the AFLPA hopes to use the players’ stories as a platform for change in the broader community.

“We have a real alliance with the industry’s stakeholders, so we hope that with the relationship we have with our players, we can use their profiles to raise awareness and understanding.”

An example of such is Better Out Than In, a digital campaign developed by the AFLPA, beyondblue, the Movember Foundation, and MATES in Construction. Aiming to reduce the stigma associated with depression, it is a website housing a series of personal stories of construction workers and AFL players. AFLPA hopes to reframe the conversation, highlighting openness, acceptance and hope, instead of shame, stigma and secrecy.

Not only is the AFLPA responsible for the players’ role within the game, but they invest significant resources for the mental health and general wellbeing of their players. They hope with time that the conversation amongst players and the broader community, about mental health is no longer stigmatised but, rather, celebrated

By Johnny Wang

Virtual reality (VR) has recently exploded into the consumer world with devices like the HTC Vive, Oculus Rift, and Samsung Gear. It refers to the complete immersion within a virtual environment, so that users are able to virtually move, touch, and experience various stimuli. Popularised within the gaming industry, VR has enabled gamers to control virtual characters through their own physical movements, allowing a deeper and more immersive experience with the game. However, the increasing accessibility of VR has also opened up other possibilities and applications that were not previously tangible.

VR has allowed for more accessible and novel methods for treating different kinds of mental health issues. Cognitive-behavioural therapy (CBT) is typically used for the treatment of anxiety disorders. A vital component of CBT requires patients to undergo exposure therapy in order to confront stimuli that trigger their anxiety or phobia, whilst preventing the use of defence or safety mechanisms. There are an endless number of situations where anxiety can arise, such as social situations (interviews, public speaking) and phobias (fear of heights, spiders, small spaces), so creating real-life environments for exposure therapy can be extremely inefficient and impractical.

VR technology overcomes these limitations by providing patients with a fully immersive environment, albeit, virtual in nature. Penate-Castro et al. (2014) analysed the efficacy of CBT with VR exposure compared to CBT alone amongst patients suffering from chronic agoraphobia. The VR component of this study involved exposure to four virtual environments, including an airport, elevator, beach and carpark, which caused the patient the most anxiety. Penate-Castro et al. (2014) found that both treatments showed significant clinical improvement post-treatment and six months later. The interesting findings were the treatment dropout rates of CBT against CBT with VR exposure. Of the thirty patients undergoing CBT alone, sixteen out of thirty patients dropped out (53.33%), as opposed to only seven of thirty patients dropping out of the CBT with VR exposure treatment (23.33%). Greater adherence rates within the VR exposure group suggest that the approach was less confronting for patients, whilst still providing significant clinical improvement in anxiety levels. These findings have also been supported with studies involving patients suffering from social anxiety disorder (Bouchard et al., 2017), post-traumatic stress disorder (Rothbaum et al., 2014), and schizophrenia (Rus-Calafell et al., 2014).

The possibility of significant clinical improvement in CBT treatment with VR exposure is promising. Virtual environments can be developed and tailored to a patient’s specific needs, as opposed to real-life scenarios where there are variables that cannot be controlled. Furthermore, it appears that using a fully immersive virtual environment does not lose any of the vital components required for exposure therapy, suggesting that VR is just as effective for treatment. As a result, utilising VR technology can be significantly more practical, cost-effective and time-efficient.

Although there is significant evidence to support use of VR for exposure therapy, there is limited evidence for its use in treating other mental health disorders. To date, there are only two studies examining the use of VR and depression (Shah et al., 2015, Falconer et al., 2016), both preliminary studies examining whether VR can be utilised as a medium. VR has also been used to treat eating disorders, with the idea that VR can help with body image, but so far, such studies have not been considered methodologically sound (Freeman et al., 2017).

Considering that VR has only recently gained popularity and widespread use, more time is needed before we can utilise the technology as an effective medium for the treatment for mental health. However, the practicality, effectiveness and cost efficiency of VR provides a promising outlook on delivering significant improvements to mental health.

By Johnny Wang

References

1. Bouchard, S., Dumoulin, S., Robillard, G., Guitard, T., Klinger, É., Forget, H., … & Roucaut, F. X. (2017). Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three-arm randomised controlled trial. The British Journal of Psychiatry, 210(4), 276-283.
2. Falconer, C. J., Rovira, A., King, J. A., Gilbert, P., Antley, A., Fearon, P., … & Brewin, C. R. (2016). Embodying self-compassion within virtual reality and its effects on patients with depression. British Journal of Psychiatry Open, 2(1), 74-80.
3. Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B., & Slater, M. (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine, 1-8.
4. Peñate Castro, W., Roca Sanchez, M. J., Pitti González, C. T., Bethencourt, J. M., de la Fuente Portero, J. A., & Gracia Marco, R. (2014). Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia. International Journal of Clinical and Health Psychology, 14(1).
5. Rothbaum, B. O., Price, M., Jovanovic, T., Norrholm, S. D., Gerardi, M., Dunlop, B., … & Ressler, K. J. (2014). A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans. American Journal of Psychiatry, 171(6), 640-648.
6. Rus-Calafell, M., Gutiérrez-Maldonado, J., Ortega-Bravo, M., Ribas-Sabaté, J., & Caqueo-Urízar, A. (2013). A brief cognitive–behavioural social skills training for stabilised outpatients with schizophrenia: A preliminary study. Schizophrenia research, 143(2), 327-336.
7. Shah, L. B. I., Torres, S., Kannusamy, P., Chng, C. M. L., He, H. G., & Klainin-Yobas, P. (2015). Efficacy of the virtual reality-based stress management program on stress-related variables in people with mood disorders: the feasibility study. Archives of psychiatric nursing, 29(1), 6-13.

Anxiety and stress are common emotional reactions experienced every day but they can become detrimental to a person’s health if they are not dealt with before they become too overwhelming. Mindfulness is a meditation technique that can help manage anxiety and stress. Research has found that practicing mindfulness produces beneficial effects for psychological and physical functioning (1), and so is often incorporated as a vital component of various psychological interventions, like Cognitive Behavioural Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR).

Mindfulness is the state of being present and aware when experiencing your surroundings. It involves keeping a level-headed and non-judgemental perspective whilst processing your thoughts, emotions, and sensations of the things around you. Mindfulness is said to be an inherent human ability but it requires practice to be able to utilise it as a form of meditation.

Mindfulness meditation doesn’t require any additional resources; you only need yourself and a bit of time. Next time you’re feeling overwhelmed and you’re struggling to focus, here are a few mindfulness techniques you can use:

• Focus on how you are walking, on how your body feels relative to the ground. Remember to stay in the present and let any lingering thoughts go. As you breathe, be aware of how the wind brushes against you while you walk. Notice the sights and sounds of your surroundings, like the cars and other pedestrians going past or how the sky appears.
• Lying down before bed. Pay attention to your body relative to the bed. Notice how the blanket covers you, how your clothes feel on you. Focus on how your breath goes in and out of your nose.
• Next time you have a meal, imagine as if it is the first time you are having this meal. Take in the flavour combinations, texture, smells, and appearance of the food. Focus on the muscles used to move your mouth while you chew.
• Brushing your teeth. Focus on getting to all corners of your mouth. Feel the bristles brushing against your gums and teeth. Notice the sounds you make as you brush, how fast and slow your brush strokes are at each angle.

These are all examples of being mindful of what’s around you. It allows your mind to focus on the present, so that other stressors and thoughts can’t intrude on your mind. By focusing on the task at hand, the build-up of anxiety or stress cannot overwhelm you as you are not giving any focused attention to them. There will be wandering thoughts unrelated to the task that will come by. It is important that you acknowledge that they are there, but to let them pass without too much thought and judgement. It can be quite an effort and exhausting in the beginning to avoid overanalysing everything when you try to be more mindful. It is important to remember to only be aware of such things, and not think about what, why, and how these things have come to be.

Mindfulness is a unique form of meditation. Rather than striving to empty yourself of thoughts or channel your spiritual mind, its aims are to pay attention to the present, or task at hand. It can be more useful compared to other forms of meditation because of its practicality. You can apply mindfulness to a task at work, conversation you are having with a friend, or even when you have some alone time at home.

App:

Smiling Mind – a modern app with creative ways of mindfulness meditation. You can track your progress as you continue your mindfulness journey.

By Johnny Wang

References

1. Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on psychological science, 6(6), 537-559.
2. https://luria.ucsd.edu/xmca/attachments/1905/mindfulnessmediation.pdf

During July, WayAhead, Being and Mental Health Carers NSW hosted a farewell lunch at the joint Collective Purpose office for outgoing NSW Mental Health Commissioner John Feneley.

Before the lunch Mr Feneley spoke to Mental Health Matters about his time as Commissioner, a role he has held since July 2012, and the achievements of the Commission in that period.

John with Liz 2017

“Our first big achievement was producing Living Well, the strategic plan for mental health in NSW. That was what the Mental Health Commission Act legislation told us we had to do first. We asked more than 2000 people around NSW – including 800 people with personal experience of mental illness – what needed to change in the mental health system and how, and it was the most inclusive consultation on mental health ever done in NSW. That is something I remain proud of. The NSW Government accepted the plan in 2014 and so all those voices are now guiding Government decisions and funding.

John with Liz and Sharon at the WayAhead Workplaces 2016 Annual Forum

“I’m also really pleased to see that some key areas that we identified in Living Well have made tangible gains in the five years I’ve been Commissioner. Suicide prevention is a big one – when I started there were a lot of people working very hard to save lives but the left hand didn’t always know what the right hand was doing. Some of the things the Commission has done, like funding the proposed Suicide Prevention Framework for NSW and forming the Suicide Prevention Advisory Group, are not things the public has necessarily heard about. But they have helped make suicide prevention in NSW more coordinated and I believe we’ll see evidence in the next few years of lives saved because of that effort.”Workplace mental health and wellbeing is another area where Mr Feneley has seen significant improvement, particularly when employers have taken a leading role in creating and implementing wellbeing programs.

“Workplaces are a wonderful example of where the message of mental health and wellness has community benefits too, because people take what they have learnt at work about mental health and wellbeing into their home lives, leading to a community change.

“The work that WayAhead has been doing in this sector for years now is just tremendous. WayAhead has been able to work with employers and workplaces to help their staff return to work and not leave unnecessarily or early. These are all key elements in ensuring the health of employees and the health of the business.”

Mr Feneley emphasised that much of the work the NSW Mental Health Commission has done since its creation has been about empowering people with lived experiences of mental illness and their carers to be more involved and informed about their condition and treatment options.

John presenting at the 2016 Mental Health Matters Awards

“How do we help people have self-agency? How do we help people feel like they can have a conversation with their doctor as an equal? How do we change the system so that it supports people to identify and achieve their own recovery goals? A lot of our projects, like the review on medication and mental illness and our carers’ forum this year, are about exactly those issues.

“Someone who has been a carer for five years for their son with schizophrenia, for example, will have a terrific understanding about medications, about their son’s needs, about what works for them and what doesn’t. Yet I commonly meet carers who have been caring for 10 years and say that no one has ever had a proper conversation with them about this. We want to get it to the stage where the clinicians will work with the person with a lived experience and their carer at the time of treatment. We want clinicians to think of best practice as when a consumer or carer asks for help, clinicians respond by saying ‘we trust your judgement and understanding of the situation and we want to work with you on a path to recovery’.”

John at the WayAhead Mental Health Expo in Chatswood 2017

Looking ahead, Mr Feneley acknowledged the next few years are likely to be a time of even more change for the community-managed mental health sector.

“With the National Disability Insurance Scheme (NDIS) rolling out it’s a time of big reform and uncertainty, and we will all need to be watching closely to see what happens. The work of the mental health peak bodies like WayAhead, Being and Mental Health Carers NSW has perhaps never been so important.”

Mr Feneley finished his term in August 2017 with former Deputy Commissioner Catherine Lourey succeeding him.

By Benjamin Graham

Fairfield is best known for its vibrancy and diversity of its residents, with a large proportion having a migrant background. Migrants have continually gravitated towards Fairfield for its long history of providing a home and a community for migrants. Since 2006, Fairfield City Council has welcomed 10,484 humanitarian entrants – the most of any local government area in NSW and almost double the number in Liverpool, according to the Settlement Reporting Facility of Department of Social Services.

In September 2015, the Australian government announced that it would resettle an additional 12,000 refugees in addition to the Refugee and Humanitarian Program, as a response to the global refugee crisis. It was estimated that about half of this special intake would be resettled in Fairfield, a suburb of about 18,000 people in the south-west of Sydney.

WayAhead spoke to Professor Newman about the challenges that refugees have experienced including trauma and trauma-related depression or stress when settling into the community, as well as the necessity for increased resources to respond to their needs.

“I have seen the whole spectrum of mental health issues displayed by refugees. I think they are very poorly understood and need more dedicated trauma-related mental health services because the impact of fleeing their homes for another country can be very damaging and long-term,” Professor Louise Newman explained.

Professor Newman has a background in child psychiatry, and worked with child refugees in south-western Sydney when she was conducting research around children and their mental health. She also worked with the Immigration Department Advisory Committee in 2013, working on reforms with the immigration policy amid growing concerns about offshore processing and detention centres.

“It is hard for refugees to reintegrate within society with these mental health issues. Some people come from certain countries and may not understand what mental health services are. They may not have had access to such support in their countries of origin but many refugees will accept mental health services if help is offered.”

Currently, all newly-arrived humanitarian entrants are eligible to receive initial, intensive settlement assistance through the Humanitarian Settlement Services (HSS) program in their first year of arrival. The services provided to help refugees settle in Australia generally include linking them to community programs to get assistance with finding accommodation and registering with schools, banks, Centrelink and other social services. When refugees show a need for mental health services, HSS may refer them to the Department of Health which offers the Programme of Assistance for Survivors of Torture and Trauma (PASTT) and NSW Services for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS).

STARTTS has a state-wide reach and provides a variety of services to refugees with a background of trauma. Their services include a balance of both community development activities and clinical approaches.

“We acknowledge that trauma impacts on individual’s ability to participate in their community and on the community’s ability to support individuals and families,” said Jasmina Bajraktarevic, the Community Services Coordinator of STARTTS. “We believe that intervention at any level of social system will have impact on the community level and will contribute to community strength.”

CORE Communities Services, a local organisation dedicated to refugee advocacy and policy work, assists refugees in navigating the Australian system including finding housing, employment, education and recreational activities to increase their social connections.

“I think there should be both investment in indirect and direct services addressing mental health for refugees. We plan activities to help refugees be more connected to the community, for example, excursions to different places of interest, like museums, or hold sporting activities that have great recreational benefits. These activities and outings have positive effects on refugees’ mental health as they are able to form social bonds and participate in the community,” explained Morlai Kamara, the Community Development and Policy Officer at CORE.

However, with the recent intake of resettlements, Fairfield is struggling to provide adequate resources for resettlement in such a short timeframe. “Indeed, [this is] five times our average annual settlement rate,” a spokesperson for Fairfield City Council said. “This translates into extraordinary pressure on the numerous community services and charities who are approached to help the new arrivals.”

“Immigration is a Federal Government responsibility and the settlement of refugees and migrants across the country is a national matter that requires open dialogue and action from the top tier of Australian government,” the Council said.

Demand for services is high with organisations having to expand to meet the need. Last year, STARTTS opened a new office in Fairfield in response to the growing demand for mental health services. In spite of increased pressures, the community in Fairfield remains open to resettling refugees and many non-government organisations continue to respond to their needs.

By Cindee Duong