The first National Lottery draw on 19 November 1994 began a revolution in British sport that has seen Team GB climb steadily from 36th in the Olympic medal table in 1996 to 3rd at the London 2012 Games. Thanks to lottery funding there is now a level of technical and logistical support for elite performers unimaginable a generation ago. Yet, in the UK at least, this seldom includes ready access to high-quality psychiatric expertise; certainly not in the manner envisaged by David McDuff in Sports Psychiatry: Strategies for Life Balance and Peak Performance.
From the first chapter, McDuff sets out the scope of sports psychiatry practice where the emphasis is not only on a set of competencies (he lists and describes eight) but also on a style of working. This style is a recurring theme throughout the book where therapies must be tailored to fit the circumstances of high-performance sport and where an on-site psychiatric presence guarantees accessibility and secures engagement.
There are fascinating chapters on stress recognition and control and energy regulation, which are rich with practicaltechniques and, along with a chapter on mental preparation, give the intended primary target audience (mental health professionals working in sport) a detailed understanding of the psychological life of athletes. A chapter on substance misuse pulls together some disparate strands but would have benefitted from more discussion of the psychological and psychiatric antecedents of ‘doping’ for performance enhancement.
Later chapters tell us what we should already know – that mental illness is no less common (and in some cases more common) in sportsmen and sportswomen. However, the key message from these chapters is the value that psychiatry adds if integrated into the support teams that surround elite performers. This is a message that needs to be heard by the book's secondary target audience of sports medicine specialists and team managers.
There might seem to be a modest audience in the UK for a book of this nature, and sports psychiatry, even in the USA, is still an emergent practice area, but McDuff has provided the template that could ensure the mental health needs of athletes are met in the same comprehensive manner as their physical health needs.
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