Chapter 4Shifting the culture and increasing awareness
4.1This chapter outlines how cultural factors and a lack of understanding about sport-related concussion and repeated head trauma can contribute to the under‑reporting of incidents, concealing of symptoms and poor management of concussive injuries.
4.2It also outlines the need for increased education and public awareness measures at all levels, including at the professional level, within the community, amongst the media and in the medical profession, to combat these issues.
Cultural issues, under-reporting and calls for education
4.3Several inquiry participants called for cultural change within sporting organisations, highlighting that ‘win at all costs’ attitudes and cultures that prioritise sporting success over player welfare and safety are common at both the elite and community level.
4.4Dr Stephen Townsend, sports historian at the University of Queensland, summarised how the culture in many Australian sporting communities can contribute to, or exacerbate the issue of sport-related concussion:
Contact sport meets a range of social and cultural needs for Australians, by providing athletes and supporters with opportunities to act out values such as strength, aggression, toughness, discipline, camaraderie, resilience, sacrifice, and bravery. Whilst these values are often worthy of celebration, in contact sport communities they produce attitudes and behaviours which heighten the risk of incurring, sustaining, or concealing a brain injury.
4.5Griffins Lawyers outlined how some athletes ‘play on’ through injuries due to stigma around admitting when they are hurt or wanting to ‘prove themselves’ to their team:
It is well documented that athletes wish to “play on,” and that historically there has been an expectation that they do play on, even in circumstances which should be approached as a medical emergency.
Some athletes perceive there to be an inherent stigma in admitting they have been hurt, or they otherwise wish to prove their commitment to their team by continuing to play through injury. This perception can extend to an athlete’s hesitance to ask for support either at the time that the injury is sustained, or later when they experience the longer-term effects of the concussive injuries.
4.6Further, several inquiry participants raised concerns about the under-reporting of concussions and concussive incidents, which the Queensland Government explained can lead to athletes at all levels being underdiagnosed, untreated and potentially suffering greater long-term impacts on their health and wellbeing.
4.7The Australian Sports Commission (ASC) outlined the extent of under‑reporting throughout the community:
Many individuals with concussion do not seek medical guidance and do not present to hospitals for assessment. Under-reporting of concussions and failing to seek medical advice range from 17% to 82% across different sports. That large numbers of concussions are going undetected and therefore unmanaged, is concerning.
4.8Shine Lawyers highlighted the need for greater education about concussion, mild traumatic brain injury and Chronic Traumatic Encephalopathy (CTE) across the community:
… there needs to be greater education by medical practitioners, schools, children, parents, sporting bodies about concussion, mild traumatic brain injury and CTE… Without correct identification and diagnosis, individuals are left feeling isolated, unheard and in pain whilst their worlds are falling upside down.
Issues at the professional level
4.9Former athletes from a range of sports provided personal accounts which highlighted how player safety and wellbeing can be impacted by cultural and competitive elements of sport.
4.10Mr James Graham, a former professional rugby league player who played over 500 professional games in both Great Britain and Australia, stated that through his career he observed players ‘playing on’ after being knocked out due a culture where it is ‘ingrained’ to not let your teammates down.
4.11Mr Graham explained that the ‘psyche’ of professional athletes, the ‘internal and external pressure to perform’ and cultures which put ‘winning and performance over long term health’ are all factors that need to be addressed when tackling the issue of concussion in sport.
4.12Miss Lydia Pingel, who played Australian football in the top women’s league in Queensland, described one instance where she tried to play on after receiving a hit to the head. She explained her mentality when she experienced this incident, as well as the broader culture and perception around concussive injuries:
I tried to run away and play on because that's what we do as athletes. We think that we're invincible.
A concussion was never taken as serious as any other type of injury like a knee, hamstring, ankle etc. There was no mandatory rehab, no monitoring or follow up care once you had a few days off, did lighter training and said you felt ‘ok’ and ‘fine’ to train and play. As a concussion is an invisible and self-reporting injury, it was easy to manipulate the club, coaches, physiotherapist, and vis versa especially if you were an ‘important player’ to be cleared to play and train because what also constituted the recovery period wasn’t clear.
4.13Ms Julie Speight, Australia’s first female track cycling Olympian, a state and national champion, and Commonwealth Games silver medallist, informed the committee of her experience throughout her professional cycling career:
Over the course of my cycling career I was never prevented from racing due to concussion, my helmet was never inspected for suitability, and I was never advised by coaches to refrain from training. The mentality was to push on at all cost.
4.14Ms Kirby Sefo, a former Australian rugby sevens and Wallaroos player (Australia’s national women’s rugby union team) also highlighted how athletes may be motivated to play through injuries due to team selection pressures:
… Most players, myself included, would never make the decision alone to take themselves off field. Often, particularly in the higher levels of rugby, this was due to the fact that taking yourself out of play or off field in a session would be compromising for your position when it came to selection.
4.15Some research from professional sport bodies outlined the extent of under‑reporting in elite competitions. The Australian Football League (AFL) Players’ Association provided findings from a survey of both AFL and Australian Football League Women’s (AFLW) players, which indicated that in the 2022 season:
9 per cent of AFL and 2 per cent of AFLW respondents indicated they experienced a concussion that they did not report.
9 per cent of AFL and 4 per cent of AFLW respondents continued playing or training after experiencing a concussion without receiving medical attention.
4.16In the National Rugby League (NRL) context, a survey conducted in 2020 found that 17 per cent of surveyed players declined to report a likely concussion during the 2018 and 2019 seasons, despite 85 per cent having received concussion education over the previous two seasons. Reasons that players provided for failing to report concussions primarily included ‘not wanting to be ruled out of the game or training session’ and ‘not wanting to let down the coaches or teammates’.
4.17Broadly, professional Australian contact sport codes and players’ associations acknowledged the issue of under reporting, and of athletes playing on through symptoms, though they suggested that these attitudes have shifted over the years.
4.18For example, Mr Paul Marsh, head of the AFL Players’ Association outlined:
… other injuries—use the shoulder as an example—are more obvious and more identifiable, and so to miss football on the back of an injury like that probably, historically, has been seen to be more acceptable, whereas a concussion is harder to see. But I do think that's changed. I think the culture within the game has seen a change there. There's lots of education that's going on. Players have spoken to me about this issue, and this is the one that they're now most scared of. I think the culture has changed, but there's no doubt, historically, that had been a reason for it.
4.19Dr Michael Makdissi, Chief Medical Officer of the AFL, similarly indicated that he has observed ‘quite a shift’ regarding the culture of players getting up and playing on after head knocks. Dr Makdissi acknowledged that the league is not there yet, and noted the importance of ongoing education efforts to continue shifting this culture.
4.20Dr Warren McDonald, Chief Medical Officer of Rugby Australia also advised he has seen a positive cultural shift in recent years, with people being more understanding that concussions are a serious injury that need to be treated as such. Dr McDonald suggested that longer stand down periods may have previously led to a greater proportion of players failing to report head injuries:
…there's evidence from our game, when we previously had a three-week mandatory standdown period, going back many years, that that actually, potentially, led players not to report their symptoms. We've got evidence that once that changed, players did come forward. To me, that's a far better situation than people avoiding the issue.
4.21Dr Sharron Flahive, Chief Medical Officer of the NRL echoed the concerns about under reporting, whilst also recognising the need to improve education in order to encourage players to self-report:
There is research in rugby league that 18 per cent of players back in 2018 were not reporting symptoms of concussion, and in rugby union that number has been as high as 39 per cent.
We do obviously need to improve the education in this area because we want to encourage the reporting of the players, so if we can enhance that side of the game that would be very beneficial to the management of concussion.
Issues at the community level
4.22The committee heard that cultural issues also exist at the community and local level of sport. Neuroscientist Professor Alan Pearce outlined:
… there's this real cultural issue, particularly at club level, to admit that a player is concussed. They want to keep showing that they're committed to their sport and they're tough and strong. While the conversation is changing, there's still very much a hesitancy to let your team-mates down.
4.23Researcher Dr Doug King also explained that many amateur clubs, officials, and coaches view winning as more important than player safety and welfare, given that they are judged upon on-field success rather than players’ health.
4.24Ms Jamie Shine, General Manager of Head Trauma at Shine Lawyers, told the committee that there is a very clear lack of understanding when it comes to mild traumatic brain injury in the community.
4.25Professor Melinda Fitzgerald, Chair of the Expert Working Group at Mission for Traumatic Brain Injury also raised this issue:
... Anecdotally we hear that there is a lot of poorly managed concussion happening in the context of community associated sport, amateur leagues and so forth—even in our children. So there's that real lack of awareness and education at that grassroots level.
4.26HITIQ raised similar concerns about how a lack of awareness regarding concussion management can contribute to longer term issues:
When a potentially concussive incident takes place, key decision makers are unaware of how to best manage the situation. Club administrators and guardians don’t possess adequate resources to facilitate quality decision making, access to medical help is often delayed or non-existent and many local GPs are not sufficiently trained in the diagnosis and management of concussion. Poor management in the short term is likely to create more significant long term issues.
4.27Concussion Australia also explained the lack of appropriate awareness and understanding about concussion in the community and emphasised the need for education:
Education is imperative in raising awareness about concussion and reducing repeated head trauma. Despite the awareness of concussion as a concept, we do not believe that an appropriate level of education has been reached across the community at large…
… Given the volume of media reporting we also believe that the Australian public is aware of concussion as a concept. That reporting often does not assist or educate grassroots clubs and parents to manage and understand concussion.
4.28Among many other inquiry participants who outlined the need for increased education and awareness about concussion at the community level, the Queensland Department of Tourism, Innovation and Sport specifically noted the importance of athletes, parents, guardians, coaches, teachers and other support personnel being aware of the signs and symptoms of concussions; as well as knowing how to appropriately respond to cases of concussions.
4.29Professor Jack Anderson, a sports law specialist, similarly set out that going forward, education is vital in terms of helping parents and volunteers at the community level to identify the acute symptoms of concussions, making coaches and administrators at all levels aware of their duties with regard to player welfare, and informing players that they can and should self-certify.
4.30Dr Paul Bloomfield, sports and exercise physician and former NRL Chief Medical Officer, who represented Sports Medicine Australia, also emphasised the need for improved education about concussion in all sections of the community:
An overriding issue is ongoing education, at all levels, particularly at the patient or player level, parent level, community sport level, coaches, schools and still also at the medical level. That includes general practitioners, emergency departments and even specialists.
4.31Several submitters who provided their lived experiences to the committee including Belinda Vardy, Mr Robin McGilligan, Mrs Kathy Strong, MsMeganKing, Ms Sandra King and Anna also advocated for increased education and public awareness regarding sport-related concussion.
4.32Some inquiry participants specifically called for public awareness campaigns to increase the community’s understanding of concussion and repeated head trauma. Neurologist Dr Rowena Mobbs was amongst these calls. She specifically urged the Australian Government to establish a public health campaign that teaches young children to understand and value their brain, older children about brain health for life and avoidance of harm, and adults including parents, coaches, commentators and spectators to recognising the signs of concussion and CTE.
4.33Dr Alexandra Veuthey PhD, an attorney specialising in sports law, submitted that educational campaigns should instruct players about the full risks of concussion, and ultimately contribute to changing their mindsets. Dr Veuthey considered the value and power of such campaigns:
… educational campaigns have value when they target other stakeholders, such as medical staff and coaches. It goes without saying that such campaigns, even targeted at the highest level, have the potential to change sport globally, as professional athletes serve as role models to young people.
4.34Dr Adrian Cohen, Chief Executive Officer of Headsafe, pointed out that it is not sufficient to simply have educational material ‘available’, but that measures should be in place to ensure members of the community actually use, engage and comply with such materials.
4.35In relation to First Nations communities, Connectivity Traumatic Brain Injury Australia (Connectivity) noted that whilst limited research has been conducted regarding knowledge and perceptions of concussion among First Nations people, raising awareness of and dispelling misconceptions around concussion is urgently needed. Connectivity made clear that First Nations peoples should be consulted to help conceive, design and implement culturally appropriate educational materials and initiatives.
The role of the media and other influential figures
4.36Evidence to the committee highlighted the important role that the media plays in affecting cultural change regarding sport-related concussion; however, there were conflicting views amongst inquiry participants on how the media reports on these matters.
4.37Dr Michael Makdissi, Chief Medical Officer of the AFL noted:
… I think the media has a big role to play in how it's portrayed in the media and how those incidents are portrayed. Certainly in the US they've moved from repeatedly replaying a big impact to actually shifting to a commercial break when there's an impact where the player is removed from the ground and a head injury assessment is performed on the ground. I think we've all got a role to play in that shifting of the culture. We've moved, but we still need to continue to move.
4.38Dr Cohen of Headsafe similarly reflected on the media’s pivotal role in community education and understanding of sport-related concussion. He raised concern around commentators trivialising and celebrating head injuries, but observed that there have been recent shifts away from these attitudes.
4.39Ms Speight encouraged members of the media to take care in how they reflect on cyclists that continue racing after a concussion:
Media reporting on cycling races and coaching staff should take care not to praise the “toughness” or “bravery” of riders that get back up and continue racing after a concussion, but rather should warn of the dangers that continuing with a concussion may present for that rider’s future health and well-being.
4.40Dr Eric Windholz, a senior lecturer in the Faculty of Law at Monash University with expertise in sports law, submitted to the inquiry in his private capacity. He highlighted that elite sports people are highly influential, and set the standard which many in community and school sport follow:
... Elite sport sets the standards that a lot of the community and school based sports follow. It sets the standards in both the rules and the practices, but it also sets the atmospherics. I remember an NRL grand final a couple years ago where a player played out the game with a fractured cheekbone, if I remember correctly, and took on significant risks—for example, if there was a repeat knock that could have fractured and splintered the cheekbone. The team won and the player was hailed a hero. To me, that permeates down into all levels of sport. If we're thinking about the rule, 'If in doubt, sit them out,' if it's not abided by at the highest level of sport— they're the role models; they set the example for everybody else.
4.41Dr Stephen Townsend pointed out that language and terminology is important when discussing sport-related concussion. He advised that wherever possible, people should refer to concussion by terms which effectively convey the seriousness of the injury. He suggested that the term ‘mild traumatic brain injury’ should be more commonly used by media figures, athletes and coaches, in the same way that Anterior Crucial Ligament (ACL)injuries are commonly referred to in sporting contexts.
4.42Professor Pearce expressed similar sentiments around the importance of language when educating and changing the culture of concussion in sport. He raised particular concern around use of the term ‘head knock’ and explained that this terminology downplays the seriousness of concussion.
4.43Professor Pearce told the committee that the media has been important in driving cultural change in recent years by encouraging people to take concussions more seriously. He noted:
… People have said that media sensationalised this issue, but I've never had that experience. What I've found is that people have actually started to read the papers and see the news and think, 'Oh, actually this is a bit more serious than I realised.' Male players, in particular, are starting to respect the injury a lot more than they did back in 2015.
4.44In contrast, other submitters argued that media reporting around sport-related concussions and related consequences is often sensationalist.
4.45The ASC outlined its view that media reporting on concussion and CTE is ‘often conducted in a sensationalist manner that is not evidence-based’. It added:
While it is essential that athletes, sport organisations and the general public are aware of the risks of concussion, it is not helpful for concern related to concussion to be exaggerated or catastrophised in a manner that is not supported by scientific evidence…
…Unbalanced and alarmist reporting in the media has the potential to discourage participation in team sports, at a time when large portion of Australians are insufficiently active… Causing excessive alarm and anxiety in relation to the long-term effects of concussion could also result in parents withdrawing their children from sporting activities, which can undermine efforts to increase physical activity to improve the health and wellbeing of all Australians. Such an outcome could result in overall worse health outcomes for the Australian population.
4.46Mr Jamie Buhrer, Player Operations Manager at the Rugby League Players Association, similarly reflected that media reporting can be ‘alarmist’ and lacking in evidence.
4.47Mr Jamie Crain, Chief Executive Officer of Sports Medicine Australia considered that media coverage ‘largely pushes negative narratives and potentially catastrophises’ concussions and potential risks. He urged for caution and balance in education and community messaging:
… we just need to be careful with the messaging: yes, there is a risk; yes, there is emerging evidence on this. We still want people to play sport but we just want them to do it safely and with awareness of what that risk is.
4.48The Murdoch Children’s Research Institute (MCRI) raised particular concern regarding the effect of sensationalist messaging on children:
Community messaging regarding child concussion and its consequences is often sensationalised and not underpinned by evidence, resulting in increased child and parent anxiety regarding participating in sport and return to activity after injury.
4.49The Concussion Legacy Foundation Australia noted that it is working towards delivering concussion education programs for journalists, journalism students, and media commentators to tackle these issues. It explained that its Concussion Reporting Certification initiative is designed as a continuing education tool for working journalists to ‘ensure appropriate concussion reporting as science and policy advances’. It explained that content includes:
… the basics of concussion, how to properly describe concussions in media articles and commentating, what should happen during in-game concussion evaluations, and what to expect after a concussion is diagnosed.
4.50Professor Vicki Anderson, head of clinical sciences research at MCRI and head of psychology at the Royal Children’s Hospital Melbourne acknowledged that while there is still some uncertainty around the risk factors and prevalence of CTE, it is important to strike a balance between providing people with accurate, up-to-date evidence and ensuring that messaging is not sensationalist.
Health professionals and the health system
4.51The committee heard that general practitioners (GPs) are often the first points of contact for social, amateur and professional contact sport players who have a suspected concussion. The Royal Australian College of General Practitioners (RACGP) explained that GPs may assess and manage concussion injuries in a variety of settings, including at the time of occurrence at sporting matches, at a general practice, and in community hospital departments.
4.52The Australasian College of Sport and Exercise Physicians (ACSEP) also explained that community sports participants with suspected concussion are often referred for medical assessment in the public system under Medicare and in public hospitals.
Need for increased training and education within the medical community
4.53Outside of sporting organisations and the media, several inquiry participants called for increased training and education within the medical community to improve how the acute and long-term effects of concussive injuries are dealt with in the health system.
4.54Shine Lawyers submitted that there is an urgent need for greater education in relation to concussion and mild traumatic brain injuries, starting with hospital staff and GPs. It highlighted that many of its clients experienced problems when seeking advice and treatment for these issues in the health system:
The experience of many of our clients is that if they do report their symptoms, very few people believe them, let alone provide appropriate referrals to providers who specialise or understand mTBI [mild traumatic brain injury] symptomology. The experience of these individuals is one of being unheard, gaslit and exhausted. GPs who identify the symptoms after often at a loss as to who to send their patients to for treatment.
… Additionally, the greatest concern for our clients is the lack of treatment options available when they are desperate for help.
4.55Shine Lawyers specifically recommended multi-disciplinary concussion or traumatic brain injury centres to help deal with these issues and the complexities of these injuries:
… currently there are very few people or places that individuals can go to (or that GPs know to refer to) for concussions, mTBI [mild traumatic brain injury] or CTE rehabilitation. These injuries are complex with a constellation of symptoms and require wholistic treatment by a range of specialists. For this reason, it is strongly recommended that multi-discipline concussions or TBI centres be set up in all capital cities in Australia.
4.56The ACSEP outlined that community sports participants with suspected concussion are often referred for medical assessment in the public system, which the ACSEP noted ‘is not well equipped’ to manage brain injuries, due to:
clinics and emergency departments often being overwhelmed with patients;
limited understanding of concussion at the primary care level; and
poor access to expert secondary care.
4.57The Princess Alexandra Hospital Brain Injury Concussion Clinic in Queensland recommended increased educational opportunities for primary care practitioners and improved awareness of local referral options to specialists to help support concussion patients in the early stages, prevent persisting concerns and improve overall recovery.
4.58Professor Melinda Fitzgerald from Mission for Traumatic Brain Injury similarly highlighted the importance of educating clinicians on these matters, as well as appropriately resourcing them:
Even research on educating our clinicians is important. I've been involved in some studies where we've asked clinicians—GPs in particular—whether they feel comfortable managing someone with concussion, and over half of them don't. They're not resourced sufficiently to be able to manage people with concussion in community, and there's also not a strong drive to go and see a medical professional.
4.59In relation to children, MCRI submitted that evidence-based guidelines are not adequately disseminated to health professionals, leading to unnecessary or inappropriate concussion management. MRCI noted further problems relating to child concussion management including variation in care, the ability to accurately diagnose concussion and increasing demands on health services.
Lived experience perspectives
4.60A number of lived experience testimonies outlined some of the challenges faced by individuals when seeking medical treatment and support. For example, the committee heard from MrsKathyStrong, who lost her husband Terry, a former grass-roots, semi-professional rugby league player who was diagnosed with high stage CTE post-mortem. She explained that when Terry become ill, she found it particularly difficult ‘convincing the doctor there was something wrong with him’. She added:
It was very, very difficult to get our family doctor to recognise that there was something wrong with him, and I had to do a lot of research on the internet. I actually went in and said, 'I think he could have this', and then he referred us on.
4.61Mr Peter ‘Wombat’ Maguire, who sustained multiple concussions within a local game of AFL in 1994, reported that among other challenges, he experienced medical practitioners not believing him when seeking treatment and support.
4.62Ms Sandra King, Mrs Jennifer Masters and Ms Annita Siliato, also informed the committee of difficulties their loved ones faced when seeking support and treatment from medical professionals.
4.63From the elite perspective, former professional soccer player MrJosephDidulica explained the range of impacts he continues to suffer after experiencing several concussions throughout his career. He described feeling like no-one provided him with answers or explanations about his brain, despite undergoing MRI scans, cognitive testing and seeing medical professionals both in Australia and across Europe.
4.64In the professional rugby context, former professional rugby league player MrJames Graham stated that former players need to be supported in many ways, but most importantly medically. He said that he often hears from other players that 'it's too hard', 'I can’t afford it', 'I don’t have the time', or 'I've tried and get messed around'.
4.65Mr Graham added that life looks completely different the day an athlete retires, with the biggest change being medical support:
Whilst playing, we become institutionalised on how we're treated medically. We never have to book an appointment. There are no referrals and no waiting lists for surgery. If you're sick or you have a problem, you call the club doctor on their personal mobile phone, and the issue is addressed almost instantaneously. Rehab is outlined every single step of the way and adjusted with progress or setbacks.
On top of this, as a professional athlete you have daily wellness apps you need to complete, weekly weigh-ins and marker scores, GPS and heart rate monitors worn in every training session and game, and perceived exertion scores. In a typical week, you would have approximately three interactions with a doctor and daily access to physios, wellbeing staff and sports scientists. Often they know something is wrong before you do. You're looked after so well and have so many resources at your disposal, and that all changes the day you retire.
Suggestions to build capacity and support medical professionals
4.66Submitters provided information on current relevant education and training opportunities for medical professionals in the field of concussion and traumatic brain injury management. The committee also received suggestions on several measures that would support medical professionals and help improve the management of sport-related concussion in the health system, particularly by GPs.
4.67Professor Mark Morgan from the RACGP told the committee that medical students receive basic information about concussion management through clinical placements and case-based learning:
Medical students get some basic information through clinical attachments to emergency departments and case based learning, but they're only halfway through their training to become GPs at the point of graduation from medical school. People heading in a path of general practice would be expected to do some emergency department work, where there would be a greater concentration of seeing people with traumatic brain injury, so that would be another source of training.
4.68Professor Morgan added that some relevant training may also be provided on the job by GP registrars, or that it could fall under the many areas of ongoing GP professional development. He acknowledged that whilst the management of traumatic brain injury is very important, it does not form a major part of most GP work.
4.69Connectivity noted it is likely that a significant proportion of clinicians that operate outside of the sporting context would be unaware of offerings such as specialist training workshops or self-paced online training courses. It also explained there is currently no online concussion course that is broadly accredited for continuing professional development by an Australian health peak body organisation.
4.70The RACGP specifically recommended that standardised, evidence-based and easy-to-access concussion and head trauma guidelines are prioritised for development and made available to GPs at the point-of-care. It also recommended:
investment in longer general practice consultations for people with concussion, repeated head trauma and other complex care needs; and
first aid responders at sporting venues have increased training that focuses specifically on treating concussion and head injury.
4.71Professor Morgan from the RACGP explained that having rapid access to relevant information, and knowing where to look to get this information is more appropriate than further education programs for GPs, given that estimates indicate that on average a GP would see someone with a head injury or traumatic brain injury, just under once a year.
4.72In relation to other health system issues, the RACGP explained that GPs and emergency departments in regional, rural and remote areas are often under‑resourced and may have difficulty in providing timely short-term care for people with concussion. It further outlined that people in lower socioeconomic groups may be disadvantaged if they do not have access to bulk billed appointments and affordable specialist care. RACGP contended that addressing the nationwide shortage of GPs more broadly would help resolve issues of patient inequity.
4.73The Department of Health and Aged Care (the department) outlined the community-based supports that are available to help people affected by concussion and repeat head trauma. It noted that the Australian Government is investing in community-based mental health services such as Headspace, Head to Health adult mental health centres, and other relevant services commissioned through local Primary Health Networks to increase access to mental health care that addresses a range of social, physical and emotional needs of Australians.
Committee view
Improving education and awareness in the community
4.74The committee is concerned to hear that cultures which prioritise on-field success over player safety and wellbeing are present in Australian sporting communities at all levels. The committee also holds concerns about a general lack of understanding in the community about the risks, identification and management of sport-related concussion and repeated head trauma.
4.75The committee understands that these attitudes and the lack of community awareness contribute to sporting environments where players fail to self‑report, conceal symptoms, and play on after experiencing a head injury or concussion.
4.76Whilst the committee recognises that community attitudes and awareness have somewhat improved in recent years, it considers that further education and awareness raising measures are required to ensure that all players, coaches, parents, teachers and other sports participants can recognise the signs and symptoms of concussion, understand the basics of managing such injuries, and appreciate the potential risks.
4.77The committee considers that further education and public awareness efforts are particularly vital at the community level, given most local sporting clubs lack the money, expertise and other resources that many professional sports organisations have at their disposal to help identify and appropriately manage such incidents.
4.78The committee also notes that members of the media and high-profile sports figures are influential regarding community attitudes towards concussion and repeated head trauma in sport. These figures also play a significant role in shaping the culture and discourse around these matters going forward.
4.79The committee recommends that the Department of Health and Aged Care in consultation with relevant stakeholders, consider how best to improve community awareness and education regarding concussion and repeated head trauma, with these measures being health lead. These initiatives would help individuals:
recognise the acute signs and symptoms of concussion;
appropriately respond to and manage such injuries; and
understand the short- and long-term risks of concussion and repeated head trauma.
The committee recommends the development of awareness and education initiatives, with appropriate consideration given to dissemination strategies; the need to review or update existing materials; and ensuring tailored resources are available to different cohorts including, players, parents, coaches, teachers, other volunteers involved in sport and the general public.
Building capacity in the health system
4.80The committee heard compelling evidence about the need to improve how health professionals (namely GPs and hospital emergency department staff) assess and manage patients suffering both the acute and longer-term effects of sport-related concussions and concussive injuries.
4.81The committee recognises that variable definitions of concussion, diagnosis challenges, as well as other well-documented issues facing Australia’s health system can create difficulties and inconsistencies in the treatment and management of such injuries.
4.82However, given that GPs are often one of the first points of contact for both community and professional sportspeople with a suspected concussion, the committee considers that any measures that would help support GPs and other medical professionals to appropriately manage and assess these injuries are essential. The committee also recognises that the RACGP has particular expertise in this area.
4.83The committee recommends that the Australian Government, in partnership with state and territory governments consider how best to address calls for:
the development of standardised, evidence-based, and easy-to-access concussion and head trauma guidelines for GPs;
suitable general practice consultations for people with concussion, repeated head trauma and other complex care needs; and
increased training for first aid responders at sporting venues that focuses specifically on treating concussion and head injury.