Sportsmen tend only to seek help when they are in crisis Late last year I went out for a meal with former Tottenham goalkeeper Erik Thorstvedt, who played alongside Paul Gascoigne for several years in the late 80s and early 90s. "You know," he said, at one point in the evening, "I have this nagging fear that any day I could get the phone call telling me something awful has happened to Gazza. It never goes away. He's not the only one. Almost everyone with a connection to Gascoigne feels exactly the same way. He may have become famous through his brilliance on the pitch, but Gascoigne is now just as well known for his troubles off it. He could beat defences at will, but in addiction and mental health issues he has found an immovable wall. On Monday, Gascoigne pleaded guilty to a charge of drunken assault at Stevenage magistrates court and was fined £1,000. It was also revealed this week that Kenny Sansom, another former England football international, is a homeless alcoholic, who has recently been sleeping on a park bench after years of drinking and gambling left him penniless, and has tried to kill himself. "I just don't want to live," he told the Sun. I don't know if I can handle it any more. The Professional Footballers Association has said it will help him get treatment, but he has yet to accept its offer of rehab. For many, Gascoigne and Sansom are just two high-profile victims of a game that has become bloated with excess. Too much money. Too much adulation. Too much everything. Get too close to the flame and some people are going to get burnt. This may have an attractive internal logic, but it's also wrong. Top-level football may well be knee-deep in cash, celebrity and self-regard but there's no causal link to mental illness and addiction problems. There are as many players with mental health issues in the lower leagues as there are in the higher ones; it's just that those lower down the football pecking order seldom make the headlines. "There's no evidence that there is a higher prevalence of addiction and other mental health issues in football than anywhere else in society," says Clarke Carlisle, chairman of the PFA. The public's perception understandably sometimes gets skewed by the sensational way these matters are reported, but the reality is that a bloke on £300 per week who gambles away his entire earnings has just as much of a problem as a footballer on £20,000 per week gambling his entire earnings. Being rich and famous does not make you any more or less likely to become mentally unwell. Not that Carlisle doesn't think football has its own issues and responsibilities around mental illness; it's just that he believes they should be carefully defined and quantified. "Football is a very competitive, macho environment," he says, "and players are competing every bit as much with their team-mates as the opposition. Everyone wants to be in the first team, which can make it hard for someone to admit he has a problem. The game encourages an image of physical and mental strength that can make any sign of vulnerability look like a show of weakness. Every industry has its own specific triggers. What we need is some proper research; football clubs have all sorts of data on players' performance but no one has yet compiled anything worthwhile on the game's trigger points that can kick-start a player into addictive behaviour or a depressive episode. We can guess that a fear of being injured or dropped may tip a player into a negative thinking spiral. We can guess that players may feel a need to keep up with their peers by partying and gambling hard. We can guess that some kids find it very hard to be rejected. We can guess that some players struggle to cope with retirement. But it is only guesswork and until we have that hard research, we are only ever going to be able to react to events rather than try to deal with problems before they occur. Getting that evidence may not be easy, though. Most data regarding mental illness requires a degree of openness and honesty from its subjects that footballers may not be willing to give. And even if the research was available, getting clubs to act on it could still prove tricky. Professional football is not a single entity; it is a collective of leagues, clubs and personalities, all with their own foibles and biases. Just as elsewhere in society, some may have progressive views on mental health while some may be determinedly old school. Carlisle cites the Crystal Palace academy as an example of best practice. "Here the emphasis is as much on teaching the players to become ethical, moral men as it is on developing their football skills," he says. Colin Bland, chief executive officer of the Sporting Chance clinic, founded by former Arsenal defender Tony Adams in 2000 to help players with addiction issues, agrees that one of the key issues is to get clubs to understand the nature of the problem. "As with those from other walks of life, sportsmen tend only to seek help when they are in crisis," he says. Before that point, most people like to think they can deal with any problem themselves. But what a club can do is foster a culture in which talking about feelings, insecurities and anxieties is regarded as a strength rather than a weakness. Rugby league clubs have made huge improvements in this regard recently and it would be good to see more football clubs following their example. Whether you can actually prevent a person from falling into addictive behaviour or a depressive episode is an ongoing debate among mental health professionals. Some believe that, with the right treatment, addictive behaviour can be contained before it proves too problematic and that recurring bouts of depression can be headed off. Others argue that all addicts need to hit rock bottom before they can get well and that no one can make any guarantees about the recurrence of depression. But what all agree on is that the greater the level of awareness and understanding and the earlier the intervention, the quicker and easier the recovery will be. Here, Bland believes there is some good news for sportsmen. "Once a player has acknowledged he has a problem and wants help, he has far quicker access to treatment than most people these days," he says. Clubs know how to access help and a player doesn't need to go to his doctor, get a referral or jump through loads of hoops. He can be seen by someone within hours. Getting players to seek help is still a struggle, though. "About two years ago - coincidentally at roughly the same time as Gary Speed killed himself - the PFA brought out a handbook on depression," says Michael Bennett, head of player welfare at the PFA, "and this has done a great deal to raise awareness. Over the last year, I've seen 57 players who have asked for help and we have started a nationwide counselling service so that no player has to wait two weeks for an appointment. But there are still many more former players than current players coming forward, so there are still issues about openness that need to be addressed. But then the same is true for many other professions. We've still got a long way to go but we're making progress.