STEP 1: Scoping Review

The searches, data analysis and reporting protocol followed The Joanna Briggs Institute (2015) for scoping reviews.

Sources and key terms:

Searches were identified using electronic databases and by hand-searching reference lists of articles. Five electronic databases were searched: Scopus, Psychinfo, SPORTDiscus, OVID interface, Google Scholar and Orygen Evidence finder (https://www.orygen.org.au/Training/Evidence-Finder). Each database was searched from 13^th May – 22^nd May 2020. Three researchers undertook the search and data extraction process to ensure reliability and quality of article selection. The search included a review of national (BeYou, Orygen, Beyond Blue) and international best practice guidelines (WHO, UNICEF).

Search key terms included a combination of: Mental health, mental wellbeing, mental ill health, stigma, mental health promotion, best practice guidelines, best practice criteria, sport, stigma, community initiatives, community based programs, evidence based guidelines, community health/mental health providers/organisations, and/or key sports sector stakeholders. In total over 2,000 items were found from the comprehensive search across databases and key search terms. The below inclusion/exclusion criteria were used to determine exemplar articles for evidence extraction and collation.

Study selection:

Systematic, literature and scoping reviews of best practice criteria for mental wellbeing promotion were included. Randomised controlled trials (RCT), clustered randomised controlled trials, quasi-experimental and pre-post studies examining the effect of mental wellbeing programs in sport that identified best practice guidelines were included. Peer reviewed studies that published best practice criteria of mental wellbeing promotion in sport that were State-based (Vic), National (Aus) and/or international and non-peer reviewed literature (i.e. PhD dissertations, reports and ‘grey literature’) in the English language were included.

Participant type:

Participants were children, adolescents and adults who were a contributor, member, leader, athlete, coach within an amateur or professional sporting club, community or organisation.

Primary target audience and project stakeholders included, such as community sports clubs and their members. Other project stakeholders included Victorian local councils, community health/mental health providers/organisations, and key sports sector stakeholders (regional sports assemblies, professional bodies/associations, topic matter experts, role models (stakeholder definition provided by VicHealth).

Mental wellbeing promotion applicable to sporting clubs:

Best practices and best practice guidelines for mental wellbeing promotion in sport which aim to create positive change/cultures in community sports clubs, by boosting wellbeing protective factors, including (but not limited to):

• strengthen positive social connections

• develops member’s personal skills to enhance resilience

• reduce stigma associated with mental ill health

• build connections with health promoters/services

• improving diversity and inclusion within clubs, specifically for subgroups who experience poorer mental health outcomes, such as the LGBTI+ community

(mental wellbeing definition provided by VicHealth)

Best practices/criteria that took a general focus on promoting mental health awareness, improving mental wellbeing or criteria tailored to focus on a specific mental wellbeing issue (i.e. stigma reduction, awareness) met inclusion criteria. To be deemed eligible criteria had to take place within a sports setting which was defined as being 1) organised and 2) competitive with 3) exertion and physical skill where “sport is more generally defined as a human activity capable of achieving a result requiring physical exertion and/or physical skill which, by its nature and organisation, is competitive and is generally accepted as being a sport” (Retrieved from: Clearing House for Sport).

Exclusion criteria applied to best practices that were outside the domain of sport (such as nursing, psychiatric clinics, leisure, art and music).

STEP 2: Exemplar articles and extraction

See excel spreadsheet for search terms, number of articles retrieved and selected exemplars: https://docs.google.com/spreadsheets/d/1UNkzbvq4P3iRqRC_bhlpoh2abEqMnad_0fVCUdQ3wnw/edit#gid=1434528633

Programs are Part of a Strategic Framework:

• Programs delivering mental wellbeing promotion to sporting clubs need to integrate with an overarching mental health and wellbeing strategic framework specific to sport. There was little evidence that such a framework exists and the review revealed a resounding need for direction and leadership in this area from one or more peak bodies.

• Mental health is a complex issue. Established supportive frameworks should be multi-layered, targeting personal, social and environmental levels. Programs should reflect this complexity.

• The development of a mental health promotion strategy in sport should be considered to provide leadership and direction.

• The strategic framework is utilised to operationalise the determinants of mental health, in doing so they are tailored to meet the specific needs of the context in which programs are to be implemented.

Programs Sit Within an Authorising Environment:

• Mental health promotion needs support from National, State and Local Governments, as well as public and private sector agencies, preferably as part of a strategic framework. Programs link to and obtain legitimacy from authorising bodies whilst helping clubs establish the case for a focus on mental health. This could be in the form of a business case with positive impacts for retention and membership growth as well as a ‘social good’ from improved health outcomes. They leverage off of government and sporting social development, health and mental health policies.

• Programs have access to well resourced expertise that can provide necessary training, support and alignment with overarching MHW frameworks and the contemporary evidence base. This could manifest itself in a number of ways:

Peak Bodies: Provide a mental health and wellbeing officer as a point of contact for sporting organisations and programs. They act to help translate frameworks into grass roots enactment, advising on programs, evaluation and support program rigour.

Sporting Organisations: Establish an expert advisory panel that includes qualified experts in MHW, participants and practitioners who implement interventions. They meet regularly to select/establish programs, evaluate them and review them.

Program Deliverers: Have regular access to one or more MHW experts who can readily translate research, understand ‘what works’ in MHW programming and give clear guidance. They establish the efficacy of programs through careful evaluation.

• Any expertise connected to programs are presented to end-users as personable and approachable. Credentials are not prominently positioned to reduce stigma. Experts refrain from telling people what to do from a position of authority.

Consistent understanding of mental health promotion:

• Understood, consistent, clear and sustained messages within and beyond sport are important for MHW outcomes to be effective. MHW programs in sport use a language that is consistent with overarching mental health frameworks. Programs that conflate mental health and wellbeing interventions to concepts like ‘gratitude’ can detract from core messages. Programs that regularly change their language can add to a confused landscape.

• Programs, like their frameworks, are underpinned by well-established models of mental health recovery such as the CHIME framework and/or behavioural change theory.

Have targeted foci and varied formats

Programs that have been found to have an impact in the sport sector have at least one or more of the following emphases:

• Bringing about social connection: connected to team members, this connection triggers positive feelings and practices

• Promoting identity security: Developing a positive sense of self and a secure identity through sport promotes recovery and countered self- and socially-stigmatising narratives.

• Enhancing normalisation: regular routine, structure and a sense of purpose

• Encouraging positive affectivity: positive feelings and emotions during programs help reduce stigma. Language around MH needs to be reviewed to not encourage self-stigma.

Programs consistently and continuously communicate their strategy. There is a clear awareness of language used, avoiding prejudicial or pejorative references so as not to encourage self-stigma.

Most effective programs or interventions consider the:

• delivery method: online, one to one, peer, in groups

• intervention/program type

• duration and frequency of intervention/program

• intervention components

However: The evidence for the effectiveness of mental health awareness programmes in sport settings lacks a sound methodological foundation on which to determine what types of programmes are most effective.

Alignment of foci to target audience needs

• Programs have foci tailored for varying levels within an organisation (ie. management, members) and exhibit a detailed knowledge of developmental, cultural, and social issues related to sport participation and systemic issues within sport settings and organisations. Programs, for example, might start with an evaluation baseline survey to establish the level of mental health and wellbeing needed, and tailor program content accordingly.

• Programs consistently and continuously communicate their strategy. There is a clear awareness of language used, avoiding prejudicial or pejorative references.

Extend and amplify foci through forming strong partnerships and collaboration

Strong partnerships and collaborations are key to effective programs for mental wellbeing promotion. For some collaborative programs, mental wellbeing outcomes are the primary objectives. However, for the majority of programs these may be secondary to other social and economic outcomes, but are valuable in their own right. Beneficial outcomes from the adoption of intersectional collaboration include:

• the adoption of a unifying language with which to work across sectors;

• a partnerships approach to allocation and sharing of resources; and

• a strengthening of capacity across the individual, organisational, and community dimensions.

Programs should be working collaboratively to:

• build on existing activity in sectors, settings and organisations;

• create different partnerships for different purposes, at varying levels; and

• create collaborative action “vertically” within government departments and organisations, and between those expert in policy, practice, and research.

Undertake Evaluations

Systematic evaluation of programs is needed to increase the evidence base as well as to determine the applicability of this evidence base in widely varying cultures and resource settings. Consequently, there is clear alignment between the program goals, what is delivered by the program and the outcomes as measured. If the program doesn’t fit the definition of mental health and wellbeing then it is not a mental health and wellbeing intervention. Other considerations include the use of valid and reliable measures to understand its impact across different settings and the extent to which evidence collected has been collated and disseminated for widespread use.

Effectiveness

In order to identify programs that are effective, feasible (cost effective), and sustainable across diverse cultural contexts and settings we need to examine program evaluations. Programs that have undertaken evaluation can be classified according to the following levels where:

- Type A: What works is known, how it works is known, and repeatability is universal.

- Type B: What works is known, how it works is known, but repeatability is limited.

- Type C: What works is known, repeatability is universal, but how it works is not known.

- Type D: What works is known, how it works is not known, and repeatability is also limited.

Program Outcomes: Consistency between program goals, content and outcomes

The program goals, content and outcomes as measured, align with a recognised definition of mental health and wellbeing promotion, the program goal leads to selected content/strategies results associated anticipated outcomes.

Part of an evaluation frame has to consider the extent to which the program focuses on MWP and not get sidetracked by the latest trend or foci that aren't related to core objectives.

Institutional or program sustainability

The program is sustainable at an organisational level if the host organisation has good governance models, is mature, able to generate ongoing funds and well aligned with the broader community. Programs need to be supported by people who are effective at leading the organisation they serve, while also meeting their legal and compliance responsibilities. They mitigate and manage risk, they have established objectives, performance indicators and quality records and they understand their financial position.

The main features that are known to be associated with institutional or program sustainability are:

• There is evidence that the program is effective.

• Consumers/funders/decision-makers were involved in its development.

• The host organisation provides real or in-kind support from the outset.

• The potential to generate additional funds is high.

• The host organisation is “mature” (stable, resourceful).

• The program and host organisation have compatible missions.

• The program is not a separate unit but rather its policies, procedures and responsibilities are integrated into the organisation.

• Someone in authority (other than the programme director) is a champion of the programme at high levels in the organisation.

• The programme has few “rival providers” that would benefit from the programme discontinuing.

• The host organisation has a history of innovation.

• The value and mission of the programme fit well with the broader community.

• The programme has community champions who would decry its discontinuation.

• Other organisations are copying the innovations of the program.

Sustainability of impact

The program creates sustainability at an individual level, in relation to knowledge development, skills to support mental health, enhanced mental health. The program creates sustainability at a community level through fundamentally changing practices within clubs. Volunteers are now skilled to support mental health, individuals are trained within clubs, the club culture has changed, club champions have been developed and mental wellbeing support is now aligned with club ethos and identity.

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