Supplementary Files

Supplementary File A

Table 1 Full thematic synthesis

Theme Sub-theme UnitThe generic representation of sport and what it represents in participants lives

An activity to be enthusiastic about and a topic of conversation

“the golf programme generated an unusual degree of enthusiasm…According to the staff, this enthusiasm seemed to spread through the centre and affected other clients.” (1)“enthusiasm spreading among the clients,other staff at the centre responded positively” (1)“he felt positive from the outset about joining the golf group” (1)“The project had been something Michael chose to engage in rather than being told to go” (2)“The days after [the golf sessions] they were still bubbling – sort of, their enthusiasm about it – especially in the first three sessions. Like Andrew was saying after the first session, “That golf was really good!” ’Cause I m missed the putting, and he said, “You weren’t at the putting – you missed a good session there!”” (1)“When clients [who] were on the group said, “I’m doing golf,” there’s other people said, “Oh, I want to try that!” And it would go like that… It seems it got people’s imagination. It’s something totally different I think” (1)“When the competition was announced, he declared that he would win it. He implied with a smile that he was a "dangerous" player and that the rest should be afraid of him”. (5)

A social experiencewith meaning

“the group also enjoyed the social experience – the having a coffee and a piece of cake after play” (1)“Perhaps for some people learning to play golf is simply an activity that is different and fulfils a purpose for a set period of time. That they stop coming under these circumstances should not be viewed negatively but ratheras a positive move for the individual into a new activity” (1)“It wasn’t just the football; it was what surrounded it as well” (2)“one of the key objectives of establishing the football project was to offer an opportunity for socialisation around an interest that had been important to these service users in the past” (2)“offered the opportunity to feel part of a wider community” (2)“for participants it was more than just the football that had been beneficial. A new and external social world was created.” (2)“social reasons included…to get involved in something and to have somewhere to go” (4)

“requirement of their recovery plan” (4)“activities which are planned, in this case sports therapy, are valued as meaningful to service users and are known to influence motivation” (4)“It’s good for his mental state…it helps him to get out of the house, helps him to meet other people and talk because he lives on his own except at weekends. He loves it” (2)“It challenges you in a way, if the voices say that you cant do something and you are physically there doing it, then obviously you know at that time they are not right, so may be other times they may not be right” (2)“I think I am a little easier to get along with…I find I did not know very many people on the trip when we started but I think I learned quite a bit from the other people…and that is something I usually have difficulty with, I tend to ignore people” (3)“I feel part of a team because of the canoeing we did together and the cooking meals” (3)“I think I was introduced to sports therapy to get me out of the house basically’” (4)“I was really looking forward to some sport of some kind, um, the effort was getting here. When I gothere, there was no looking back’” (4)“having a coffee and a piece of cake after play…they told stories about their play: the good shots and the near misses” (1)“Nurturing and encouraging this social time was, we felt, important to the success of the programme” (1)“There was limited enthusiasm from some participants regarding the use of sports therapy primarily because of the effort required to do it and feeling tired afterwards” (4)“The opportunity to socialize with other similar people was welcomed as a provision of social support” (4)

A new autonomous social role

“There were meetings to decide who the team were going to play and away trip to organise…by networking and liaising with other organisations, tournaments were organised both nationally and internationally”” (2)“prior to the football project, many of the footballers had not had the confidence, motivation, finances or social network to travel outside Birmingham” (2)“the characteristics of the environment that seemed to be crucial to client changes during the canoe trip were challenge, activity and positive normalising expectations” (3)“Peter said to me last week that it’s given him the incentive to come out and do it on his own, come out and play again. ’Cause I think he’s played before but it had gone by the wayside. He said, you know, “I’ve really enjoyed it and I want to continue,” so I said, “Will you come up on your own?” and he said, “Oh yeah, definitely.” So that’s really nice” (1)

“We plan to continue it, basically. If we can. If we can get the minibus and can organise it all. And we’ll try to get it next Wednesday! I think it was a brilliant idea. It was really, really excellent” (1)“I think its very important to be involved with the football. I was a bit withdrawn, I tended to stay in, not speaking to people for days, which used to give me greater worries, make me feel more depressed. I’m more outgoing now, I mix with people, an I enjoy going places with people” (2)“…now I am able to look at somebody’s face a lot better now, without even hesitating, not as afraid if they look back at me because of the trip I went on with some new people” (3)“I was searing inside my head if only I wasn’t on this medication I could do this blood stroke...well after a while I, as I became accustomed to it, I became more confident” (3)“Especially when I came into the room and found all those people in here. I was thinking, oh God!’ (FG1 40). However, over time these feelings dissipated, ‘A bit shy, . . . but just stick at it and you’ll feel more comfortableand easier and, um, start to enjoy it more, stop worrying about the social aspect of it and get used to the peoplearound you, and things like that, and start having fun’” (4)“The height of my life, you are in charge of your own destiny really, nobody can do it for you, so it is good for self-esteem; that you perform in the gym’” (4)

The Translational benefits of sport

Undertaking a ‘normalised’ activity

“The importance of providing the group members with a route into ‘normal’ society was emphasised by André” (1)“For some members of the group, the opportunity to play golf was simply an opportunity to try something new and different” (1)“Robert found the project helped him overcome a sense of social withdrawal” (2)“For Michael, football provided this social interaction. However it also offered a safe environment to reclaim an old and important identity as a footballer” (2)“being seen as a ‘good footballer’ provided a meaningful social role and allowed him to escape from this identity as someone with a ‘mental illness’”(2)“Larry was another service user who saw football project as offering a sense of normalisation in his interactions with individuals outside of the project” (2)“all said that being involved in the football project had a positive effect on their lives by promoting a sense of normalisation and offering a safe opportunities for social interaction where a diagnosis was superfluous” (2)

“Clients noted how different their interpersonal interactions were from their usual daily experience” (3)“the positive and normalising expectations held by the staff members towards the participations were supportive of changes in client functioning. Clients commented positively about the trip being a normal experience” (3)“Participants understood that the ‘therapy’ part of the sports sessions was to assist people because they were unwell, but for some, despite this, its name was unnecessary [sport was about being disassociated with mental health]” (4)“Distraction was experienced from sports therapy because it provided participants with time when they do not think about their illness, or the problems they have. For some this is a welcome relief from normal thoughts, for example, an escape from illness” (4)“Anything out of the system is brilliant… Away from the medical world, away from the institutions. You know, that’s a really, really good thing. So people were quite impressed with that.’” (1)“Ive got friends who know about my illness but these people don’t know nothing about me, they just respect that I am a good footballer and they like me because of that…you don’t need to mention your mental health. You’re accepted for being part of that group. It breaks down barriers and builds bridges” (2)“I was gradually leaning thing, it was a perfectly sort of normal learning experience” (3)“I don’t go out and play sports therapy, I go out and play badminton, or tennis or whatever” (4)“because it does help you out of a hole, basically, doing something which takes your mind off the illness’” (4)“I think, as well, that when you are in the gym or whatever, I don’t think they (other people) take much notice of you anyway, they are all too engrossed in what they are doing” (4)“sometimes you think “I don’t want to meet these people because all I’m going to talk to them about is “I took two pink pills in the morning and four green ones in the afternoon” sort of thing. Its all “down” conversation/ But it you can tell them you went to play football, they beat us 4-0, and then its “hat are you playing football for?” it makes him feel as though he’s part of a group and not estranged from “normal” population” (2)“its good for me, I can brag about it. I can tell people I am a canoer. Its tremendous. Its is a first step situation for me because I happened to try it, like it, respected myself a lot more and others respected me” (3)

The benefit of distraction from sport

“Four out of the five research participants acknowledged that they had used football to direct their attention away from these symptoms and reinforce a more positive version of reality” (2)For Brian, the simple distraction of participating in the football allowed him to ‘take his mind off things a bit” (2)Robert believed that if he could no longer participate in the football project then he would ‘definitely get more

voices” (2)“In the psychological subtheme, there were properties of well-being, distraction” (4)“It’s a very good therapy, to channel his thoughts and things into what he’s doing and not think about the voices as he had done” (2)“ One participant identified that there was a combination of mechanisms responsible: ‘Not just an endorphin release but a distraction’” (4)

An impact on social discourse and an increase in social confidence (in manuscript documented in the above theme only)

“the golf programme gave the participants something positive to talk about outsidetheir health problems – a way of taking a tentative step into a world beyond mental health problems. ” (1)“Roberts carer agreed that it helped him meet and communicate with other people. Other services and projects failed to engage Robert’s interest” (2)“In the social subtheme, there were social interaction opportunities and increases in social confidence” (4)“Social benefits from participation included opportunities for social interaction and perceived increases in confidence in social settings. It was acknowledged that sometimes it can be difficult to socialize with others, for people with mental health problems, in settings other than exercise or sport” (4) “Social as well. It is talking to people; maybe new people coming in, maybe you haven’t seen before, and talk to them for a bit if they want to, whatever” (4)“I heard of it from another patient, that I met because I previously had an interest in sport I could recognize the link. I mentioned it (to the other patient), and (the sports therapist) got in touch with me” (4)“It was a time when the whole group could be together, and it appeared from the banter, jokes and laughs that this was an important part of the programme for the group members too.” (1)“Richard’s comments, for example, suggest that one of the main things that kept him coming each week was the chance to get out of the house and enjoy the ‘banter in the bus, a cup of coffee, and a piece of cake’. Richard said it was fun hearing Harry and William verbally spar with each other, concluding: ‘I’d like a bit of what they’re on!’” (1)“It helped us get to know the group and the group members get to know each other.” (1) “for participants it was more than just the football that had been beneficial. A new and external social world was created.” (2)“one client articulated well the effects of challenge on his sense of belonging” (3)“social reasons included the opportunity for social interactions” (4)“They were, however, complementary regarding the sports therapist and their role in their rehabilitation,

emphasizing that the sports therapist had an important role in supporting service users through their treatment.” (4)“‘I like being with people, you see, I like being social, I like having a laugh and stuff like that. I don’t like sitting on my own with my thoughts.’” (4)“sport activity, might even…improve social skills” (5)

Achievement accomplishment and pride

“Important in creating a non-competitive, caring environment was the approach to the coaching, which emphasised and highlighted personal improvement and achievement” (1)“Most clients reported experiencing a feeling of accomplishment and pride in successfully completing the trip.”(3)“the staff members were constantly offering genuine positive feedback and support to the clients and each other. This attitude generalised to the clients during the trip as they began to be encouraging and supportive of each other” (3)“Progression did not appear to be planned which for some, was disappointing.” (4)“In the psychological subtheme, there were properties of well-being…achievement and satisfaction, and management of condition” (4)“Several well-being-related and cognitive benefits were experienced: • feelings of accomplishment and well-being”“Satisfaction for participants was experienced: and was achieved through recognition that they had accomplished something” (4)“Achievement and satisfaction were gained through doing something purposeful, similar to work. Purposeful activity or sports therapy helps maintain individuals with a sense of coping, happiness, and a good feeling” (4)“I find that if I do exercise in the day I have achieved something and therefore it makes me feel happier in myself, and at the end of the day, I know it is only exercise and it is not working or anything, but to me it is something that keeps me going’” (4)

Feeling and emotions generated by the sports

“the degree of challenge involved in the canoe trip should not be under-estimated. Most of these individuals had never been in a canoe before…All but one spoke of being afraid or scared at some point during the trip” (3)“Some clients reported that being afraid as what contributed to the trip being exciting and fun…the clients who felt most nervous were the ones who reported the trip as most fun”(3)“pleasure was associated with completing tasks, from activities of daily living to getting through a tough set of rapids” (3)

“there seemed like a little bit of danger and I think that is interesting” (3)“It appeared that as a method of self-management, the exhaustion from the exercise seemed beneficial in relieving symptoms and feelings of anger and frustration which was supported further by some knowledge of the evidence base underpinning this” (4)“The outcome of enjoyment also echoes previous research regarding positive mental health benefits” (4)“They [the group members] seem to be really enjoying it – I talk to them in the café. The general feeling was that it was really, really well-accepted and people really, really enjoyed it” (1)“I felt keen, you know, ’cause I felt it was good time out and, you know, it’s not as if I’m playing a hectic sport, it’s pretty relaxed… It looked a very relaxed style sport – that’s the beauty of it” (1)“afraid of capsizing…afraid of not being able to get to hospital” (3)“I think you do produce serotonin when you exercise. More serotonin that gives you the feel good feeling. Not too sure if that is actual fact” (4)“it gives me a good feeling of well-being, every time I do an activity come out of it feeling I’ve done myself benefit’” (4)“sport again has helped me stay mentally positive and that’s about it. Really beneficial” (4)“but it is anything that makes a contribution to feeling anything other than listless where every effort iswash and shave in the morning is like being asked to go on a 100 mile track. Anything that improves your ability to face those challenges and gives you more energy is worth it” (4)“I don’t think there is anything so satisfying and more stress relieving as a good game of football’” (4)“All my frustrations and angers, and everything I was fed up about, I took it out on the punch bag and I tell you what, punching that thing six or seven repetitive punches, you’re out of breath. You know you don’t last long, and soon as you feel annoyed, or down, or fed up, you just go back in there, bosh, bosh, bosh. It was really good” (4)“At the tournament, he felt some apprehension concerning the level of the other players, but exhibited good table tennis technical abilities during the warm-up. He easily won the first match and then subsequently disappeared… M. lost the semi-final match and was "in despair". It was explained that he could still win a prize as he would play for the 3-4 place. His mood then improved. During that match, he led by a few points, but was tense. Each time, the opponent closed the gap, he became very fearful.” (5)“ He smiled heartedly while lifting the trophy.” (5)“L. participates in the contest with some fear” (5)

“patients (both contestants and audience) experienced several hours of excitement, interest and joy.” (5)The Construction of the sporting activity

The need to structure the sport so that it progresses the individual to independent engagement

“on the group’s first trip to the golf course, having organised play for the first two holes” (1)“The move from the driving range to the course marked a move from learning to hit the ball to learning to play the game. At the driving range there are no penalties for miss-hit shots or misdirected balls. Once on thecourse, however, under traditional golf rules, a wayward shot must be played from wherever it lies. A ‘Texas scramble’ is an excellent way to help the beginner play round the course without getting disappointed by errant shots or getting bogged down continually looking for balls.” (1)“The marketing, advertising, and recruitment of sports therapy were considered to need developing as there appeared little information readily available. Furthermore, the recruitment of participants seemed to be ad hoc with one participant explaining that they had heard about the sessions and been recruited by ‘word of mouth’ from another ‘patient’” (4)“Over the course of the first few sessions responsibility was gradually transferred from the organisers to the participants” (1)“By week seven, most group members could cope without the need for direction from the organisers… By the end of the programme some of the participants were sufficiently confident of the situation to consider continuing to play golf when the organised sessions finished” (1)“Before I approached the next pair, I watched for five minutes from 50m away. They were both appearing to get on well with each other and their game. I saw Jerry play a good tee shot on the 5th. It led me to wonder whether my presence with each pair disrupted their natural play and interaction as Jerry and Peter seemed so at ease” (1)“we organised and prompted most aspects of the programme: the amount of coaching, the length of the sessions and the activities during the sessions.. We decided how many holes were to be played.” (1)“The low intensity of golf as a form of physical activity was considered by clients and staff to encourage continued attendance” (1)“André highlighted the importance of a low intensity exercise for this client group” (1)“I think the good thing about golf is, in some ways, it’s not too over-physical. Because you get a lot of people with side effects of the medication, putting on weight, for them to go swimming or them to go to football, or for them to do those sorts of activities is even harder because of all the excess weight they carry.” (1)

The environment and atmosphere

“we organised and prompted most aspects of the programme: the location” (1) “The Texas scramble is also thought to foster team spirit as all golfers hit from the same spot every time and so have a vested interest in their team mates’ play.” (1)“safe environment” (2)“the social network and support provided by the Trust in the form of the sports therapist was also a useful influence for attendance and the provision of such staff in encouraging positive health behaviour mirrors previous research into the importance of social support through a social network” (4)“our own observations suggest that we successfully created an atmosphere of ‘caring golf ’” (1)“Katie linked the positive atmosphere to an absence of competition between group members” (1)“client statement describing changes in themselves during the canoe trip fell into three broad categories: experiencing pleasure, a sense of belonging, and the ability to talk with one another” (3)“Their opinions of the culture and atmosphere of the sessions also appeared conducive to attending” (4)“It’s the banter, it’s the crack. When you have had a bad day...then you can go out for football for an hour and a half with complete strangers and they don’t know what I do; they just know me to play football with and that how I like it” (2)“You had that kind of support system in place which kind of helps you to progress, because we go two steps forward and . . . two steps backward, and you need that kind of support there to help you, this is one of the ones (treatments) that does’” (4)

Individual considerations of the sport and activities chosen

“we decided which players were in which group” (1)“there was one occasion where we believe a mental illness issue was a factor in one group member dropping out of the programme [fear of going over bridges]” (1)“For these reasons, a Texas scramble is often used with beginner groups. Despite its worthy ethic, this approach to the game did not appeal to all members of the group. Harry hadenthusiastically attended every session until the Texas scramble in week four. The following week he was absent.” (1)“Most of the group appeared to enjoy the challenge, except Ronnie, who felt under unwanted pressure. Commenting on the golf programme as a whole, Ronnie singled out this competition as a negative experience” (1)“it was the side effects of medication that made the difference and not his illness…Larry had the same concern that his medication ‘might take the shine off any performance that I might do…Robert had similar experiences”

(2)“According to participants, there is a support system in place to identify when participants do not attend and appropriate follow-up action is taken” (4)“Participants suggested that a more holistic approach could be adopted that incorporates otherelements of health such as diet and weight management” (4) “One thing I don’t like is what we did [at the range] – we took in turns you see and I’m quite a shy person – I don’t like having competition I just like enjoying myself… I don’t like people hitting in a competition, who’s winning, who’s losing. I just like to enjoy and go with the flow you know.’” (1)“[The medication] slows you down so that you cant run properly without your joints feeling like you’ve got bricks inside them. That upsets you because you cannot perform at the level you want” (2)“I found that one of the most debilitating symptoms I get with my illness is exhaustion, doing it to try and increase my energy level’ (FG1 50) and to feel better” (4)“I am a new boy I have been going 6–7 weeks, and, um, so far I found it an effort to do, and I know what it is to feel mood elevated by exercise, . . . I found it sometimes has left me feeling tired after I have been to the gym; I really haven’t had that buzz I am looking for I suppose’” (4)“It’s not so much the social interaction, it’s finding the energy to actually get out” (4)“He declared that he must win a trophy, but regarded the prize (a sports hat) with little value. When close to victory, someone said that the trophies will be awarded on the next day. M was stunned and everybody laughed. M won and we calmed him and promised to give the trophy today.” (5)

The use of functional social support

Esteem “Nurturing and encouraging this social time was, we felt, important to the success of the programme” (1)“highlighted personal improvement and achievement by drawing attention to the positive aspects of each individual’s play” (1)“the staff members were constantly offering genuine positive feedback and support to the clients and each other. This attitude generalised to the clients during the trip as they began to be encouraging and supportive of each other” (3)“Assisting participants to overcome their motivation problems included the sports therapist, other participants” (4)“Recognition was given for the support that is required to address motivation, especially given the fluctuating nature of the illness” (4)“they’ve got to be reminded… Just to encourage them really and remind them.” (1)

“His face brightened when I talked about him looking athletic on the golf course. He seemed really pleased to have positive input about how he had played. He smiled a lot when I gave him encouragement and said a very warm “Thank you”.” (1)“The idea of getting an outsider, someone who plays golf professionally, people were really keen on that” (1)“I know, well I was persuaded as part of my recovery to come, but when you are not well you need a bit ofpersuasion, but I am so glad I did’” (4)“M is the favorite to win the tournament, but he refused to wake up for it. Following firm persuasion, he left his bed and subsequently won the tournament.” (5)“L. participates in the contest with some…encouragement from us, and finally wins the second place” (5)

Emotional “A recurring belief among service users was that there was little support or empathy expressed by mental health professionals about the common side-effects of weight gain and lethargy” (2)“It also felt comforting to have knowledge and experience that other people were similar to them” (4)“The positive atmosphere was complemented by a large amount of consideration for each other. There really was, once again, no feeling of competitiveness. Everybody seemed to want everybody else to do well. Ronnie asked the group, “Can I go next, do you mind?” and Andrew replied, “No objections at all.” Simple things, but positive, supportive, encouraging, and considerate” (1)“You [author] are very, you’re approachable, and you’re human and you have a laugh and you’re not just standing there telling them what to do. But you’re sort of part, you were part of it all… But you also had all this knowledge that none of the others of us had so you were a kind of central point really. But yeah, you were friendly and talkative and explained it” (2)I didn’t feel isolated at all. It was sort of a spirit of camaraderie between everybody because of the challenge it think, going down the rapids and pulling together as a team and you know just being friends with one another I guess” (3)“I had a set back and I didn’t come down for 5 weeks and the people here phoned me up. “Where are you?” and asked me where I was. You know, it was nice to think somebody was thinking about me’” (4)“People were very supportive, especially out canoeing on Saturday and Sunday, so I don’t think you were afraid that you wouldn’t be helped. People were great. Sort of have an extra sensory feeling towards people in the group” (3)“name of the sports therapist) . . . he knows about mental health problems and things, and you can actually take him

to one side and have a word in his ear if you need to” (4)“you know, you can say things and he is quite sensitive about how he explains things and how he talks to you” (4)“One way or another we are in the same boat, they all got things going on in their heads and that’s the thing that helps you feel more comfortable, is knowing that other people are going through the same thing” (4)“it was good because everybody had gone through something along the lines of mental health illness and, um, you got that support there as well’” (4)“ You’re making friends, socializing with other people with the same sort of problems’” (4)“This close support provided participants with a ‘safety net’” (1)

Informational

“directive coaching style helped participants to achieve immediate improvement in terms of the technical skills of the game” (1)“I do think the fact that you were there with your obvious knowledge and coaching skills, I do think that was a very important part of the positive responses because people were able to see an improvement because you were able to be quite directive and say: “This is what you do, this is what you need to do, this is what you’re not doing.” You know, you could see all that. And I think that was a very valuable part of it, that kind of direction really” (1)“I think everyone mentioned that coaching’s been good… It was softly, softly sort of thing, in a friendly way. It wasn’t pressurised. It was broken down into nice parts, with a bit of humour. Just casually but not too casual.’” (1)

Tangible “help participants make their way tothe sessions each week” (1)“the golf programme was free encouragedattendance” (1)“Another factor affecting participation was cost. The costs of the sessions, outside of the Trust, prevented people from doing more activity” (4)“Money is a major thing – they wouldn’t go out and do it ’cause of money basically. Yeah, one comment was [that] they wouldn’t do this because it would most too much and they wouldn’t be able to afford it.” (4)“I used to go to the local sports centre, . . . I stopped because of the financial cost of it’” (4)“It is the access as well and the cost involved. I mean, if you are not working and you are on reduced pay or whatever, it’s difficult” (4)

“Patients who won the first three places were awarded prizes and trophies.” (5)“but regarded the prize (a sports hat) with little value.” (5)“There were two clients of mine, and two of Katie’s [a carer] that we had to phone up just to basically remind them – they wouldn’t come…But that is the norm with those two they’ve got to be reminded… Just to encourage them really and remind them.” (1)

1 = Carless and Douglas 2004, 2 = Carter-Morris and Faulkner, 2003, 3 = Clarke et al 1991, 4 = Crone et al., 2008.

Supplementary File B

Figure 1. The translational benefits model

A line of argument synthesis (new generation of knowledge) was generated from the thematic analysis. Figure 1 provides an outline of the translational

value of sport model for individuals with severe mental illness. The model centres around three elements which illustrate how translational psychosocial

outcomes are achieved. The first element considers the different and varied social representation of sport, that is, what sport represents socially for

individuals with severe mental illness. From the current findings we suggest five social representations of sport: (1) experience in a new supported, safe or

protected environment, where the introduction and functional support can be used to aid the experience in the sports environment, (2) provision of a new

and extended social network of individuals who become accessible as a result of participation, (3) access to success and achievement experiences in the

community environment, for example, even attendance to the sport venue is a success, (4) change of social environment and challenge of the physical

environment; the environments were importance representations for individuals, and (5) access to a positive group identity and culture which could help

promote a positive sense of self and improve their social confidence which was modelled by peers. The second element is how these different social aspects

of sport create positive change for individuals. This was identified in six domains: (1) by providing positive emotional experiences, mainly enjoyment, but

also excitement and thrills, (2) by protecting or distracting individuals from perceptual or cognitive bias that can often accompanied social or community

interactions, (3) by providing access to a different and new social discourse which is not focused on mental illness, (4) by providing an experience which is

considered by individuals as normal, (5) a social learning experience where individuals could learn or model behaviour and interactions from others, and (6)

positive social interactions which demonstrate that interactions are possible even with complete strangers. The final element was the translational

psychosocial outcomes from the sport which was identified in four areas: (1) decreased social isolation by providing an increased social network, (2)

increased enthusiasm for social engagement following positive interactions, (3) increased social confidence and autonomy as individuals are able to adopt a

proactive approach to community engagement, and (4) increased self-belief in that individuals are able to overcome their barriers and successfully engage

in the community

New Mjsupported, Mj

safe/ Mjprotected Mj

environment Mj

Change & Mjchallenge of Mjenvironments Mj

New and Mjextended Mj

social Mjnetwork Mj

Positive MjGroup Mj

Identification Mj

Access to Mjsuccess and Mjachievement Mjexperiences Mj

in the Mjcommunity Mj

The Different MjSocial Mj

Representations Mjof Sport of Mj

individuals with MjSevere Mental Mj

Illness Mj

The MjTranslational Mj

Change MjMechanisms Mj

Experience Mjwhich is Mj

considered Mjas 'normal' Mj

Protective MjBuffering MjEffect or Mj

distraction Mjfrom Mj

perceptual Mjand cognitive Mj

bias Mj

Positive MjEmotional Mj

Experiences Mj

Access to Mjdifferent and Mjnew social Mjdiscourse Mj

The MjTranslational MjPsychosocial Mj

Outcomes Mj

Increased Mjself-belief Mj

Decreased Mjsocial Mj

isolation Mj

Increased Mjsocial Mj

confidence & Mjautonomy Mj

Enthusiasm Mjfor Mj

engagement Mjin community Mj

Positive Mjsocial Mj

interaction Mj

Social Mjlearning Mj

Figure 1 The translational benefits of sport model