Let’s talk about…. mental fitness in sports

Let's Talk About CBT

In this episode of Let’s Talk About CBT, Helen Macdonald speaks with Phil Cooper, mental health nurse and co-founder of the charity State of Mind Sport, and Ian Knott, former professional rugby league player and State of Mind presenter.

Phil shares how State of Mind was born out of tragedy and developed into an award-winning mental fitness programme, now reaching thousands of athletes across the UK and beyond. Ian talks candidly about his experience of severe injury, depression, and suicidal thoughts after retiring from sport, and how CBT helped him to rebuild his life.

We hear how sports settings are being used to break down stigma, encourage conversations, and promote mental health support—particularly among men—and how brief interactions and powerful personal stories can save lives.

Resources & Links:

State of Mind Sport website

Information on CBT and how to find a therapist

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Credits:

Music is Autmn Coffee by Bosnow from Uppbeat

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License code: 3F32NRBYH67P5MIF

This episode was produced by Steph Curnow

Transcript:

Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen MacDonald, your host. I'm the senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies

Today what we've got for you is an episode about mental health, mental fitness and sports, and I've got Phil and Ian here to talk to me today. Phil, will you just introduce yourself?

Phil: My name's Phil Cooper. I’m a mental health nurse by background. I used to work as a nurse consultant in mental health and drug and alcohol misuse. I love sport. And, for some strange reason or quirk of random chaos, I became to be one of the co-founders of State of Mind Sport charity that focuses on mental fitness.

Helen: Thank you, Phil. Ian, please, will you introduce yourself?

Ian: My name's Ian Knott. I'm a former rugby league professional and I currently am a presenter for State of Mind. I talk about my story, my lived experience of having to retire through a serious injury and then developing mental illness. So I talk about that.

Helen: Thanks very much, Ian, and I'm sure our listeners will want to hear more about that later in this episode. Firstly though, can I ask Phil to tell us a bit more? Phil, will you tell us about State of Mind and how it came to be and what it does?

Phil: Sure State of Mind Sport began unfortunately on the back of a tragedy within the sport of rugby league, where a Great Britain Rugby League international called Terry Newton, unfortunately took his own life in September, 2010. Sent great shock waves, I think, through the whole sport for such a high profile player. At the time there was relatively little support or mental health support for players at that time. I suppose as a mental health nurse who loves rugby league and sport, I read a league paper on a Monday morning, somebody wrote an article saying how the NHS and the sport should get together to try and prevent suicide. Also, somebody also wrote a letter, again a mental health professional, called Malcolm Rae and Ernie Benbow had written the article and I saw this and thinking, wow, this is Monday morning, I shall write these two individuals- checked with my chief exec, of course, because obviously you have to be doing all these things- and then invited them to a meeting we were going to have in good old health style a conference, that soon changed when we invited a couple of players such as Ian, and they suggested, why didn't we ask the governing body for a round of fixtures to promote mental health at that time or mental fitness. I then found myself in the strange position being ferried to Hull Kingston Rovers Ground to be presented before all the chief execs of all the top divisions with clubs to say, this is a really good idea. It's free. So the sport love that bit and, we’ll deliver a session to your players before the season and then a round of fixtures themed around that. So we had a State of Mind round in 2011 and player bought into it. There was very little support, as I said, and they began to talk about it on social media. They wore t-shirts in the warmup before the round of fixtures, but crucially, they knew what it was about, and they were all bought in. Things have grown massively since that time, which has been great for us. And also promoting mental fitness in rugby league, one of the toughest sports on the planet.

Helen: Thank you Phil. So can you tell us a little bit more about what you really mean by mental fitness?

Phil: Certainly, okay. I think language is crucial, as I'm sure all your members will realise and will think about on a regular basis. So for me, to get into a situation of encouraging men or engaging men into something that will help them, if I say, if I used to say, well, we'll come in and deliver a mental health session for you into a local grassroots sports club. I can imagine the reaction would be flipping heck, I'm not going into that. However, when you can make the case that actually you are going to go to training for physical fitness, what a lot of athletes will tell you that the mental fitness is perhaps the most important aspect of being a professional sports person or being the best sports person you can be. So therefore, if we go in and say, well, we're going to try and improve your mental fitness, men tend to sort of buy into that, especially if you go to them in their grassroots club, they wouldn't come to me in a community mental health team, but they would certainly go training two nights a week in their local club. And you have a captive audience potentially, especially when the weather's bad and they can't train on the pitch. And the coaches will want something different to either entertain or, keep the players focused on what they want to achieve. So State of Mind deliver mental fitness sessions so we look at anxiety and depression using a GAD-7 and a PHQ-9, as I'm sure your members will be very familiar with and again, we deliver that in a style that's not sat down in front of somebody asking them to fill in a questionnaire with a pen or online or whatever. So we'll do that. We will have two presenters usually. So Ian being one of those, I might have been the clinical dude once or twice with Ian, of course, and I'll ask him about how he's been feeling over the last few weeks using a PHQ-9 or a GAD-7. He'll tell me some strange answers, which he never used to tell me what they were going to be, I would then ask the audience how anxious or how low in mood Ian was based on those answers. So you keep all the information away from your audience, but you involve them to use all the different learning styles, so audio visual, kinaesthetic, all of those learning styles to get to as many of those people as possible. So we've been doing that for 10 years. Hundreds of thousands of people have attended sessions, which is ridiculous when I think back, but also numerous people have told us that they changed their mind about taking their own life and that's the sort of thing that keeps you going every week. And going to wherever we're going of a Tuesday or a Thursday evening, or even as I found myself in a dressing room last Saturday, so before a football match, just talking to players. So all of those things, we do mental health first aid. You can look on stateofmindsport.org if you really want to know. I don't want to want too much about that, but that's what we do. And we go to people where they are. We try to engage people where they are.

Helen: And I'm hearing you are reaching a huge number of people, probably people who wouldn't easily go and look for help, like perhaps men in maybe more traditional settings where we don't talk about mental health or mental fitness as you put it. That's really important. But also this work is saving lives and that seems to me as a really important piece of work that's happening here. And I wonder if I can ask Ian to come in now. And Ian, you said, about your lived experience and that's what's brought you into working with State of Mind Sport. Can you talk a bit about your experiences?

Ian: So my kind of story started in 2004 while playing for Leigh Centurions. At the time I probably had about 12 years I think at professional rugby. I played at the highest-level barring international level, and after 12 years of playing at the highest level, I dropped down division to play for Leigh Centurions And at the time, Leigh were making a massive push to get into Super League. I never played in Super League before, and halfway through the season, I can remember we played against Halifax away from home, and I ran with the ball, and I got tackled and there was nothing wrong with this tackle at all, but I felt these god awful pains in my lower back and it felt like my leg was, I don't know, it's like tingling and my foot was in like a bucket of water or something like that. So it felt, which was strange because we are really hot summers day. So obviously I came off reluctantly, because we are a bit stupid, old rugby players, we do play with injuries. But I did come off, and then a couple of days later the pain got worse, so I got sent for a scan. And I got told in no certain terms had a very large disc prolapse at the bottom of my back. So they said you can't play, you need to obviously get treatment and then you'll be okay for the next season. So I went back and had a meeting with the club, and we all came to the sensible conclusion to ignore the surgeon and played with a slipped disc for half a season. Now to say that was painful would be an understatement. During the week, I couldn't train at all, the pain was that bad. Then on a Saturday morning, I'd have a painkiller injection to do a ball work session. Then on a Sunday, I'd have two full syringes in for 24 places in the spine to try and get me through these games. I’d be throwing up on the pitch, the pain was that bad. It was very hard. It was very difficult, but it ended up being quite rewarding because we won the treble and we gained promotion to Super League, which was amazing. I was lucky enough to be captain and so I managed to lift all three trophies. So then two days after the grand final, I remember having an operation to relieve the disc, woke up in recovery and all the pain down my leg had gone and it felt amazing. I still had a bit of back pain but I could cope with that. So from there, I had rehab and then race to pre-season, and then the next season, like Leighs first year Super League. I think we were about 12 games in, and I think we played Halifax away again, coincidentally. And it's a similar story. I took a ball in but this time it was quite a bad tackle. I got clothes lined, so the legs went from underneath me, and I landed on my spine again. Now these pains came flooding back. I couldn't quite describe to you now how bad the pain was. because it was horrendous. But the best way to describe it would be, my wife was sat at the top of the stand, and I was in the middle of the pitch, and she would hear me screaming from where I was. The pain was bad. So I got stretchered off, straight to hospital. Again, another scan. So as I'm waiting in hospital for the operation, my surgeon came to see me, and he put my scan up on a whiteboard next to me. So obviously I asked him, you know what's the problem? So he said, look, he said, you're not going to be able to play rugby ever again. He said, in my opinion, you're going to struggle to find work again you know the damage is that bad and God knows what I'm going to find when I open you up and look in.

Now, at the time I was strong mentally, so I thought, so I'm thinking to yourself, obviously I'm going to start find work again because I need to, I have two young boys at the time, I have a wife I was supporting, so I need to find work. So I thought, I'll prove you wrong. I woke up in recovery, unfortunately for me, I was screaming in pain, the operation just didn't take, and I spent the next, I'd say roughly 12 months in that hospital. I had five operations on my spine in the space of probably two and a half years. To say that my mental health dipped in that period would be a massive understatement. I'd gone from being a full-time professional and I trained three times a day if I was bored when I got home, I go for a run. Basically, I was hyperactive, I couldn't keep still. I went from that to literally being that to being completely bedridden. My wife, she had her dream job, she absolutely loved it. She had to give that up to become my full-time carer. She had to wash me in bed, dress me in bed, she shaved me in bed. if I needed the toilet for a pee she’d help me pee in a bottle. If I needed a toilet for anything else, she'd help me with that. My wife was amazing how she did what she did, I do not know. But I did I appreciate her for it, not one little bit. I’d do nothing but shout and scream at her all the time. She'd be trying to talk to me, encourage me and I’d just shout at her all the time. Like I said, I had two young boys and they'd come off from nursery and I'd hear them coming upstairs to see their dad, excited and then that for me was like somebody putting the nails down the blackboard, they grated on me so much. I hate saying this now, I really do, my kids and my wife and my world, everything I do is for my wife and kids. But during this period, I wanted nothing to do with them because I was obviously very depressed. I did not know what depression was. And I come from an era and from a sport as well really, where you don't show any weakness. So, I took that into my normal life, and I just tried to put a brave face on things and I wouldn't talk about it, even if I did know what depression was because I was supposed to be a big tough man, so I'm not supposed to talk about the problems. So I didn't and it just got worse and worse. It felt like my head was stuck in a vice and every day this vice was just getting tighter and tighter to the point where I just felt like my head was going to explode. I was taking roughly 30 painkillers a day. I was on liquid morphine. I was on morphine patch. So if I wasn't screaming in pain or screaming at my wife and kids, I was doped out on drugs. That was literally my life in these same four walls all the time. I just, I wasn't living, I was just existing, if that's the right way to say it. And I just didn't know what to do. But I got a lifeline because I got a chance to have a device implanted in my stomach, a pain device, which is, it's called a morphine pump. It's got liquid morphine, it's got anaesthetic inside it, and it goes directly into my spinal fluid. Now, obviously, if we all have a headache or anything, you take tablets and it obviously goes down your body and then it goes to your head. With me, I was taking all this medication it had gone all the way around my body before it got to my back and by the time it got to my back, it wasn't doing anything. So I had a trial for this morphine pump and the pain relief was amazing. But it couldn't fit me in for an operation straight away. I had to wait another six months. So I had this kind of high of having this trial, which was amazing. And then the lows again the depression sinking in because you had to wait another six months. So, as I was waiting, obviously the depression got worse and worse. Again, shouting at my wife and kids again. And I'd say about three days before the operation. I can remember my spirits picked up and I was really buzzing thinking, I’m going to get my life back because that's the way they kind of explained it to me. This pump, you're going to be able to walk about more, you're going to be able to socialise more and things like that. So I was really excited. I was buzzing, so I went in for the operation thinking that's it, now my life's going to start again. But unfortunately for me, I woke up in recovery and I was screaming again in agony. The pain just didn't, so it was worse, the pain relief just didn't work whatsoever because during that six-month period, I was taking more and morphine patches, I was taking even more liquid morphine. So the dosage that they used in the trial, literally just didn't touch me. So again, I spent the next 12 months in and out of hospital. I'd say roughly about between 25 and 30 times trying to get this dosage sorted. And again, to say that my mental health dipped in that period would be an understatement because there's no other way of saying it, I became suicidal. For me, every thought on my mind was not only do I not want to be here, but mainly the way I rationalised it was I didn't deserve to be here. My wife deserves someone to love her, to cherish her, to treat her like the brilliant woman that she is. I wasn't doing that. And my kids deserve someone to love them, to play with them, to teach them right from wrong and just to be a good dad. And again, I wasn't doing that at all. So I thought the best thing for my family and for me to be honest with you, would be for me not to be here.

So it wasn't a case of, I didn't really think that I wanted to die, but in all honesty, I just didn't really think that I wanted to live anymore. That might sound weird to say, but I just, I couldn't cope with the pain that I was feeling and I couldn't cope with the pain that I could see on my wife and kids face all the time. So, I went downstairs one morning, I just had enough. I got a pint of water, a box of tablets and a bottle of Oramorph, liquid morphine. I took the tablets in the water upstairs, I started to swallow all the tablets because I couldn't cope with it anymore. I realised I forgot the morphine, so as I get up to get the morphine, I've got photographs of my wife, me and my family going all the way down my hallway and down the stairs. I started to look at these photographs and I, throughout my depression and throughout the era of suicidal thoughts, I've gone past these photographs, and thought nothing of it, but for some reason, now I'm not religious at all, but I thank God to this day that I really started to look at these photographs and it's like, I just thought to myself, what am I doing here? I think I'm doing my wife and kids a favour by ending my life when the reality is I'm going to ruin my wife's life, my son's life, my family's and God knows how many others. So I went to the bathroom as quick as I could. I put my fingers down my throat to get as much medication out as I could. Obviously rang for an ambulance and everything. And then from that point I was under the care of the crisis team at the mental health clinic for the best part of eight months, I think something like that. And my time there was, it was difficult, but you know what? It ended up being very rewarding. That's where I was introduced to CBT. And what really helped me was managing to change my thoughts because I honestly thought at the time I was a burden to my family. My wife hated me, my kids hated me when the reality is they didn't, they loved me. And it was me managing to change my thought patterns that really helped me get through this. In all honesty, I struggled with it for a little bit, the CBT, because it is difficult, but the more and more I put my mind to it, the better and better I felt to the point where, at the moment I'm in the best place mentally I think I've ever been. And that's down to me opening up and talking more. Because obviously I had counselling as well, but also through the CBT, to the point where I'd say, I think was it three, three years ago now, I was diagnosed with a form of leukaemia and what could have been the hardest 12 months of my life having chemotherapy. I wouldn't say it became a doddle because it wasn't a doddle, but it became a lot easier, and that was through, obviously, the techniques that I've picked up in the past. Because in the past I would've thought to myself, God, why me again? I've had these back problems, why me? And the reality is, loads of people go through chemotherapy, and loads of people survive it. I spun it in a total positive mindset from it. As I sit here now, I probably, I can be honest with you and say I enjoy what I do more now than what I did before when I ever played rugby, and I thought it was my dream to play rugby, where I'd say now I'm living it where I'm helping others and talking about my problems.

Helen: Ian, thank you so much for sharing that with us, and I'm aware that there's some hard-hitting stuff in there. And I really appreciate how open you've been about sharing your story and for me hearing you tell us about that, you reached rock bottom and, sort of, you found something that kept you with us, which I'm really grateful for, and I'm sure the people who care about you are incredibly grateful that something stopped you from doing that, and hearing about how you had the right therapy and you faced more challenges again, that anybody would find incredibly difficult to manage but your approach to it, the way that you've dealt with it, has been more positive because of what you learned about maybe challenging some of the ways that you were thinking, learning different ways of approaching things. And I wonder if I can ask you, I mean, I'm a CBT therapist and I know that it isn't just about positive thinking. I just wonder if you could tell us a bit more about how you and the person you were working with went about, I don’t know, learning how to think about things differently. What happened there?

Ian: Well, the best thing that helped me was doing a thought diary and, actually checking what I was thinking about and then changing it. That did really help me because the thoughts that I was coming up with at first, it just, as I wrote them down and when I came to the conclusions, it just wasn’t rational. It just, why is everyone looking at me? Why do I think people are judging me? And, they weren't, but it's what was going on in my head. I was actually thinking that, so to be able to talk about this with my specialist and obviously writing things down, which I still have now, and I still look at them now and I still do write some diaries sometimes. So, that would be the mainstay of what helped me definitely.

Helen: And I imagine after everything that you'd gone through up to that point, there must have been things about having the CBT that were also quite difficult. Can you tell us about the stuff that you perhaps didn't want to do or the stuff that sort of wish you hadn't had to do.

Ian: Most definitely that would be the homework. Because I've had counselling beforehand and obviously that's face to face and just talking. But coming home and then doing it at home because like at the time, because obviously you're not in a positive mind space, I was hoping to get like an instant result, if that makes sense, like just to be able to go and see my specialist a couple of times and all of a sudden, I'll be okay. And it's just not that simple, you really do have to put the work in and a lot of it is homework and writing down your thoughts and then looking at them again and then thinking well, is that right? Am I thinking about that right way? Could there be another way of thinking about that? And at first, like I said, I struggled with it. I really did. It's like, God, I don't want to do this. But the more and more I did it, the more and more it really did help me. And that, so that would be the hardest thing I did, but also probably the best thing I did as well, because that really did help me change the way of thinking.

Helen: So how did you get from whatever was happening there to getting involved with Phil here and getting involved with State of Mind Sport?

Ian: Well that was a chance meeting, to be honest with you. I went to a grand final, that's, I say this about 9 or 10 years ago, watching a game of rugby and then I was about to get in the car, I saw a friend of mine, so I started talking to him and Phil was stood next to him. So as I'm talking to my friend, my wife started to talk to Phil and it turned out that Phil is a Warrington fan, I was an ex- Warrington player. So, I started to talk to Phil, and Phil had heard about my issues. So, he invited me to come along to a meeting that to the lads were putting on and then see if I fancied talking. At first, I went to the meeting, I thought the meeting was fantastic, it really opened my eyes but then obviously my first couple of talks I really struggled with because, opening up and talking about the problems, which I've never done before, it, it really did get to me. I’d become very emotional, I’d cry and then I’d come home, and I’d feel like an adrenaline dump and I feel shattered for a couple of days, it was really hard. But the more and more I did it, the better and better it felt to the point where I really look forward to doing them now.

Helen: And that's for me, it's taken a lot of courage to do that. I mean, I'm hearing about you being at the top of your game, literally being a star in rugby, and the journey that you'd gone through to then start talking to people about what that had been really like for you. And I'm just wondering if I can come to Phil about what it was like then for you meeting Ian and getting him involved in all this?

Phil: Oh man. Well, for me, see, I told you I love sport, you see? So I've watched Warrington all through my life. I'd seen Knotty play for points and loads of times. So I knew all about his playing career, that he kicks some fantastic goals. And he talks a little bit about that when he speaks as well around some of the thought processes around that. So for me it was great. To meet Danielle is, he's a good lady who, he rightly praised immensely earlier on was great because I was thinking, ah, I was thinking. I remember going to a match at Bradford once and at half time they had some former players who had injuries such as Ian. Ian was one of those players walking round. It was a Warrington against Bradford game, and I was thinking wouldn't it be great to get Knotty to speak? But obviously I didn't know him. I've never met him sort of thing. So to bump into his wife at the grand final, you can't miss an opportunity like that to ask, say well do you think he'd be interested in having a meeting? Because I don't know anything about him really other than that. And she was going oh man, he'd love to do that, he was saying that he didn't really have a focus, wasn't obviously, because he of injury, he wasn't working and stuff. So I was thinking, because I've taught alongside many people who lived the experience. I was just hoping, well I know he's got a good story because he used to play rugby. He's had a bad injury, so I'm assuming he will have found that difficult for all the things you said from the being at the top and then not being able to play. So yeah, it's great for me. So I'm a bit like a kid really. So when we did those first sessions many years ago for all those players, my excitement was getting a signed in sheet with all the autographs of the players. Now that's sad, but, and I still got them in me loft, so obviously meeting Knotty is great for me. I'm meeting heroes and being privileged and humbled by hearing Knotty’s story. I've heard Ian speak many times in front of many audiences. And also finding it difficult when he first started. But now he can hold an audience very well. And as you heard, the power of the story that he tells. So, for me, he was great rugby league player, but he is also a great presenter. Now so for me that's fantastic. So I feel privileged to have met Knotty and been able to work alongside him really.

Helen: Yeah, that's brilliant. So if somebody was coming to a mental fitness session, they might hear somebody tell their story like Ian's just told us. What else might they expect?

Phil: Okay. So I suppose the way we plan it is, so thinking about blokes and how blokes respond to different health interventions or don't, should I say. So involving players was a crucial element. So obviously someone who's a former top player, like Knotty, talking about his vulnerabilities and also how he overcame those vulnerabilities, gives you a great buy-in and engagement from blokes in an audience. Because they're seeing a bloke who plays the sport, they play a really tough sport. But being able to talk about that is an immense, again, privilege and humbling experience for me. But also, we also try to entertain people. There's always a difficult balance, I guess, or a tricky balance. You don't want to make light of any subject, however, blokes like to have a laugh when they're in any situation, so you have to be aware of that and do that in an appropriate sort of way. Really trying to do it in a stigma free, so in a rugby club or a sports club, so a nonclinical environment usually will engage blokes more.

So I think, I mentioned, a story when we first began in State of Mind when we had that round of fixtures, myself and, Jimmy, who Knotty knew at the Grand Final, was with me that day, before Knotty was involved. And we were just beside the ground. We had a free ticket. It was great. We had a marquee on the terrace. We'd only just started, people didn't know what State of Mind was. And this guy came up with this lady and said, I don’t know what State of Mind is, but this is my friend and his son died recently and he's been talking about joining him on social media. So I had a chat with him about 15 minutes before the game kicked off, about support that was around in the local area or stuff that we could point into if he wanted to, so he just walks off. So I'm thinking, oh, right crikey, I hope that went okay. And then at the end of the game he came back and, on his own, but not with his friend this time. And he just said, oh, thanks for talking to me. Before, he said, this was going to be my last game of rugby league. I was going to take me on life tonight, but I don't think I will now. And then he buzzed off again. But I suppose that gave me the insight of, in places where blokes are and giving him some, an outlet maybe have a conversation. And that was a very simple conversation. And, but also something that obviously you do all the time as a therapist and when you are working in mental health. The great thing was we went back a couple of years later, same ground, different team playing against his local team. He came back with his, with his other son and his grandchild, or his grandson came up, gave me a massive hug and said, oh, I feeling emotional talking about this and he just said, oh, thank you so much for your time that day. He said. I don't know whether I'd still be here, I wouldn't be a granddad, that type of thing. And again, that just sort of ramps home the importance of Knotty telling his story. Just you've no idea who's going to hear that story and make a change based on that. Seeing someone else who can do something that's helped them, whether it's CBT or accessing support. Brilliant. And that's the point of doing what we do and that's what keeps us motivated to keep doing what we do.

Yeah, so you'll have a laugh. It's in a stigma free location. Again, little sort of brief interventions that you do as well as part of that. So there's one about alcohol where we'll have a picture of Homer Simpson and I'll do a very brief alcohol screen for people, just four questions, yes or no. And then it's just getting people to think about a situation and then move it on. You don't have to do a therapy with them, you just get them to think a little bit. And hopefully that might make them think, maybe I do need some support here. And that's all perhaps you can do in a simple, in a particular session. But we had a couple of people who've, or students and stuff who've done like, research or dissertations around what we do, been to see some of the sessions and interviewed audience members afterwards, and they say the fact that the sessions are relatable. So you can be clinical, I could be clinical and be dull as anything for half an hour. However, when you are, when you mix clinical information and Knottys powerful story, you've got a bit of a winning combination in my experience. And that prompts people to change a little bit. And just as all therapists will know, their personal interaction with somebody on a one-to-one basis can have such an important influence on the outcome. Having those sort of positive role models in front of you in somewhere that you are very comfortable being and you're not on your own, there's loads of other blokes going, And then what great feedback we get from clubs is that, blokes are talking about it next week in training, job done. You've got people to actually talk about and think and then, so we've not been an embarrassing subject to talk about, but something that they can think on, maybe go and talk to other significant others, whether it's family or whichever friends, but raising the conversation to think like, yeah actually I can talk about this. and it's quite okay and normal to do so whatever normal is, and then you can apply this to playing rugby league or whatever sport you play, you get mentally fitter, and you'll play better and get better results. There you go. Simple really.

Helen: Simple, maybe. Absolutely Phil, and maybe not always easy, but I'm really noticing that those sometimes brief conversations and being in situations where you are going to be somewhere anyway, and that message that it's okay to talk about it, and yeah there's some very heavy stuff in there sometimes, but also having a laugh with other people, while learning something about mental fitness is really positive. And again, I've already said this, but saving lives by doing something that brings that message in places where it's not always heard. And I know that, from what we were talking about before we started the recording, that you've expanded out beyond Rugby League. I'm not a rugby league player and honestly, it's a very long time since I went to see a rugby match of any kind. Tell us a bit more about how this message and this style of helping people to learn more about getting mentally fit, how's that spreading? How are you getting involved in wider things?

Phil: Okay a couple of things really. Been over to Ireland and Northern Ireland. And State of Mind has an organization or a parallel organization there. In the National Ruby League, Australia and New Zealand and Papua New Guinea, they utilise State of Mind, as a means to deliver the same messages across communities in Australia. And the Australian Rugby League team who are currently playing in the Pacific Championships, they have State of Mind on their sleeves, which is like ridiculous really in terms of having conversations and reading a paper on a Monday morning. But I just think lots of other sports, it doesn't really matter what sport you play so, for example, currently we're doing a project with two open age football teams in a local economically deprived area where suicide rates are high. The council asked us if we could have some input. Me and Phil Vievers, another one of our presenters, a former rugby league player and head coach went to, speak to players. They dragged them away from training, so I can't believe that they came. So we had a room full of these lads and they told them about what we want to do, want to try and improve their mental fitness and their mental toughness to play football in the third division of the Warrington and District League. So we're not talking like Premier League game by any stretch, right? So last Saturday, Bold Miners FC, give a quick plug there, they won't believe that they're getting a plug in this location. However, played a local Derby against Redgate FC. Now this was potentially going to be a very feisty experience at this level of a local derby where lots of players knew each other, had moved from different, from each other's teams from time to time Anyway, so met with the coach, the manager before, the head coach before, and he said, oh, why don't you come in the dressing room and have a chat with the lads before. So I just told him a little bit more about what we wanted to do, we sent them a survey that they'd responded to, so they said 80% of them wanted to improve the mental fitness. And I found myself doing an impromptu controlled breathing session for five minutes in the dressing room, about 20 minutes before they went out to, to do their physical warmup before they played. So I'm here and they're all just sat there in a dressing room, in through the nose, out through the mouth, that type of thing, thinking, wow, this is surreal that I'm doing this. But they went out, won six nil. So then now they think I'm great, they're quite happy for me to come back and do more stuff with them, which is great, clearly has nothing to do with me. We thought they played really well. However, that's the potential that you can do. So that's about being in a place where you can do something specific. I sent them another survey, said, well, which bits of these elements of mental fitness do you want to focus on? Managing stress and anxiety, emotional control, well some of the players needed that, a bit of anger management as well, but that's another thing. But they were keen to sort of address it and, help them to be better footballers. But obviously I know that's going to also include, being able to better control stress and anxiety or refer people on. So they all have my email address now, so if anyone's struggling mental health wise, they can contact me, have a chat, and I can signpost them to whether it's NHS Talking Therapies or CBT therapy in different locations. Or mental health services like, Ian spoke about. And I think every time we've been in different sport, it doesn't matter where we've been, we've been to gay league football, hurling, rugby union, rugby league, cricket, football, it doesn't really matter where you are. It doesn't matter what gender, you might have a different emphasis for the women's teams that we address, but again, you can get into that location and hopefully make a difference. And that's the key, just as every therapist will do whenever they engage for that first one-to-one assessment and try and build that initial rapport. That's what it's about. It's a simple opportunity to do

Helen: Thank you so much, Phil. I'm going to ask Ian, people out there listening, some of them may have quite a lot of familiarity with mental health or mental fitness, some might really not or be worried about engaging with it. If you had one key thing that you'd want everybody out there in the general public to know or to bear in mind, what would you say is most important from your point of view?

Ian: No matter how small you think your problems are, because everyone goes through life, at some point you have issues, you have problems and so no matter how small your problems are you need to speak your about straight away, get them off your chest as soon as you can. Especially with men, because we tend to dwell on things and we don't want to talk about our problems, but it's the worst thing you can do because it’s a vicious cycle and it just gets worse and worse. So for me. Definitely it'd be to talk about your problems as soon as you can. Like I said, it doesn't matter what your issues are. It could be money problems, relationship issues, it could be anything with school bullying or social media, anything like that. You need to get things off your chest as soon as you can. It's hard and it's very brave to talk about your problems, but for me, we need to get past the being brave, and it needs to be the norm that we can all talk about our problems, and we can all just speak to our friends, just open up and talk no matter what the issue is. So that would definitely be my main thing to, to get across is to open up and speak out and offload.

Helen: That's an absolutely fantastic message, Ian. Thank you so much. And what we will do, alongside this episode is we'll put some links on the show page to make sure that people can find out more, link to the work that you are doing and other projects or other sources of help to make sure that, anyone listening who wants to find out more can do that.

Phil, have you got any final thoughts that you would like everyone out there to know?

Phil: Yeah, I suppose so. Thinking from a therapy point of view really, I think. so sometimes we're limited in where we're located, I guess, and thinking about a new 10-year plan from the labour government about health after the last 10 year plan about a few years ago. But ultimately, a prevention's going to be a big part of that, I think, and perhaps sometimes being able to adapt your practice maybe where you're located. For example, embracing different technologies like immersive technologies where you could do lots of different things to compliment the therapy work that you're doing. The other thing for me as well, again, sorry, I'll just plug this a little bit, but, Mind and Sport England nationally have a draft version that's going to be published next year, which is around safe and effective practice for organisations who provide physical activity, movement, or sports. So those people who work in those locations can feel comfortable enough or confident to signpost people, whether it's to NHS Talking Therapy, CBT, or wherever it is. So for us, it's, we are part of trying to endorse that and utilise all those principles within State of Mind and encourages many other physical organisations or charities or small organisation to try and reassure therapists about if you refer to state of mind or anywhere else, or a swimming group or a fishing group or whichever. But the people who are involved in those groups, are, look at this guidance and can, and feel comfortable and confident enough to refer people to. they're fantastic therapists that are around and, access that support. So if people are talking as Knotty mentioned, then, to get them to the right, the best place to try and find that, and therapy has a massively positive effect on so many people. So that'd be my thing. Just trying to adapt and think about how you deal with some of those things.

Helen: And it really brings to mind for me that when you broaden it out to any kind of sport and activity and making sure that we are making things accessible to anybody from any background, I know that we've spoken mostly about, men in sports where perhaps traditionally the idea of being manly isn't to talk about your feelings and actually how much bravery and courage it takes, but how beneficial it is. But that really does apply across the board. I mean, you've mentioned it doesn't matter what gender and any other background that people come from, there will be a way of accessing the right kind of help. And the more that we can do to make things available in the communities where people actually go anyway, much more likely for people to be able to get the right help if they need support, sooner more geared to their particular needs.

And I'm delighted to hear from you two because I mean, I'm a therapist and we talk quite a bit about men who don't talk about their feelings. And you two are a great example coming from, I don’t know if I could use the word quite macho kind of sport, talking in such a way that's really showing that talking about it. However hard it is really worth it and can be done by people who might not normally do that.

Ian, can I just ask you if there's anything else that you would like to say before we finish this episode, is there anything that you would like to share with our listeners?

Ian: Yes, there is actually, it's no matter what therapy you kind of diagnosed to go down or what someone advises for you, to stick at it. Because I've had counselling a couple of times, obviously CBT, mindfulness, and for me, you've got to stick at it because I think every single one of them at one point, I thought, Oh my God, I don't want to do this anymore, this isn't working, but the more and more you do stick at it, the better it gets and it will help, 100%. That's my opinion anyway. I honestly think that no matter what the therapy is, if you put enough work into it, you'll get the help that you need.

Helen: Thank you, Ian. Any final thoughts? Phil?

Phil: Yeah, just to add to that really Knotty that, any therapist working with anyone who does any sport. If they've ever done any training, they'll know about repetition and trying to be as good at kicking a ball, passing a ball, whatever it might be. So to continue to that repetition of controlled breathing or mindfulness pays off. So as you say it's a good sort of way to encourage someone to continue when you put it in the terms of physical fitness and training. So it's exactly the same, just different ball games, so to speak.

Helen: Ian and Phil, thank you so much. It's been a great opportunity to speak with you today.

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