Malte Christian Claussen
Statement of the Swiss Society for Sports Psychiatry and Psychotherapy SSSPP on violence and abuse in competitive sports and on the report “The Magglingen Protocols“ in Das Magazin of November 1, 2020: The SSSPP shares the suffering of victims of violence and abuse in any form, in competitive sports and in the general population.
All athletes have a right to engage in “safe sport”, defined as an athletic environment that is respectful, equitable and free from all forms of non-accidental violence to athletes. Yet these issues represent a blind spot for many sport organisations through fear of reputational damage, ignorance, silence, or collusion.
All forms of harassment and abuse breach human rights and may constitute a criminal offence. Therefore, there is a legal and moral duty of care incumbent on those who organise sport, to ensure that risks of non-accidental violence are identified and mitigated .
The SSSPP supports the position in the International Olympic Committee consensus statement: harassment and abuse (non-accidental violence) in sport . The risk of violence and abuse in competitive sport requires policies and procedures to protect athletes [1, 2].
Violence and abuse in sport
Violence and abuse in sport affect all athletes of all ages, in all sports, and at all levels of performance . Psychological, physical and sexual abuse and neglect occur in sport either alone or in combination, once only, continuously or repeatedly, manifesting themselves through different mechanisms, directly and indirectly, and must always be considered in a cultural context . A high risk of becoming a victim of psychological, physical and sexual abuse and violence, which increases with career and performance progression, has been described for all competitive athletes, as well as for minor, para and LGBTQIA* (lesbian, gay, bisexual, transgender/transexual, queer/questioning, intersex and allied/asexual/aromantic/agender) athletes [1–3]. Psychological abuse is the most common form of violence in competitive sports . Stafford et al. reported a prevalence of psychological abuse in young athletes in the order of 75% . Perpetrators of violence in sport can include members of the medical and coaching teams, as well as peers, training partners and teammates . A considerable number of unreported cases of violence and abuse in sports is suspected .
The mental health consequences of violence and abuse are devastating, long-lasting and, according to Reardon et al., in sport can be associated with reduced performance and achievement, early exit from sport, reduced self-esteem, body image disturbances, disordered eating and eating disorders, substance use disorders, depression, anxiety, self-harm and suicide . In addition, the propensity to cheat and dope is increased in the context of violence in competitive sports; furthermore, childhood psychological abuse correlates with long-term, complex post-traumatic and dissociative symptoms . Violence and abuse in sport affect the victims and their athletic environment, as well as the victims' personal and social relationships, even outside of sport .
Psychiatric-psychotherapeutic expertise and the interdisciplinary approach
The possibility of experiencing violence, within and outside of sport, should be considered and inquired about by clinicians to whom athletes present with psychological symptoms . Recognising violence and the psychological consequences of violence and abuse as such, being able to deal with disclosure by those affected, and the serious psychological consequences and trauma sequelae, require psychiatric-psychotherapeutic expertise and an interdisciplinary approach that includes the victims’ environment [2, 5].
Violence and abuse in sport require the development and implementation of effective measures in competitive sport . However, the available evidence on violence in sport and corresponding recommendations also raise the question as to why effective measures, not only by the federations and clubs, but by all those responsible in Swiss competitive sport and in the current care model, have not been implemented or have not taken effect so far. Prevention is the central element in the development and implementation of effective measures against violence and abuse, as well as for the maintenance and promotion of mental health in competitive sports. Prevention should be an integral part of care concepts, but requires appropriate clinical expertise and qualification, as do diagnosis, therapy and aftercare. The groups at risk for violence and abuse in sport should be given special attention in prevention.
The incidents described in the “Magglingen Protocols” must be clarified transparently. Equally important is the development and implementation of preventive measures to protect all athletes, in all federations and clubs, as described, for example, by the International Olympic Committee consensus statement: “Harassment and abuse (non-accidental violence) in sport at the level of sports organisations, athletes, sports medicine and related disciplines, and research” .
A systematic, multi-agency approach involving athletes, their sporting environment, medical and therapeutic practitioners, educators, and criminal justice agencies is recommended .
The Swiss Olympic Ethics Charter and the Code of Conduct for Coaches must be observed . The principles proclaimed under the direction of the International Centre Ethics in Sport for the protection of underage athletes, namely quality, prevention and danger avoidance measures should also be a binding part of every association and club structure for the sake of transparency .
Sports medical and psychiatric examinations
An annual review of possible violations against athletes should be integrated into the sports medical examination SPU in Switzerland. In the event of suspected violence and abuse, an accessible, qualified contact person should always be guaranteed for those affected, as well as for those in their athletic environment and professional helpers, and should be involved before initial treatment steps are taken.
Specialists in child and adolescent psychiatry and psychotherapy, and in general psychiatry and psychotherapy with expertise in the area of trauma sequelae and optionally in sports psychiatry and psychotherapy, should be an integral part of an interdisciplinary medical approach to violence and abuse in competitive sports and its serious psychological consequences, in prevention, diagnosis, therapy and aftercare. The stresses and risks for mental health in competitive sports, however, already require the integration of a qualified mental health practitioner in the care concepts within competitive sports, independent of the described problems of violence and abuse in sports. In addition, a corresponding coordinating office for sports psychiatry and psychotherapy is required in every large association and club.
The SSSPP is ready to make a substantial contribution and is in favour of interdisciplinary prevention and treatment concepts against violence and abuse, as well as for the promotion of mental health in competitive sports.
The most important facts in brief:
- Reappraisal of the events in Magglingen calls for a critical approach to the concepts of care in competitive sports.
- Questions about the qualification and competence of those responsible for recognising and dealing with violence and abuse must be answered, as well as whether the handling of the serious psychological consequences was empirically substantiated and in accordance with guidelines.
- The physical and psychological consequences of violence and abuse require demonstrable clinical and medical competence, which includes psychiatric-psychotherapeutic expertise and, in the case of minors, expertise in child and adolescent medicine. This disorder- and disease-specific expertise should always be mandatory.
Published in the name of the SSSPP Executive Committee [Malte Christian Claussen, Carlos Gonzalez Hofmann, Christian Imboden, Erich Seifritz, Marcel I. Raas, Ulrich Hemmeter] and with the collaboration of Andres Schneeberger.
Claussen MC. Stellungnahme der SGSPP: Gewalt und Missbrauch im Leistungssport. Schweiz Ärzteztg. 2020;101(5152):1725–1727. doi:https://doi.org/10.4414/saez.2020.19405
Malte Christian Claussen, President of the Swiss Society for Sports Psychiatry and Psychotherapy SSSPP
Mountjoy M, Brackenridge C, Arrington M, Blauwet C, Carska-Sheppard A, Fasting K, et al. International Olympic Committee consensus statement: harassment and abuse (non-accidental violence) in sport. Br J Sports Med. 2016;50(17):1019–29. doi:https://doi.org/10.1136/bjsports-2016-096121.
Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53(11):667–99. doi:https://doi.org/10.1136/bjsports-2019-100715.
Schneeberger AR, Gupta R, Flütsch N, Recher A. LGBTQI and sports – future implications for sports psychiatry. Sport & Exercise Medicine Switzerland. 2020;68(3):28–9.
Stafford A, Alexander K, Fry D. ‘There was something that wasn’t right because that was the only place I ever got treated like that’: Children and young people’s experiences of emotional harm in sport. Childhood. 2015;22(1):121–37. doi:https://doi.org/10.1177/0907568213505625.
Mountjoy M. ‘Only by speaking out can we create lasting change’: what can we learn from the Dr Larry Nassar tragedy? Br J Sports Med. 2019;53(1):57–60. doi:https://doi.org/10.1136/bjsports-2018-099403. PubMed
Swiss Olympic [Internet]. Ethik-Charta – Neun Prinzipien für den Schweizer Sport; c2015 [cited 2020 Nov 12]. spiritofsport.ch/verbaende/werte-ethik/ethik-charta
Safeguarding Youth Sport project consortium (International Centre Ethics in Sport) [Internet]. Safeguarding Youth Sport – Stimulating the individual empowerment of elite young athletes and a positive ethical climate in sport organisations; c2015 [cited 2020 Nov 12]. fis.dshs-koeln.de/portal/de/projects/safeguarding-youth-sport(6ced66d5-b3e7-4c05-a648-24682b35d021).html