Table I.

Football-based intervention studies in mental health

Evaluation	Project name/description	Form/frequency	Target group	Intended outcomes	Methods	Identified themes
O’Kane and McKenna (2002)	Five-a-side football project, Lanarkshire, Scotland	Five-a-side tournament Winter league (teams playing 24 games) Summer league	Clients with chronic and enduring mental health problems	Improving levels of physical fitness Enhancing physical self-concept Enhancing levels of self-confidence and self-esteem Encouraging improved communication skills Reducing barriers and promote better staff/client relations Increasing sociability	Interviews with clients and carers (qualitative)	Self-reported increase of general well-being Level of fitness Increased levels of self-confidence, communication easier Clients felt more motivated and considered participation in other similar physically active sports Carers perceived their family members as more proactive and communicative, more alert and in touch with their surroundings
Hynes (2008)	“Positive Mental Attitude” (PMA) League, England (London-wide)	Training 1-2× per week; matches played on monthly basis	Men and women who are experiencing or recovering from mental illness	“Improving lives” Overcoming stigma and exclusion Developing positive attitude Educating players on the importance of healthy eating Improving general fitness, weight loss, smoking cessation Increasing confidence and self-esteem Learning about importance of team work	Interviews of three participants (anecdotal evidence)	Some anecdotal evidence for elevated symptoms. Participants reported gaining independence, confidence, self-belief, happiness and motivation. Employment. Enjoyment, equilibrated mood, regaining of structure, inclusion
Darongkamas et al. (2011)	Park House United Football Club, Staffordshire, England	Voluntary training at football club	Men with mental health issues	(No aims specified)	Quantitative: Warwick-Edinburgh Mental Well-Being Scale Resource Generator UK Qualitative interviews of ten participants	Improvement in mental health, attitudes about themselves, general well-being Five themes: social inclusion, changes in attitude and behaviour, enjoyment and importance of the club, changes to mental health, self-confidence
Henderson et al. (2014)	“Imagine Your Goals” (Sixteen Premiership clubs, England)	Regular training sessions	Men and women with mental health problems	Improving physical health, building confidence, reducing social isolation Social contact, bringing people with and without MH problems together (Campaigning for Time to Change)	Warwick-Edinburgh Mental Well-Being Scale, The Resource Generator-UK (RG-UK) Focus groups	Improvement only at personal skills subscale, individual skills (The Resource Generator-UK; RG-UK) Improved levels of health and fitness, including weight loss; social contact/inclusion; improved well-being; improved self-esteem, creating more structure, new experiences, appreciation of exit routes, fear of project ending
Carter-Morris and Faulkner (2003)	“Longfield United”, Birmingham, England	Regular meetings in team and regular tournaments (international)	Male service users with enduring mental health problems (three out of five had schizophrenia)	Positively impacting on the lives of service users Inclusion/ getting participants out of social isolation	Semi-structured interview of ten participants Qualitative analysis: themes analysed through inductive analysis	Three themes: Promoting normalisation and a personally meaningful opportunity for social interaction Challenge auditory hallucinations and delusional beliefs characteristic of schizophrenia Side effects of medication identified as key barrier to greater participation
McElroy et al. (2008)	Manchester’s “Grassroots Initiatives” (England)	Care Standards Improvement Programme (CSIP) league; 15 minute matches, six-a-side version of the game	“Socially excluded, particularly those who experience mental health/learning-related difficulties”	Heath improvement Internal experience Inclusion Confidence/security	Likert scales on experience of energy, optimism, anxiety, development of coping skills, sense of inclusion of 131 participants	Perceived physical and mental health improvements Reduction of anxiety Perceived improvement of coping Improved tolerance towards others Subjective feeling of inclusion Increased confidence
Mynard et al. (2009)	“RecLink” league, Melbourne, Australia	A community-based Australian Rules Football league	16-60-year-old men with psychiatric, and cognitive impairments (and others)	Tackling social, occupational disadvantages associated with mental health	Ethnography (one team observed through one season, five in-depth interviews)	Three major themes associated with the experience of belonging to this RecLink football team: Spirit of inclusion Team building Meaning of team involvement
Carless and Douglas (2008)	Football (and other exercise) at Rehabilitation Centre in Leeds, England	Voluntary Football Training at Rehabilitation Centre	Male Residents with serious mental illness issues at a Rehabilitation Centre	Recovery/inclusion	Participant observation Medical records Interviews	Reconnecting to old self Gaining satisfaction and sense of achievement Social network Emotional well-being Time use/keeping busy Improvement of social and interpersonal difficulties Attitudes towards others
Carless and Sparkes (2008)					Qualitative approach: semi-structured interview (3 participants)	Feeling supported Self-confidence Happiness/satisfaction/enthusiasm Fitness
Mason and Holt (2012b)	“Coping Through Football”, London, England	Two training sessions per week with Leyton Orient coaches; occasional workshops and match visits	Younger men with severe mental health problems	Improving mental and physical well-being Reducing social isolation through inclusion and help finding exit routes into volunteering and/or employment	Interviews of participants, coaches and referrers for grounded theory analysis	Identifying with past self Service with a difference Opening up to the social world Psychological Safety “Feeling good” Empowerment
Grant and Oldknow (2008)	“Recreational Enterprise Assisted Client Training”; Football Training Academy, Doncaster, England	40-week basic training programme	Men and women with severe enduring mental health problems, along with individual levels of social dysfunction	Development of football skills Health promotion Healthy lifestyle Healthy eating First aid and photography skills	Qualitative Interviews (details of evaluation method and number of participants not stated)	Improved football skills Physical fitness Better self-image Higher self-confidence Feeling part of a team Common identity Improved moods Exit routes/new opportunities
Brawn et al. (2015)	Mental health and football well-being league, North West of England	Ten six-a-side local mental health teams. In total, nine months of a year	Men with mental health problems	Widening the social opportunities Facilitating improvement in their mental and physical health	Interviews of seven participants aged between 25-63. Narrative-oriented inquiry – themes identified	Self-reported improvement of physical and psychological well-being and sense of self Sense of belonging Connecting to previous history Distraction from current problems Sense of achievement
Steckley (2005)	League for young people with emotional and behavioural difficulties, Scotland	Participation in league	Boys in residential care with emotional and behavioural difficulties	Promoting pro-social values Enhancing Resiliency Providing healing Enhancing environments Self-experience	Observation/case studies	Enjoyment of training/game Empowerment Stronger sense of self Resilience Inclusion
Butterly et al. (2006)	Community-based physical activity project (MUSCSEL) in Leeds, England	Weekly five-a-side soccer sessions overseen by staff from Leeds United Football Club	Male and female mental health service users in the Leeds area	Increasing the physical activity levels of mental health service users in the Leeds area This should result in reduced demand not only on social services but also on NHS resources allocated to mental health provision	Questionnaire Semi-structured interview	Enjoyed exercise/activity but barriers prevented them from participating further b) – Increased self-confidence Increased energy level Reduction in the incidence of severity of their symptoms Felt more confident socially and made more friends Exit routes: some participants planned to go for more educational and vocational qualifications felt fitter weight loss positively affecting self-image and self-esteem
Magee et al. (2015)	Three football projects in the UK (anonymous)	Recreational/competitive sessions Healthcare Treatment Programme Support Workshops Programme	Male participants were recruited though drug and alcohol services, youth offending and probation, mental health services	Assisting mental health recovery: service user engagement; stigma; and social isolation	Semi-structured interviews with participants, project staff and associated professional medical staff and partner agency staff (thematic analysis)	Connecting to people who experience similar mental health issues/sense of community Sense of safety, social connectedness, and peer support Counteracting stigma Some participants criticised idea of “recovery model” as they felt it implied “something needs fixing”
Abib et al. (2010)	Football intervention of the Psychosocial Care Centres (PSCCs)/Porto Alegre	Football workshop weekly for one-and-a-half hour	Adults with mental health problems (mainly from PSCC)	Psychosocial rehabilitation of people with mental health problems, reintegration into community	Ethnography methodology	Integration Self-control proactive role in receiving MH care opportunity for self-organisation