Improving treatment pathways for gambling harm
Gambling is associated with significant health and wellbeing concerns but this is frequently overlooked when patients present with multiple or complex issues, according to Tony Clarkson, Principal Clinical Advisor to the Victorian Responsible Gambling Foundation.
‘Because of the significant comorbidities, gambling harm can fall through the cracks in primary care settings when a person seeks treatment for other co-occurring issues such as mental ill-health, drug or alcohol use disorder or family violence,’ he says.
Each year, more than half-a-million Victorians experience harm related to their own or someone else’s gambling. This commonly manifests as feelings of regret, shame or guilt; irritability; headaches; sleeplessness; difficulty concentrating; depression; anxiety; increased use of alcohol and other drugs (AOD); and family violence.
‘People with these symptoms often turn to a trusted health professional like a psychologist, GP or allied health practitioner for advice, which is why it’s important that we’re able to recognise potential signs of gambling harm and confidently link people to relevant treatment and support services.’
Screening for gambling harm
A 2017 study found that up to 30 per cent of people presenting to primary care, AOD and mental health services are experiencing problems with gambling.[i]
To improve support for people in this situation, the Foundation is piloting a simple, single-question screener validated as having a 92 per cent detection rate for identifying gambling harm in patients in a primary care and medical setting.
The question: In the past 12 months, have you had an issue with gambling?
The pilot includes a training program developed by the Foundation, with guidance from the Gambling Minds team at Alfred Psychiatry and clinical consultant Dr Jane Oakes.
It aims to help primary and allied health professionals improve treatment pathways for people negatively affected by gambling together with at least one comorbidity, such as mental ill-health.
‘This clear and straightforward guide to gambling harm and treatment options will certainly help our therapists keep gambling harm in mind,’ says Dr Eli Kotler, consultant psychiatrist and Medical Director of Malvern Private Hospital.
‘I have no doubt that this will lead to fewer missed opportunities for those suffering from gambling harm, and better outcomes for those who are already seeking treatment for related issues.’
Stigma
It’s not unusual for patients to be reluctant to talk about gambling harm. The stigma associated with it is a barrier to help seeking,[ii] which partly explains why those affected sometimes fall through the cracks.
It’s telling that Gambler’s Help agencies in Victoria have reported that many people would rather acknowledge a drug or alcohol addiction than disclose a gambling problem.
‘Patients often feel so shamed, they don’t raise it, so it really is up to us as GPs to start the conversation,’ explains Dr Hester Wilson, practising GP, RACGP Fellow and Chair of the College’s Addiction Special Interest Group.
‘Asking one simple question can help us identify gambling harm in patients and allow us to intervene or refer to specialist services,’ adds Dr Wilson. ‘Doing this will limit the harm caused to our patients, their families and communities, leading to better health and wellbeing outcomes for everyone.’
Professional support
Gambler’s Help offers free, confidential advice, support and referral 24/7 to people experiencing harm from their own, or someone else’s gambling. GPs and allied health professionals can also call Gambler’s Help to discuss patient referrals and appropriate treatment options.
These include face-to-face, telehealth and online therapeutic counselling, peer support and financial counselling. In addition, counsellors have the expertise and resources to support and refer patients experiencing complex co-occurring AOD and mental health issues.
The Gambler’s Help number is 1800 858 858.
Information about the full range of support resources, including help in other languages, Gambler’s Help Youthline, support for First Nations communities, self-help tools and apps, is available from gamblershelp.com.au.
For specialist psychiatric support with patients experiencing gambling harm and mental health issues, GPs and allied health professionals can contact the Gambling Minds team at the Alfred on (03) 9076 9888 or visit gamblingminds.org.au.
Screening pilot follow-up
The Foundation’s screening tool and training pilot is being undertaken by Ballarat Community Health and Child and Family Services, which provides Gambler’s Help services in the region, and the Salvation Army’s Gambler’s Help service in metropolitan Melbourne.
Following an evaluation, enhanced training resources will be available to GPs and allied health professionals in early 2023. For more information, please email Tony Clarkson.
Sources:
[i] Lubman D, Manning V, Dowling N, Rodda S, Lee S, Garde E, Merkouris S, & Volberg R. (2017). Problem gambling in people seeking treatment for mental illness. Victorian Responsible Gambling Foundation, Melbourne, (2017) p.33.
[ii] Hing N, Russell A.M.T, Nuske E and Gainsbury S.M. (2015). The stigma of problem gambling; Causes, characteristics and consequences. Victorian Responsible Gambling Foundation.