RUGBY LEAGUE WORLD CUP 2021 X MOVEMBER

INSPIREDBY RLWC2021 AHEAD OF THE GAME MENTAL FITNESS PROGRAM 1

CONT

TENTS INTRODUCTION 4-5 NEED 6-9 HEALTH INEQUALITIES 10-11 THE ROLE OF SPORT 12-13 PARTNERS 14-15 SPORT, MEN AND MENTAL HEALTH - EXISTING PROGRAMS 16-19 RUGBY LEAGUE WORLD CUP 2021 20-21 PROJECT PROPOSAL 22-27 APPENDIX 1 28-29 3

INTRO

The Rugby League World Cup takes place Rugby League Cares and the Movember in 2021 when men and women from across Foundation already have a proud record in the planet will converge on England for a successfully delivering mental wellbeing celebration of international sport. programs to men and adolescents. Initiatives such as Offload and Ahead of the Game have The tournament will demonstrate sport’s helped men build resilience by arming them unique ability to make a positive difference to with the skills and tools needed to manage the lives of people involved at every level, be their own mental health in a positive manner. they players, staff, administrators, spectators or television viewers. Our RLWC2021 project aims to bring these programs together, take best practice RLWC2021 officials, Rugby League Cares and from each, and develop a new program to the Movember Foundation are committed to be delivered as part of the tournament’s working together to change the lives of all InspirationALL legacy program. these people for the better. While the players give their all in a quest to be By harnessing the passion for Rugby League crowned world champions, our program will that unites nations around the world, our champion the importance of good mental health partnership will seize the opportunity to raise and wellbeing, and create a sustainable legacy awareness of mental health issues and deliver the sport can be proud of. interventions to improve health and wellbeing. 5

NEED

MEN’S HEALTH Despite overall improvements in life expectancy across the globe, rates of premature male mortality, remain an important issue of concern. Men experience worse longer-term health than women and die on average six years earlier. Prostate cancer rates will double in the next 15 years. Testicular cancer rates have already doubled in the last 50. Three-quarters of suicides are men. Poor mental health leads to half a million men taking their own life every year. That’s one every minute. MEN’S MENTAL HEALTH Men are three times more Men commit likely than women to report Statistics in the UK suggest frequent drug use 86% that women are at significantly greater risk of developing a 4.2% 1.4% of violent crime and are Common Mental Disorder twice as likely to be (CMD), with one woman in five (4.2% and 1.4% respectively) and more than victims of violent crime diagnosed compared with one two thirds of drug-related deaths occur in men man in eight. Men make up Over However, men may be less likely than women to recognise 95% 80% emotional and psychological distress in themselves and less of the prison population and of children permanently likely to seek treatment. Many population-level indicators 72% excluded from school for suggestive of difficulty, distress behavioural difficulties and disconnection reveal men are boys to be the majority affected. of male prisoners suffer from Research suggests that men 73% two or more mental disorders are less likely than women to recognise signs and symptoms of adults who ‘go missing’ from home are men Men have measurably of CMDs and less likely to seek lower access to the social help either from professionals 87% support of friends, relatives or family and friends. and community. Research Traditional masculine norms of rough sleepers are men shows that there is a clear of self-reliance, ideas of relationship between lack strength and being providers, Men are nearly three times of social connectedness risky behaviours and lack of more likely than women to and psychological distress. social connections all contribute become alcohol dependent to men’s poor mental health. 8.7% 3.3% (8.7% of men are alcohol dependent compared to 3.3% of women) 7

MEN’S MENTAL HEALTH 2017: 5,821 REGISTERED UK SUICIDES WOMEN 25% OF THE 5,821 SUICIDES REGISTERED IN 2017 IN THE UNITED KINGDOM, MEN THREE-QUARTERS OF THESE WERE MEN 75% 7.6 17.0 3.5 12.9 4.3 4.2 AGE 15-19 AGE 20-24 AGE 25-29 RATE OF SUICIDE PER 100,000 (IN ENGLAND & WALES) Suicide is consistently more common among young males than females aged 15-19 (7.6 compared to 3.5 per 100,000), 20-24 (12.9 compared to 4.3 per 100,000) and 25-29 (17.0 compared to 4.2 per 100,000)

E STANDARDISED SUICIDE R E STANDARDISED SUICIDE R 15.5 4.9 PER 100,000 PER 100,000 ATE ATE AG AG MALES AGED 45-49 (24.8 PER 100,000) ARE MORE LIKELY TO DIE BY SUICIDE THAN OTHER AGE GROUPS SUICIDE IS THE MOST COMMON CAUSE OF DEATH FOR MEN AGED 20-49 YEARS IN ENGLAND AND WALES 9

HEALTH INEQUALITIES

MEN’S HEALTH IS A HEALTH INEQUALITY There is a direct connection between levels of social deprivation and health. The report ‘Fair Society Healthy Lives (The Marmot Review) states that health status is determined by many factors and that different approaches are needed to target those in greatest need and to reduce health inequalities. Those living in areas of high deprivation are more likely to experience low income, insecure employment, unemployment and low educational achievement, for example, all factors that increase individuals’ vulnerability to mental illness. Men are considered ‘hard to reach’ by services when it comes to engaging them with their health. Research reinforces the belief men are less likely to engage in healthcare until they consider an issue is serious, and that they often rank their health and wellbeing as good despite the presence of one or more significant risk factors. Issues cited by some men include living in a masculine culture and always having to appear strong, finding it difficult to verbalise or recognise potential problems or stigma specific to men, or having a fear of disclosing mental health problems. However, men are interested in their health when it is presented to them in a way that is more accessible and in terms of terminology (such as control of health and fitness levels rather than wellbeing), location and opportunity, and this provides opportunities for using settings such as sports clubs. MENTAL ILL HEALTH IMPACTS AND INEQUALITIES FOR YOUNG MEN Globally, mental ill health can be considered the single most critical issue facing young people and early detection and intervention are key to influencing trajectory and preventing life course recurrence. The first onset of mental ill health typically occurs in the years of adolescence and emerging adulthood. For a significant proportion of adolescent boys and young adult men, symptom onset marks the beginning of a life-course persistent pattern of mental ill health, impacting across the life span in broad domains, including social adjustment, functioning, and economic productivity. With rising rates of adolescent and young adult mental ill health forecast to translate to unprecedented demand for services, the Lancet's Commission on Adolescent Health has called for major investment into prevention and intervention for this population. 11

THE WHY SPORT? ROLE OF Sports stars talking about SPORT mental health can make young people more likely to talk about IN THE UK and seek information relating to mental health issues. 60% (approx) High profile sports stars talking about mental health is the OF YOUNG PEOPLE number one preference of men TAKE PART IN who have attempted suicide TEAM SPORTS for disseminating information to men. Early sport participation improves trajectory of mental health from early childhood to adolescence. Organised sport participation during adolescence is associated with a reduction in risk for mental health problems, when compared with those who drop out of sports by 10-20%

WHY RUGBY LEAGUE? Rugby League is played in over 70 nations throughout the world. Seven countries - Australia, Canada, England, France, New Zealand, Papua New Guinea and Wales - have teams that play at a professional level, while the rest play at amateur level. Thirty six national teams are ranked by the Rugby League International Federation (RLIF) and a further 32 are officially recognised and unranked. The strongest senior men’s rugby league nations are Australia, England and New Zealand. The last men’s and women’s Rugby League World Cups took place in Australia in 2017. Australia are the current men’s world champions and the current women’s world champions. The last Wheelchair Rugby League World Cup took place in France in 2017 and the current wheelchair world champions are France. RUGBY LEAGUE IN THE UK Rugby league is played across the UK but with a focus across communities in the North West, Cumbria, North East and the Yorkshire and Humberside regions. All these regions have poor health outcomes for men with lower than average life expectancies and higher than average rates of cancer, circulatory disease and respiratory disease. Suicide rates for men are consistently higher in these regions than the national average. Currently more than half of clubs engaging with Rugby League are located in the north of England. Of these clubs, 52% are located within the areas where the socio-economic position (SEP) on the gradient is situated within the top quartile (25%) of deprivation. This equates to nearly half (46%) of all participants playing Rugby League in areas within the top quartile of deprivation. Community Rugby League clubs play a significant role beyond sporting opportunities, in Rugby League and often other activities, for harder to reach participants in areas of considerable health inequalities and other forms of social deprivation. They contribute to creating and supporting community cohesion, resilience and a sense of pride and shared identity in some of the nation’s most disadvantaged neighbourhoods. Rugby League fans attending matches are approximately 70% male. They have a passion for the sport and an affinity with their local clubs and players. Clubs are embedded in the communities that they service and are an integral part of the social fabric. Sport participation is and among boys who 13 associated with a reduction participated in sports, there in suicidal ideation among was a reduction in suicide boys by attempts by 35% 39%

PARTNERS RLWC2021 LEGACY TEAM Rugby League World Cup 2021 (RLWC2021) are delivering a diverse and ambitious legacy program, InspirationALL. It will use the sport and the tournament as powerful platforms to connect with the rugby league community and beyond, aiming to inspire people and make a positive impact on peoples lives. InspirationALL consist of three strands: EmpoweredBy RLWC2021: Citizens in host locations will have the opportunity to get involved in the tournament in unique and exciting ways through volunteering. CreatedBy RLWC2021: £10million investment into community clubs with funding for capital items, kit and equipment or to refurbish/improve existing facilities. Driving participation, building capacity and supporting the sustainability of community rugby league clubs. InspiredBy RLWC2021: A range of programs to inspire and engage communities through health initiatives, education programs, arts and cultural programs.

MOVEMBER Movember is the leading charity changing the face of men’s health through addressing some of the biggest health issues faced by men: prostate cancer, testicular cancer and mental health and suicide prevention. Movember know what works for men, and how to find and fund the most innovative research to have both a global and local impact. They are independent of government funding, so can challenge the status quo and invest quicker in what works. In the last 15 years they have funded more than 1,200 men’s health projects around the world. By 2030, they aim to reduce the number of men dying prematurely by 25%. RUGBY LEAGUE CARES Rugby League Cares is an independent charity that supports players at the end of their careers when they make the transition to life after rugby, providing education and training grants that equips them with the skills and qualifications they need for the next stage of their lives. RL Cares also offers current and former players who are enduring poor health or hardship by offering practical and financial support. RL Cares promotes mental fitness and healthy lifestyle initiatives through projects such as Offload and Back Onside, projects that are transforming the lives of men in rugby communities with the support of current and former professional Rugby League players and health professionals. 15

SPORT, MEN AND MENTAL HEALTH EXISTING PROGRAMs

MOVEMBER AHEAD OF THE GAME – GLOBAL PROGRAM Ahead of the Game (AotG) is a program to improve youth mental health through community sport. It targets adolescent male mental health by engaging with the whole community around the local sports club. The AotG research project conducted the largest controlled trial in the world with respect to mental health. It is possibly the only program of its type in the world that has demonstrable efficacy and further, carries no risk of doing any harm. The findings indicated that these adolescent males perceived sport to be an engaging vehicle for supporting mental health, particularly in teams, and through interest in elite athletes' mental health. They considered coaches and parents/family to be key support individuals. In addition, these adolescents expressed a need to know how to help individuals close to them who may be struggling with a mental health issue. The participants perceived the need for resources to prevent and cope with mental health issues. AotG involves a series of different programs which have been designed with input from young male athletes, coaches, and families. Participating clubs sign up for the program which is delivered through a mix of digital and face to face interventions throughout the season. Programs are available for adolescent males aged 12-17 years, their coaches and parents of the players to participate in. The Ahead of the Game Awareness Campaign is rolled out through participating clubs and each club is provided with health information collateral which can be displayed around the club as well as goody bags for all the adolescent participants. The campaign focuses on improving mental health knowledge, decreasing stigma and promoting help-seeking. The current global program is working across sporting codes in Canada with Hockey and the GTHL (Greater Toronto Hockey League), in New Zealand with New Zealand Rugby, in Australia with Cricket Australia and in the UK with Rugby Union. AHEAD OF THE GAME OUTCOMES The AotG program has led to meaningful changes in knowledge, attitudes, and behavioural intentions of participants that underpin the prevention and early intervention of mental health problems, including: Increased mental health literacy Increased intentions to seek help from formal sources such as psychologists Decreased stigma for mental health problems Increased intentions to help others with a mental health problem Greater confidence to seek help 17

RUGBY LEAGUE CARES – OFFLOAD - UK Offload is a mental fitness project designed for men, by men. Delivered in professional sports environments and workplaces, venues where men feel comfortable, it utilises sports language and male sporting role models to de-stigmatise conversations about mental health. Offload is not a treatment program for mental health disorders; it is instead a prevention and education program that empowers, educates, upskills and motivates men to look after their mental fitness as they do their physical fitness. It addresses key mental fitness issues; including challenging negative thinking, understanding resilience, building positive coping strategies and practical tips for managing anger. The ‘fixtures’ (sessions) use Rugby League players, who are traditionally known as men who cannot show weaknesses, to open up frank, honest and personal conversations that enable at risk males to recognise, acknowledge and talk about their mental state and feelings. Through Offload, men are not only achieving the projects key outcomes and learning life-long skills, they are also developing new social support networks and friendships.

OUTCOMES - OF THOSE PARTICIPATING IN THE OFFLOAD PROGRAM: 78% felt they were more aware of how to look after their health and wellbeing 74% felt better able to cope with everyday life and manage setbacks and challenging situations 66% rated that they now have a stronger relationship with their family 65% felt they had more support around them Over half of participants reported that they had a stronger relationship with their family Just under half of participants reported they experienced fewer challenging situations with family 19

THE MAIN EVENT In 2021, for the first time, the men’s, women’s and wheelchair competitions will be staged in a single, celebratory event, culminating in an epic finals weekend to crown the champions of each. The tournament will take place 23rd October - 27th November 2021 across 16 host cities in England and largely across the north of the country. The men’s tournament will involve 16 teams from England, Australia, Fiji, New Zealand, Papua New Guinea, Tonga, Samoa, Lebanon, France, Wales, Jamaica. The remaining five qualifying countries will be known by November 2019. The women’s tournament will involve eight teams from England, Australia, Brazil, Canada, Cook Islands, France, New Zealand and Papua New Guinea and the Wheelchair nations are England, France, Australia, Norway, Scotland, Spain, USA and Wales. RUGBY LEAGUE WORLD CUP 2021

Host towns and cities: NORTH-WEST YORKSHIRE BOLTON DONCASTER The University of Bolton Stadium The Keepmoat Stadium LIVERPOOL KIRKLEES Anfield and M&S Bank Arena The John Smith's Stadium ST HELENS HULL The Totally Wicked Stadium The KCOM Stadium TRAFFORD LEEDS Old Trafford Elland Road and Emerald Headingley Stadium WARRINGTON SHEFFIELD The Halliwell Jones Stadium Bramall Lane and the EIS Sheffield WIGAN AND LEIGH YORK Leigh Sports Village The Community Stadium WEST MIDLANDS London COVENTRY LONDON The Ricoh Arena Emirates Stadium and Copper Box NORTH-EAST TEES VALLEY The Riverside Stadium NEWCASTLE St James’ Park 21

PROJECT PROPOSAL

RLWC2021 will be the first major sporting event with a dedicated commitment to supporting the mental health of all participants in the tournament from players through to volunteers, spectators and the wider community. We propose to do this through the following programs: 1 COMMUNITY ENGAGMENT PROGRAM Ahead of the Game program 2 TOURNAMENT WORKFORCE AND PARTICIPANT TRAINING Mental health and wellbeing training for staff, volunteers and participants 3 CAMPAIGN Mental health and wellbeing campaign during the RLWC2021 Tournament 4 TOURNAMENT LEGACY Legacy plan and evaluation MISSION: To inspire communities to make a positive impact on mental health AIMS: By the final whistle of the final game of the RLWC2021, we will have: Improved mental health awareness across the sport and communities of rugby league from grassroots to elite Worked with over: 8000 360 8000 parents of young community coaches to rugby players improve their mental young rugby players health literacy Trained over RLWC2021 staff, volunteers, and tournament 2000 participants in mental health awareness to support their own mental health and the mental health of those around them Delivered a mental health awareness campaign during tournament time that reaches a global audience of: 750k spectators across the three tournaments 300 million across social media 150 million viewers worldwide across 115 territories Left a sustainable legacy by training community clubs to deliver AotG Provided participating nations the tools to develop mental health programs in their own rugby league communities 23

1 COMMUNITY PROGRAM AHEAD OF THE GAME PROGRAM - INSPIREDBY RLWC2021 We will work with community rugby league clubs, professional rugby league clubs and foundations and key partners in host cities and surrounding areas to deliver Ahead of Game to adolescent athletes, parents and club coaches with the aim: To improve mental health literacy and awareness across all three cohorts To improve resilience in adolescent athletes PROGRAM: HELP OUT A MATE PLAYERS (ADOLESCENT MALES) A one-hour workshop delivered by trained facilitators. It introduces participants to common mental health problems, teaches them how to look out for signs that a team-mate or friend might be struggling, and what they can do to help. PROGRAM: NUMBER 1 SUPPORTER PARENTS A one-hour workshop designed to increase parents’ knowledge about adolescent mental health and wellbeing. It helps parents to differentiate between ‘normal’ adolescent behaviour and possible signs that an adolescent might be struggling. It covers how to promote positive mental health, how to start a conversation about mental health with your teenager, what to do if you are concerned, and where to seek help. PROJECT PROPOSAL

The Ahead of the Game program will be developed for a rugby league audience to support engagement and involvement. Through the rugby league clubs and community clubs in each host city we have the opportunity to reach and work with over 8000 young men, 8000 parents and 360 coaches playing, supporting and delivering rugby league. PROGRAM: MENTAL HEALTH LITERACY COACHES A one-hour workshop delivered by trained facilitators. It introduces coaches to common mental health problems, teaches them how to look out for signs that one of their team members might be struggling, and what they can do to help. PROGRAM: YOUR PATH TO SUCCESS IN SPORT PLAYERS (ADOLESCENT MALES) A one-hour workshop session supported by online modules. This is a sport psychology program that helps adolescents identify and develop skills for managing the challenges that sports (and life) can present. Participants consider key skills for being resilient and successfully navigating their own path through sport, including the importance of effort, learning, embracing challenges, and managing setbacks. 25

2 TOURNAMENT WORKFORCE AND PARTICIPANT TRAINING PROGRAM MENTAL HEALTH AND WELLBEING TRAINING FOR STAFF, VOLUNTEERS AND PARTICIPANTS. This program will develop bespoke mental fitness training based on the Offload project and will be delivered by RL Cares in the run up to tournament time. It will use the learning from the Offload program to create training that up-skills tournament staff, volunteers and participants in mental health literacy with a focus on their respective roles as part of the RLWC2021 experience. It will also utilise Movember’s Mo-rated online training package, originally developed for barbers to have conversations about health with customers and now being redesigned to work for a range of professions. We will also work with the Royal Society of Public Health (RSPH) to utilise their existing training and accreditation program. Training will include: Mental health literacy and awareness How to recognise signs and symptoms / support others How to have conversations about mental health and wellbeing Where to signpost to national/local services A program of training will be delivered to: STAFF NUMBERS: At tournament time the staffing footprint will be approximately 60. WHAT: Face-to-face training with additional online resources. Training would form part of the staff induction program as staff are recruited. As well as the key elements it would have a focus on workplace wellbeing and supporting colleagues in the workplace. VOLUNTEERS NUMBERS: At tournament time there will be approximately 2,021 volunteers across the 16 host areas. WHAT: Face to face and follow-up online e-learning training. Training would be a mandatory part of volunteer training for the role. As well as the key elements above it would focus on their role as a volunteer in supporting fans and each other during tournament time. Some volunteers could also be offered an enhanced role as Mental Health First Aiders. PROJECT PROPOSAL

TEAMS NUMBERS: Approximately 870 – 900 people across 16 men’s teams, eight women’s teams, eight wheelchair teams and the match officials team. Teams include all support staff, not just the players. As well as the key elements above it would focus on supporting players and staff with the pressures of being away from home and the intensity of tournament time. WHAT: Face-to-face training and/or online e-learning. 3 CAMPAIGN MENTAL HEALTH AND WELLBEING CAMPAIGN DURING RLWC2021 TOURNAMENT TIME During the RLWC2021 tournament in October and November 2021 we will deliver a mental health and wellbeing campaign. At this stage it is envisaged the campaign will include the following: Match day activation – fan zones / in stadium activity / messaging Community outreach activity – Competing team community visits Content – social media, videos, interviews, high-profile supporters of the program. This campaign will be developed with partners nearer the time but would build upon the work of this program and existing campaign activity 4 TOURNAMENT LEGACY LEGACY PLAN AND EVALUATION This would follow post-November 2021. In England, RL Cares and Movember would look at developing a sustainability plan for the programs delivered and share the learning from the project widely. We would look to develop a number of resources to support participating nations with tools to pilot similar programs in their own Rugby League communities. We would also plan to share learning with upcoming sporting events across the globe to explore the value of running similar legacy programs aligned with sport, tournaments and communities. Both of the existing programs have been academically evaluated with positive outcomes. We would continue to evaluate the individual programs with robust monitoring and data collection but also evaluate the use of sport and the approach we are taking using a sporting event as a way of engaging participants and improving health outcomes. We will also use tools developed to measure the social value impact of the activity in a sport environment. 27

APPENDIX 1 Health Data Participating nations PARTICIPATING LIFE LIFE SUICIDE % OF % OF NATION EXPECTANCY EXPECTANCY RATES PER POPULATION POPULATION MALE FEMALE 100,000 REACHING 65 REACHING 65 POPULATION MALE FEMALE AUSTRALIA 80 85 11.8 90% 96% ENGLAND 79 83 9.2 81% (UK) 88% (UK) FIJI 67 70 8.5 65% 78% FRANCE 79 85 16.9 85% 92% JAMAICA 74 78 1.4 77% 85% LEBANON 78 81 3.1 88% 91% NEW ZEALAND 80 83 12.6 88% 92% PAPUA NEW GUINEA 64 68 10.3 59% 69% SAMOA 72 78 5.7 75% 85% TONGA 70 76 3.5 72% 82% WALES 78 82 11.8 81% (UK) 88% (UK)

Health Data Local Communities /host cities AREAS LIFE LIFE SUICIDE RATES PER EXPECTANCY EXPECTANCY 100,000 POPULATION ENGLAND MALE FEMALE BOLTON 9.6 COVENTRY 79.6 83.1 11.9 DONCASTER 77.8 81.6 8.8 HUDDERSFIELD 79.5 82.4 10.7 HULL 77.9 81.7 9.4 LEEDS 78.6 82.5 14.1 LIVERPOOL 75.6 79.9 11.8 LONDON (ISLINGTON) 78.2 82.2 9.9 MANCHESTER 76.1 80.2 9.5 NEWCASTLE 79.4 83.2 9.3 PRESTON 75.7 79.5 9 ST HELENS 78 81.2 10.7 SHEFFIELD 77.8 81.1 17.9 TEES VALLEY 77.5 80.9 7.7 WARRINGTON 79.2 82.4 9.2 WIGAN & LEIGH 78.1 81.4 8.5 YORK 78.9 82.4 11.2 77.8 80.9 13.4 80.2 83.5 29

ENJOY THE GAME, LOVE THE CAUSE. MOVEMBER FOUNDATION RUGBY LEAGUE CARES RUGBY LEAGUE WORLD CUP 2021 TRACY HERD CHRIS ROSTRON TRACY POWER Program Manager, Head of Rugby League Cares Legacy Director Young Men and Sport, UK/Europe Phone Phone 07917 282322 07595 520181 Phone Email Email 07961 577998 [email protected] [email protected] Email RUGBYLEAGUECARES.ORG RLWC2021.COM [email protected] MOVEMBER.COM MOVEMBER - REG CHARITY NO.1137948 (ENGLAND/WALES) SC041981 (SCOTLAND) RUGBY LEAGUE CARES IS A REGISTERED CHARITY IN ENGLAND AND WALES (1150763) 30