How do esports companies support their community’s wellness?

Highlights

• Examines evidence of policies, programmes, and partnerships of 70 esports companies, to assess support for wellness within their communities.
• Discovers varied provision, with pockets of best practice and innovation, but no continuity, monitoring, or evaluation.
• Proposes an in-platform solution to esport player management, taking into account priorities in shared data ownership within healthcare, management of data monopolies, and the importance of arm’s-length approach to care.

Introduction

In June 2018, the CEO of England’s National Healthcare Service (NHS), Simon Stevens, argued that social media companies should bear greater responsibility for the mental health crisis young people are facing (Iacobucci, 2018). His statement came at a time when the World Health Organization (WHO) was expressing mounting concern that people’s lives within digital environments are so extensive now that their experiences may be characterised as a disorder, worthy of medical attention (World Health Organization, 2018). While these claims were controversial and likely only to imply a fraction of the population who enjoy life in digital space, it is also accompanied by growing evidence that many people are anxious about their levels of exposure to life online. For example, the Pew research center found that 54% of US teens feel that they spend too much time on their mobile devices and two thirds of parents are worried about this (Jiang, 2018).

These findings resonate with research by Rich et al. (2020), which evidences the feelings of young people that life online brings with it pressures that are not always positive. For example, in 2017, Instagram came under fire after claims that its algorithm was elevating images and videos of self-harm, which were leading to harm for its user base. In a case where a 14 year old girl committed suicide, her father expressed how his impression that the supposed intelligence of platforms to show users what it thinks they want to see, in the case of his daughter, drew her closer to content that exacerbated her feelings of depression and negative thoughts, which culminated in her suicide (Hern, 2017). More recently, the rise of TikTok as the newest generation of algorithm generated, hyper-short video content, has been subject to similar criticisms, namely, that exposure to certain content can be harmful to young people (Murphy and Yang, 2019).

Following these concerns, in October 2019, England’s NHS set up its first "Centre for Internet and Gaming Disorders", within a wider National Centre for Behavioural Addictions, aimed at supporting children and young people who are characterised as having a disordered relationship with gaming (NHS, 2019). Moreover, the British Government inquiry into Immersive and Addictive Technologies (Secretary of State for Digital, Culture, Media and Sport, 2020) found that there is considerable cause to seek a deeper, legal ‘duty of care to make companies take more responsibility for the safety of their users’, which was the outcome proposed in the government’s White Paper on ‘Online Harms’ (Secretary of State for Digital, Culture, Media & Sport and the Secretary of State for the Home Department, 2019)

Yet, it is also apparent that modern lives have been reconfigured around the use of digital devices in ways that are liberating, compelling, and desirable. Indeed, in healthcare alone, there is a considerable drive towards more mobile digital solutions, which speak to a future where people are likely to be even more present within such environments. For instance, in July 2020, the WHO launched ‘Florence’, an artificially intelligent digital person, who would provide personalised healthcare guidance to users (WHO, 2020). Alternatively, in July 2018, AI health care provider Babylon Health, announced integration of Google’s Alexa for its mobile application (Babylon Health, 2018), taking humanity a step closer to having doctors ever present within the home, providing support whenever it is called upon. In this respect, there is a tension between the concern that people are spending too much time within their digital platforms and the fact that, increasingly, healthcare services are being delivered via such platforms, raising questions as to how society as a whole should attempt to reconcile these tensions.

These concerns are not absent from the world of esports, which have been subject to a range of criticisms over anti-social and damaging behaviours. For example, in August 2018, a shooting took place at an esports event in the USA (BBC, 2018), where a losing player seems to have been so incapable of dealing with the loss in competition that they were driven to violence. This raised questions as to whether special kinds of emotional and psychological support are required for individuals such as these due to the nature of time spent within digital worlds. Indeed, esports has had to grapple with a complex history of anxieties about the impact of gaming, which, to this day, continue to shape public opinions about gaming, whether it is competitive or not. Furthermore, the harms span all parameters of human life, mental, physical (health, injury), social (emotional, psychological, psychiatric), and economic (gambling).

It is within the wider context of these digital world experiences that the present article is situated. Its focus is on understanding how the esports industry publicly evidences its commitment to addressing the risk of harm associated with its competitive culture. In so doing, it investigates the publicly shared policies, programmes, and priorities of healthcare support from a number of prominent esports organizations publishers, game developers, event organizers, and esports associations, to understand how risks are defined, assessed and managed.

Methodology

The initial phase of the research involved identifying and selecting a sample of esports organizations, which assume roles of responsibility in the production of esports. Specifically, organizations were identified based on their prominence in terms of game sales, player hours, or centrality to the esports tournament economy using insights from the esports news platforms Games Radar (James, 2020), The Loadout (Hore, 2020), Setup Gamers (2020), and Repeat (Amin, 2020). Each of these publishers provided dedicated articles on the most prominent platforms in 2020, which was used to refine the search process. These sources elicited the identification of 70 organizations, which spanned prominent publishers, titles, platforms, and tournament organizers. Once identified, a qualitative assessment of these organizations’ public, digital assets took place, focusing on what was expressed in the websites of each of them, along with a wider media search around their programmes of health support, corporate social responsibility expressions, and, where evident, the existence of player associations.

More specifically, these materials were read in detail and programmes of work were identified and coded, so as to identify evidence of activity that would describe activities and investments that speak to how these organizations supported player health and, particularly, which articulated principles that underpinned their approach. The range of criteria to evidence activity was broad, consisting of searches for a) codes of conduct and/or community standards, b) evidence of specific programmes of health support, and c) any wider initiatives or partnerships that were in existence. To this extent, the aim was to be generous rather than overly specific, so as to capture the entire breadth of evidence that is available. For example, Riot Games describe a partnership with a mental health support phone service and, on the criteria used within this study, this constitutes an active investment, even though the service is not their own. Alternatively, Community Guidelines sometimes encompass aspects of wellness provision, even though these are not specific programmes of support. When discovering a particular type of programme that did not fit the search protocol, additional searches took place with similar language for all other organizations, to cross-reference for similarity.

Results

Evidence of Investment into Community Wellness

The initial selection of companies for evaluation spanned the following 70 titles/companies:

• Developer/Publisher: 1047 Games, Activision Blizzard, Electronic Arts (EA), Epic Games, Fishlabs, Garena, Konami, Namco, Nintendo, Psyonix, Respawn Entertainment, Riot, Supercell, Tencent, Turn, 10 Studios, Valve
•  Game Titles: Apex Legends, Arena of Valor, Clash Royale, Call of Duty: Modern Warfare (COD:MWR), Counter Strike: Global Offensive (CS:GO), Defence of the ancients 2 (Dota2), FIFA 20, Fortnite, Forza Motorsport 7, Galaxy on Fire 5, Garena Free Fire, Hearthstone, League of Legends, Madden 20, NHL 20, Overwatch, PES 2020, PUBG, Rocket League, Splitgate, Street Fighter V, Super Smash Bros, Tekken 7, World of Warcraft
•  Games Platform: Apple, Microsoft Windows, PlayStation, Xbox • Streaming Platform: Caffeine, Facebook Gaming, Huya, Steam, Twitch, YouTube Gaming
•  Tournament Operator: Blast Pro Series, Dreamhack, Eden Esports, ESL, Kronoverse, LVP/Fandroid, Nodwin Gaming, Estars Studios
•  Tournament Platform: Battlefy.com, Gamersaloon.com, gamerzarena.com, Gamesbattle.majorleaguegaming.com, mogul.gg, Playerslounge.com, Proplayers.eu, Toornament.com, UMGgaming.com, WorldGaming.com, XYgaming.com.

While this selection process did not expect to be a comprehensive overview of the entire esports system, it was determined to be a reasonable overview of a range of prominent esports environments, from very well-known platforms to niche spaces. The aim was not to capture the entirety of what gaming companies are doing to support player health, but to identify enough of a variety of programmes, so as to understand the range of concerns and approaches that are apparent from within the wider esports community.

Among the 70 organizations investigated, the percentage of those with some form of policy, programme, or partnership to support the wellness of its esports community is summarised as follows:

• 50% of 16 developers/publishers
• 54% of 24 game titles
• 25% of 4 gaming platforms
• 43% of 7 streaming platforms
• 16% of 19 tournament platforms

The following sections outlines some of the characteristics, to evidence the variety and range of these programmes.

Community Behaviour Standards

Across each of the categories, there were similar kinds of concern evident. For instance, 30% of the organizations studied published Community Standards or Codes of Conduct on their websites, which set out principles and values that articulate expectations for behaviour within their game community. Even more of them have User Agreements, which require the user to agree to the platform’s expectations. For instance, Section 6 of EA’s User Agreement compels users to not ‘harass, threaten, bully, embarrass, spam’ and generally engage in behaviours that are inconsistent with their moral code (EA, 2019).

In some cases, such documents express partnerships with independent organizations or coalitions, such as the Esports Integrity Commission (Esports Integrity Commission, 2020) or the AnyKey initiative, each of which seek to uphold arms-length practices to ensure that game companies are in receipt of guidance from independent authorities with diverse remits. For example, while sponsored principally by ESL and Intel, AnyKey describes itself as an ‘advocacy group that supports diversity, inclusion, and equity in competitive gaming’ (AnyKey, no date). Its affiliates consist of gaming communities, charities, individual activists, professional players, and teams. Members are asked to uphold their ‘code’, which is underpinned by the four values of ‘compassion’, ‘integrity’, ‘respect’, and ‘courage’ and its priorities consist of promoting inclusion, diversity, and it describes all of its work as research-led. In this case, while ESL’s digital assets describe policies of ‘Global Rules’ (ESL) and game specific rules, its wider work is expressed through its support for AnyKey and the wider community that surrounds this group.

Other publishers outline similar approaches or have organized their own community oversight organization, such as EA’s Healthy Communities Player Council, established in 2019 (EA). Alternatively, Activision’s Code of Conduct emphasises the principles of respect, responsibility and fairness within competition, breaches of which may imply removal from the game environment (Activision).

Gaming Disorders & Health

In contrast, 7% of the sample indicated evidence of activity that might be typically associated with the wider public concern around wellness, as characterised by the broad concerns associated with the WHO’s identification of gaming disorder (WHO, 2018), such as addictive or compulsive tendencies. For example, in May 2020, streaming platform Twitch launched the Twitch Safety Advisory Council (Stephen, 2020), in order to promote ‘healthy streaming and work-life balance habits’, protect ‘the interest of marginalized groups’ and will focus its work on policy development. In this case, the reporting of its creation is described in the context of a range of widely reported incidents that caused public alarm about the platform (Smith 2020). Alternatively, Microsoft’s XBOX publish a ‘Healthy Gaming Guide’ on their website, which emphasises injury risks to prolonged gaming and the importance of living a balanced lifestyle as a gamer, by eating well and resting. Its guide also encompasses ‘Tools for Families’, to ensure parents are aware of what their children are accessing through games.

Partnership Programmes

Approximately 11% of the sample evidenced activity associated with identifying and monitoring the health risks associated with excessive esports competition. These activities include:

• Helping players to understand the importance of a healthy lifestyle (sleep, nutrition, exercise)
• Guidance for parents to safeguard the playing experiences of their children, and
• Wider mental health support for players who experience feelings of disordered play, where this may consist of growing experience of depression or the desire to self-harm, commit suicide, or being concerned about gambling.

For example, EA launched their Positive Play Charter in 2020 (EA, 2020), focusing on addressing toxic behaviour within its games. Alternatively, through its League of Legends title, Riot Games launched ‘Learn with League’ an educational programme seeking to support young people to integrate their gaming activity with wider learning development. Within this programme, it also partners with Australian National Youth Mental Health Foundation, Headspace (League of Legends, 2020). Their delivery of insights that can help players took the novel approach of integrating broadcast content during a tournament stream schedule, to reach players and audiences whilst they were already watching an event.

Working with dedicated health support organizations is a feature of many of those organizations that have invested into health support programmes. For example, in May 2020, the Counter Strike Professional Players’ Association (CSPPA) also announced the creation of a mental health hotline for players following the decision of prominent player Lukas Rossander (aka @Gla1ve_csgo) to take leave from competition due to ‘stress and burnout’ (Rossander, 2020). Also, within Facebook’s Safety Advisory Board, it outlines partnerships with a range of national bodies, from India’s Centre for Social Research, to the USA’s National Network to End Domestic Violence (Facebook).

Among tournament organizers, there was evidence of agreements in place to uphold a range of standards for the competitions. For example, Dreamhack publishes ‘General Rules’ that cover a wide range of issues from the prohibition of weapons in venues to a ‘zero tolerance policy’ on harassment (Dreamhack, 2020). Occasionally, there is also evidence of player associations mobilising to protect player health within tournaments. For example, the CSPPA publishes ‘Event Minimum Standards’ which outline a range of expectations for tournament producers, from the provision of ‘healthy snacks and drinks’ in player loungers, to the availability of ‘first aid, doctor, physiotherapist and massage therapist’, the costs of which are to be borne by the tournament operator (CSPPA, 2020).

Discussion

Given the prominence of public concern around wellness and gaming, the data reveals a relatively low prevalence of policies, programmes and partnerships associated with such concerns from among the esports industry. Moreover, much of the evidence is either wrapped around Codes of Conduct or User Agreements, which are likely to be born out of the company’s concerns for litigation associated with their product, rather than the moral conduct or wellness of its community.

Where evidence of significant investment exists, it is very recently employed, with many programmes not beginning until 2019 or 2020. For instance, within Valve’s DOTA 2, it was only in 2019 that a new feature was introduced called ‘Avoid Players’, which allows users to identify specific players they’d like to avoid being teamed up with, because they feel that the player has a negative impact on their gaming experience (Castello, 2019). By being able to avoid a player, users could then play games without the mental stress associated with these individuals. Alternatively, while Counter Strike has been around since 2000, the Counter Strike Professional Players Association (CSPPA) was established only in 2018 and has only just begun a programme of work to better protect the interests of its members. These initiatives reveal how esports player governance is still embryonic and many organizations are seeking to transform the conditions of care that exist within these competitions.

Overall, the highest prevalence of activity is found within the game developer/publisher category, with 50% of games publishers demonstrating accessible, dedicated programmes of support to promote health awareness and care for their users. Their approaches to provision often appear to be reactionary, prompted by a public outcry over high profile incidents or outcomes from research led initiatives that have claimed the need for further evidence of social responsibility. For example, in May 2020, the CSPPA also announced the creation of a mental health hotline for players following the decision of prominent plater Lukas Rossander (aka @Gla1ve_csgo) to take leave from competition due to ‘stress and burnout’ (Rossander, 2020).Thus, while the professionalisation of esports has led to greater independent scrutiny and the rise of independent organizations that seek to hold gaming companies to a higher standard, it also appears often reactive. When there is a high-profile incident, then gaming companies have responded with new programmes, plans, and policies.

Many of these initiatives are relatively rudimentary in their approach, often encompassing little more than codes of conduct. Generally, they consist of documents, audio visual resources, events, or the creation of oversight committees to hone in on the key issues. Occasionally, there are efforts made to integrate these programmes within the gaming environments where the players are situated, as for the case of the League of Legends Oceanic pro league broadcast on mental wellness, which took place within the scheduled tournament stream.

Many of the programmes that have been established are not specifically tailored to the elite esports profession. Instead, they speak to a wider community of gamers, which may be seen to be in the service of the professional scene. In this sense, while it is always useful to be mindful of the difference between amateur gaming and professional esport, their communities are related and many amateur players will pursue gaming aggressively in order to aspire to professional competition. While the findings indicate a varied picture in terms of proactive investment into the healthcare support of esports players, the data is likely to omit significant activities that emerge from other organizations, such as national esports associations. It may also reflect variation in how different types of esports organizations imagine their role in their wider community. For instance, the low prevalence of activity from tournament platforms (16%) compared with developers/publishers (50%) may indicate that tournament platforms do not consider it to be their role to deploy such provision.

There is one, unifying characteristic of all forms of support for wellness across all the data, which is that provision is offered outside of the context where the risk occurs, namely the competition environment. Mostly, it involves drawing attention to potential concerns, rather than programmes that manage the risks of the community from within the platform. There is no evidence that shows efforts to intervene with risky behaviour once the players/users are within the experience itself. The closest exception to this is found in the case of the Australian ‘Learn with League’ programme, which integrated dedicated programming into its tournament live stream schedule.

This absence raises a question about how advanced and comprehensive these commitments are to community wellness. After all, if one examines patterns of investment in a wider range of digital environments, it is apparent that in-platform support is becoming the optimal way to intervene. Indeed, the direction of travel for healthcare services is to bring them directly to the patients using digital platforms and we see this across all sectors of healthcare. From the rise of videoconferencing for patient consultations to the integration of digital wellbeing functions within social media, the emphasis is to recognise that the best way to ensure impact is to work within the environment where the risk exposure occurs. Even platforms like TikTok have ‘Digital Wellbeing’ settings, which allow the users to modify their experience by asking the platform to limit certain exposure.

Overall, this paper found that 41% of its sample yielded evidence of publicly disseminated policies (30%), programmes (7%), and partnerships (11%) which evidence commitments from esports organizations to support player/user wellness. In some cases, organizations had more than one programme, but generally this was very unusual. However, there is a lot that is unclear from the sample. For instance, while 59% of the sample revealed no evidence of activity, it is possible that evidence may be found within the closed space of the gaming world itself. For instance, some publisher may only publish such material within the game platform, made apparent to players when accessing the game directly. Alternatively, it is likely that esports teams have specific support for health from within their team entourage. In each case, there may be no wider, public dissemination of such activities or, indeed, no public discussion about their merit.

There are also other organizations that champion the importance of wellness, which require further investigation. These companies work either as advocacy groups to influence gaming provision or establishing programmes of support for players. These, too, must be treated as part of the network of wellness support for esports communities and should be investigated accordingly. Indeed, more research is needed to undertake in-depth consultations with such organizations, to understand where such organizations interface, if at all, with the wider esports world. Further research should also investigate the prevalence of player associations or informal player support groups and to assess their effectiveness in supporting player wellness. It should also collect data from players themselves to examine the use of these work programmes and whether they consider them to be effectiveness in supporting their wellness. It would also be valuable to assess data for prevalence of activity by game type, as this may yield insights into whether particular types of games are more prone to wellness concerns than others.

Conclusion

One of the problems facing the esports industry today is the fragmented manner in which support for wellness is approached. For instance, while only 16% of tournament platforms yield evidence of some form of support, 50% of publishers have evidence of activity. This may reveal that there is a limited amount of joined up thinking across the gaming sector on how best to approach player welfare and this also raises questions about how best to approach matters. There is also no evidence of discussion or agreement between organizations on what might constitute minimal provision for wellness support.

Some guidance may be found from what is happening within the healthcare sector more widely. For instance, in the UK, the NHS has gone through over a decade where its approach to supporting health has transitioned dramatically, especially when considering approaches to digital health. In its early phases, the NHS responded to the proliferation of digital health apps by providing a library of recommended apps (Bauer and Murphy, 2017). Subsequently, it developed closer working relationships with app providers, to then ensure greater insight and responsibility over recognising their efficacy. In 2019, this transitions once more into the creation of NHSX, which seeks to provide more integrated digital solutions and a simplified route into the NHS for patients (Department of Health and Social Care, 2019).

To this end, what seems absent from esport wellness provision is the existence of a common set of protocols and digital integration across platforms and a common understanding of where vulnerabilities exist among different communities. Finding a mechanism to agree these principles - perhaps in a way that is similar to having universal age ratings - may be the next, critical step towards finding effective solutions. Indeed, the next stage of esports provision should be to identify a common approach to a digital, integrated solution for monitoring and caring for players, rather than expect players to seek out such opportunities outside of digital environments. An in-game healthcare solution and agreement around minimum expectations would be the optimal way to deliver such support, particularly when thinking about the mental health aspects of such experiences, which are most likely to be felt strongest during the game playing itself. To achieve this, esports organizations need to work more collaboratively to agree how best to approach their collective contribution to supporting wellness within their competition environments, rather than to develop programmes in isolation.

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