Gambling harm in mind event series

Some 92 people zoomed in on Monday 22 March for the first session in the inaugural Gambling Harm in Mind event series. It’s proof positive that the virtual environment offers convenient ways to gather that the demands of in-person events simply can’t match.

Susan McDonough from the Victorian Transcultural Mental Health (VTMH) began the session with a discussion of ‘intersectionality’, a legal word coined in 1989 by Professor Kimberlé Crenshaw to describe how race, class, gender, and other individual characteristics ‘intersect’ with one another and overlap. The Oxford Dictionary further defines it as, ‘The interconnected nature of social categorisations such as race, class, and gender, regarded as creating overlapping and interdependent systems of discrimination or disadvantage’.

Susan described it as ‘the personal experience of the big picture’.

Challenges at the intersection

At the intersections of poverty, ableism, homelessness, homophobia and sexual orientation discrimination and racism, Susan noted that people are particularly disadvantaged: ‘There are more social issues when there’s more inequality’.

This is compounded by the broad recognition that mental health services are not culturally safe spaces where people feel heard, believed and respected. Inclusion, on the other hand, is about actively engaging, with curiosity, with the less seen and less heard.

As the VTMH engages with and supports migrant and refugee communities, ‘we look at the interactions between identity, power and social hierarchies,’ she said. ‘We work together to create healthy, connected communities where no one is left behind, considering all dimensions of a person’s identity from private troubles to public issues; from the deeply personal and experiential to the structural.

‘We’re not the same, but we are all equal.’

Creating a sense of belonging

Settlement Services International (SSI) is the Foundation’s new statewide multicultural service partner. The service has only been operating in Victoria for two and a half years and two staff members introduced webinar attendees to its range of services.

Already well established in NSW in particular and with some 800 staff across Australia, SSI works with many ethno-specific services to create a sense of belonging and helps disadvantaged people reach their full potential.

Mandy Zhang from EACH Gambler’s Help Eastern talked about the challenges and opportunities of service delivery to multicultural communities.

‘When people don’t speak English, they often don’t know their financial rights,’ she said. ‘They may fear that creditors will take action against them. The Chinese concept of “saving face” is about honour and social standing, and many fear the shame and stigma of losing face.’

Telehealth can relieve some of that stigma and provide information to lower people’s guards and relieve their anxiety. Mandy provided a case study of clients in dire straits who, without engaging any external services, paid their debts before buying food and paying rent. Counselling can teach people in their own language about utility and rental relief grants.

Cultural safety within service provision

Rita Seumanutafa, a community engagement, research & advocacy (Pasefika) consultant at VASA Consultancy, then picked up the subject of belonging leading to social change. She noted that self-determination and cultural safety are the most important enablers.

At VASA they ‘advocate for community and report back to community’. Using grassroots community networks and sourcing community translators, they ensure fast turnaround on vital information such as keeping people safe on social media and food banks, for example.

The final speaker was Megan O’Keefe, a cultural strategy worker from Bendigo Community Health Services. With a population of about 120,000, Bendigo has been welcoming refugees and asylum seekers for more than 10 years. The main groups include some 3000 Karen from Myanmar, 250 Hazaras from Afghanistan and a growing number of people from South Sudan.

‘The health and wellbeing of this population exist in a complex environment that takes into account both pre- and post-arrival experiences,’ said Megan. ‘Evidence-based planning and flexible service provision are key.

‘Many have grown up in refugee camps and have low literacy in their original language so bi-cultural workers are vital. They can meet people where they gather such as places of worship.’

Since the first cases of COVID-19 community spread were recorded in Victoria in March 2020, the 100 Day Challenge forum has been a window into the experiences of those who want to change their relationship with gambling. In his online discussion forum, people share their challenges and progress and seek support.

Some common themes emerged.

Lockdown as a ‘lifeline’

Initial reactions to the sudden closure of physical gambling venues were overwhelmingly positive. In subsequent months, forum members would reflect on this event as having been a ‘blessing’ or a ‘lifeline’. People who had previously gambled within venues reported benefitting from this opportunity to reset as they rebuilt their finances and felt emotionally calmer.

• ‘… then the venues closed. I think for me that saved me. I had a chance to stop and find myself again.’
• ‘So nice to have money in the bank and the totally obsessive behaviour and thoughts have nearly gone.’
• ‘For the first time in my life I have money in my account after paying my bills and loans and putting food on the table! I love this new life.’

The closure of the venues was often perceived as acting like a safety net against relapse, making life feel a little easier for some forum members.

• ‘Silver lining to COVID. Couldn’t play pokies if I wanted to.’
• ‘…the restrictions and venues closed, it helped me a lot more, I didn't have the temptation to go because I knew I couldn't, even if I wanted to.’
• ‘I found the restrictions gave me enough time to get through the initial withdrawals.’

Effects of boredom and isolation

As the lockdown period extended, however, and with almost all leisure and social activities outside the home suspended, coping with boredom, isolation and stress was extremely challenging. This left some short of distractions and vulnerable to relapse or gambling more.

• ‘The initial lockdown a few months ago was a tough period for me losing about 10k over the space of about 2 months. The hard part was entertaining myself.’
• ‘Really over corona-life and I have relapsed, bit by bit.’
• ‘It’s not like a consuming urge where I want to win back losses. It’s just I’m bored and feel like having fun cos I’m trapped in isolation.’

Online gambling did not appeal to everyone and it was not inevitable that people who had bet within venues would transfer to gambling online. Some increased or initiated online gambling during this period, however, and reported experiencing sudden and/or large losses.

• ‘I’ve never had an online account because I couldn’t trust myself and would have punted 24/7 so all bets are off while this virus is around.’
• ‘With restrictions in place and the casino closed I found myself using the online casino.’
• ‘I started turning to online pokies, they are just as ruthless as the real ones... I blew $4200 in less than 2 hours.’

The stress of venue reopening

The anticipation of venues reopening caused anxiety for many people already seeking support for their gambling. Some discussed their fear of potentially losing personal or financial gains achieved during lockdown.

• ‘I am nervous about pubs/TAB reopening tomorrow. Once I get a beer in me I feel like punting.’
• ‘180 days without playing the pokies. Unfortunately I can't take any credit for the 180 days because the venues have been closed. I’m dreading the day the doors are opened again.’

Concern about venue reopening was not unfounded. Some forum members based outside of Victoria, where venues reopened mid-year, reported almost immediately returning…and losing.

• ‘…as soon as the venues open, like a desperate idiot, I go and play the pokies.’
• ‘Pubs reopened and I’ve spent the majority of what I saved during lockdown.’
• ‘…now that everything's opened up, I went and played and lost.’

Some nostalgia for lockdown emerged after reopening.

• ‘The only thing that has assisted me is COVID-19. Strange how something so horrible has been my lifeline.’
• ‘I had so much money and so much time. Now it’s open again and I am left with no money and still trying to find money for day to day living expenses.’

Broadly speaking, two groups emerged.

Those who usually bet within physical venues that closed and did not bet online appeared to experience the pandemic far more positively than those who gambled online.

An examination of the forum shows us that some people experienced financial and emotional benefits when venues were closed. It was not inevitable that people would transition to online gambling.

It also provides insights into the challenges people faced when unable to visit venues, such as coping with boredom, should their access to venues again be curtailed due to future lockdowns.

Beating a gambling addiction can feel like you have the odds stacked against you. Neuroscience can tell you why: your brain thinks losing can be as exciting as winning.

‘Near-misses in the pokies really matter because it activates the same area in the brain as a win,’ according to Valentina Lorenzetti, who studies the neuroscience of addiction and is deputy director of the Healthy Brain and Mind Research Centre at the Australian Catholic University. Emerging research in neuroscience shows that anticipation, thinking about a reward, can be very powerful, she says.

Advancements in fields such as neuroscience, digital innovation and mental wellbeing are becoming increasingly important in tackling gambling harm and addiction. And COVID-19 and resultant lockdowns and lifestyle changes have provided a new prism through which to look at resilience, change and gambling harm.

Lorenzetti joined John Gleeson, the centre director at the Healthy Brain & Mind Research Centre, and Toby Kent, former chief resilience officer, City of Melbourne, to discuss how individuals, organisations and societies tackle change, with a particular focus on gambling.

Researching the COVID impact

While the link between mental illness and gambling disorders still requires more research, achieving better mental health can help people overcome gambling harm issues. The COVID-19 lockdowns – which affected Victoria more than any other Australian state – focused attention on the importance of mental health as well as emotional resilience.

The Victorian Government will put funding towards researching the link between the pandemic and gambling harm, said Michaela Settle, the Member for Buninyong, during the webinar. The findings will provide a foundation for future initiatives to combat gambling harm.

That’s important because, while lockdowns were temporary, the protracted nature of tackling the pandemic is taking on many of the features of chronic stress, Kent said. This is taking place against a backdrop of demographic change which is already affecting both young and old. The pandemic has adversely affected women, younger people and those on lower incomes – and soaring property prices in Sydney and Melbourne are locking in elements of social inequality.

Anticipating events

Research shows the ability to recover from adversity depends greatly on the level of social connection that existed before an event happens, he said. ‘We need to work together to anticipate and then come together to be better connected.

‘We so often know what the social outcomes will be of urban design decisions and development decisions. We know what the likely consequences of catastrophic events will be, and yet we too rarely actually intervene early enough to stop things going wrong.’

All three speakers agreed that strategies need to be designed in collaboration with those who can contribute lived experiences to the solution. ‘It’s really critical to put our findings from neuroscience into a real-life context where actual people live,’ said Lorenzetti.

Decades of research illustrated that autonomy, competence and relatedness (or connectedness) are universal psychological needs, said Gleeson. These appear to be intricately linked with positive behaviour change.

‘This has emerged across many fields of human endeavour – health, education, the workplace. Even in digital technology, it seems that if our interventions can address and support these needs, then behaviour change is more likely,’ he said.

Co-design absolutely critical

From the begining, partnering with those who have lived experience ‘is absolutely critical to make sure we’re focusing on outcomes that really matter; that really do reflect the perceived and actual psychological wellbeing,’ continued Gleeson.

And while there is great scope for digital applications and platforms to support psychological wellbeing and assessment, the field still needs evidence-based research and quality studies on long-term engagement and the magnitude of effects.

Technological advances in neuroscience have also shed more light on how the brain reacts to gambling. They even show how different parts of the brain come into play over time as gambling moves from a fun activity to one of habit or compulsion, and the release of stress.

‘This does really show that it is so hard to quit gambling because it is deeply rooted in the brain,’ said Lorenzetti.

Even a short amount of time with mindfulness strategies can make a difference. While gambling disorders do affect the brain in the same way drug addiction does, mindfulness therapies boost cognitive control, break the cycle of addiction, are low-cost and can be delivered online.

Connectedness can be enormously effective, releasing feel-good hormones and directly reducing stress, continued Lorenzetti. ‘There really is a lot of value in this real thing that happens in the brain when we are socially connected with others.’