Screening and supporting patients for gambling harm

People who are experiencing harm from gambling sometimes disclose their struggles to someone they already trust before seeking help. Often, the person they trust is a health professional - such as a GP, psychologist, or allied health practitioner - who provides support or treatment for other health and wellbeing issues.

Stigma associated with gambling, and a lack of awareness of the signs of gambling harm, can act as barriers to a person seeking help from gambling support services.

Therefore, there’s an opportunity for health professionals to talk to patients about gambling harm within the context of a broader health and wellbeing conversation and discuss options for support and recovery.

On this page:

Health professionals outside Gambler’s Help services are often the first port of call for people seeking help with problem gambling.

As a health professional, understanding and identifying the signs, effects and co-occurrence of gambling harm can help you:

• effectively screen patients for gambling harm
• make appropriate treatment and referral interventions.

Gambling harm is highly stigmatised. People affected by gambling harm and another stigmatised issue, such as drug use or a mental health diagnosis of anxiety or depression, have reported they are more willing to acknowledge the other issue.

The reluctance of many people to talk about a gambling problem can be due to a number of factors, including:

• shame and embarrassment
• a lack of hope that their gambling can change based on a history of unsuccessful attempts at self-change
• a fear of being judged
• they do not recognise gambling as the main issue
• they recognise the problems caused by their gambling but do not feel able or ready to tackle the issue.

Gambling harm is any negative consequence or side effect experienced as a result of gambling.

Financial problems are the most obvious harm, but others include:

• feelings of embarrassment, regret, shame and guilt
• increased tobacco and alcohol and other drug (AOD) use
• reduced work or study performance
• sleeplessness, stress, anxiety, depression, suicide
• family violence and relationship problems.

Gambling harm is a complex issue that often co-occurs alongside mental ill-health, use of tobacco and AOD, family and relationship conflict, or various forms of trauma (such as interpersonal, multi-generational or acquired).

Research shows that in Victoria:

• 39% of people who experience problem gambling* have a diagnosed mental health condition, such as depression, anxiety, alcohol use disorder or post-traumatic stress disorder
• 39% of people who experience problem gambling* are in a state of high distress, compared with 5% of the general population (measured on the Kessler Psychological Distress Scale)
• self-reported satisfaction with life drops as risky gambling behaviour increases (Australian Unity Wellbeing Index)
• there is a correlation between risky gambling behaviour, and heavy alcohol and tobacco use.

*As defined by the Problem Gambling Severity Index (PGSI), which is a tool used by researchers and counsellors to estimate a person’s risk of experiencing problem gambling. The most severe harms are experienced by people in the problem gambling PGSI category, but the majority of harms (70%) are experienced by people in lower risk categories.

There are a range of health and wellbeing signs that may indicate the presence of gambling harm. If these signs come up during a consultation, health professionals can use them to prompt a conversation about gambling using the screening question, ‘In the past 12 months, have you had an issue with gambling?’

Behavioural signs

Your client:

• spends a lot of time in gambling venues or on the computer
  
• has stopped doing things he or she previously enjoyed
  
• complains about changes in their patterns of sleep, eating or sex
  
• neglects self-care, work, school or family tasks
  
• uses alcohol or other drugs more often
  
• neglects personal or parental responsibilities.

Emotional signs

Your client:

• feels guilty about mood swings, anger or frustration vented at their family or friends
  
• complains about unexplained stress, anxiety or sleeplessness
  
• complains of boredom and restlessness seems depressed or suicidal.

Financial/legal signs

Your client:

• frequently seeks unexplained emergency financial assistance
  
• has ongoing financial problems that cannot be logically explained
  
• seems to have a bare house (very little food, no utilities, little furniture)
  
• has legal problems related to gambling.

Health signs

Your client has complained about stress-related health problems, such as:

• headaches
  
• stomach and bowel problems
  
• difficulty sleeping
  
• overeating, or loss of appetite.

If you think your patient may be experiencing harm from gambling, asking them if they have had an issue with gambling in the past 12 months is the best way to find out.

‘In the past 12 months, have you had an issue with gambling?’

This screening question is validated as having a 92 per cent detection rate for identifying gambling harm in patients in a primary and allied health care setting.

Initiating the conversation with the screening question gives the patient permission to talk about gambling in a non-judgmental and professional way, and gives health professionals the opportunity to recommend a range of free, confidential and tailored support options.

You may feel uncomfortable about talking to patients about their gambling, however if they do have a problem, they may be relieved to be able to discuss it. If they don't, they're unlikely to be offended by the question. Many clients will feel reluctant or uncomfortable about calling Gambler's Help services, and many may not know such services exist.

All Gambler’s Help services are professional, free, confidential and available 24/7 for people experiencing harm from their own, or someone else’s, gambling.

Treatment options include:

• counselling (face-to-face, telehealth, online)
• peer support
• financial counselling.

Gambler’s Help has the expertise to support people experiencing complex co-occurring AOD and mental health issues.

General practitioners

Use the service finder (gamblershelp.com.au/service-finder) to locate a Gambler’s Help agency that is convenient for your patient.

Write a referral for your patient to share with the Gambler’s Help agency including:

• your contact details
• the date of consultation
• key issues discussed (e.g. need to cut down on gambling, initial presentation of mental health conditions or AOD issues).

Note: Patients can contact Gambler’s Help directly if they prefer.

Allied health professionals

Encourage your client to visit gamblershelp.com.au or call 1800 858 858 to find the support that’s right for them. Alternatively, you can call Gambler’s Help on your client’s behalf for advice on how best to support them.

Whether a patient feels ready to change their behaviour now or in the future, a referral to Gambler’s Help can help them understand the range of treatment options available and set them on a path to recovery.

By working with professional support, patients are twice as likely to successfully achieve their goals.

What if my patient refuses a referral to Gambler's Help?

Change seldom happens from just one suggestion. It's more likely that people change when they get messages from several sources which is why it important for you to raise the issue with your client. At the very least you will have sown the seeds for change.

If your client cannot be persuaded to attend Gambler's Help services, then your local Gambler's Help providers can still work collaboratively with you and the client. This allows the client to maintain their primary relationship with you, while also receiving a specialist problem gambling service.

Health professionals can contact Gambler's Help on 1800 858 858 anytime to explore the most appropriate response.

More information:

• The change process: understanding what motivates people to make positive life changes.
• Counselling techniques: guidelines for talking about gambling harm.

Health workers can help First Nations clients by having conversations about gambling harm. Download the guide to learn:

• how gambling affects First Nations communities.
• how to start a conversation
• strategies for listening and responding to clients
• how to support and refer clients.

Download: Reducing gambling harm in First Nations communities – a guide for health workers

Factsheets for GPs and allied health professionals

Essential information about screening for gambling harm, how to start a conversation about gambling, and the range of support options that are available.

• Essential information for general practitioners: Gambling harm is a health issue (pdf)
• Essential information for allied health professionals: Gambling harm is a health issue (pdf)

Gambling harm screening tool and training program

A gambling harm screening tool, GHA1 (Gambling Harm Assessment 1), and training program have been developed by the Victorian Responsible Gambling Foundation with guidance from the Gambling Minds team at Alfred Psychiatry and gambling harm clinical consultant Dr Jane Oakes.

The screening tool and training program are designed to improve the experience of patients who are negatively affected by gambling together with at least one other co-occurring health issue, such as mental ill health, drug or alcohol use disorder, or family violence.