One simple question on the path to recovery

By Maryrose Cuskelly

There’s a strong co-occurrence of gambling harm and mental health issues, a reality that confronted Fred Rubinstein when he gambled away the inheritance left to him by his father. His mother, recognising the challenges to Fred’s mental health, ‘dragged’ him into a psychiatrist’s office. It was the beginning of his recovery.

The Victorian Responsible Gambling Foundation is currently trialling a screening question for gambling harm with allied health practitioners where clients are routinely asked, ‘In the past 12 months, have you had an issue with gambling?’. Behind the strategy is the realisation that people often disclose their gambling problem to their physiotherapist, chiropractor or even their hairdresser rather than their GP or mental health provider.

In a discussion as part of Gambling Harm Awareness Week 2022 and led by Tony Clarkson, the Foundation’s Principal Clinical Advisor, three experts in the field considered the usefulness of such a tool, and ways to improve pathways to services for those seeking help.

On the panel were Dr Hester Wilson, GP, addiction medicine specialist, and chair of the Royal Australian College of General Practitioners’ addiction medicine special interest group; Angus Clelland, CEO of On the Line Australia, which delivers online and phone counselling, and suicide prevention services; and Dr Evan Symons, consultant psychiatrist and Head of Consultation Liaison and Emergency Psychiatry at the Alfred Hospital, and medical lead of the hospital’s addiction stream.

GPs haven’t traditionally screened patients for gambling harm.

GPs haven’t traditionally screened patients for gambling harm, Dr Wilson says. They’re generalists and often pressed for time, she points out.

‘We want to be able to assist our patients with all their health issues and gambling is just one of them.’

She agrees that the trialled question, designed to be objective, impartial and without bias, could be useful and easily included in routine health assessments. However, GPs may not be aware of where to refer someone who is experiencing gambling harm.

Effective referral requires a solid understanding of a particular service, Dr Wilson says. Readily available information about a service’s staff, fees, wait time and access would allow GPs to make a confident recommendation.

Angus Clelland’s believes a similar question could prove useful for On the Line’s counsellors. ‘It would be quite easy to slip into the standard operating procedure, if you like.’

It would be highly beneficial for such an approach to be standardised across commonwealth- and state-funded health intake and assessment services, he says.

Dr Symons points out that one-fifth of those currently being cared for in community mental health services experience gambling-related harm. Recognising this, the Alfred’s Mental Health and Gambling Harm Program, along with the training the hospital provides to psychiatric registrars, aims to improve understanding of gambling’s impact on mental health.

‘Problem gambling, gambling harms, gambling disorder are core business for mental health specialists,’ he says.

‘… gambling harms, gambling disorder are core business for mental health specialists.’
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Rapidly screening a client experiencing gambling harm is only one part of the challenge Angus Clelland says. While an enormous amount of effort has gone in campaigns to raise awareness in recent years, resourcing appropriate services able to respond immediately is vital.

‘Critically, we’ve got to make sure that support services for … gambling are available 24/7,’ he says.

‘We have a huge problem with what we call the “missing middle” in mental health,’ referring to those who have issues that are more complex than what a GP might be able to effectively treat, but which don’t reach the threshold where they can access services designed for acute mental health episodes.

Client choice is also a referral consideration, he adds.

‘It may be that their preference is to seek help through a telephone or a web-chat service. For others, it’ll be face-to-face or a group setting.’

More GP training is crucial in improving the health sector’s approach to gambling harm, Dr Wilson believes. Training should be offered at both undergraduate and graduate level and via a variety of platforms, including online, she says.

… a one-question screening tool may be the start of a life-changing journey.

All three panel members look forward to a time when a higher proportion of those experiencing gambling harm feel able to seek help and, at the service level, are satisfied by the response.

Despite the work still to be done on integrating services available to people experiencing gambling harm and co-occurring issues, and improving pathways to those services, it’s encouraging that a one-question screening tool may be the start of a life-changing journey.

As for Fred Rubinstein, he’s now a member of the Foundation’s Lived Experience Advisory Committee, proof of the crucial role that mental health support can play in recovery.