SBC News Voice of the Sports Betting Industry
Writing for SBC, Gordon Moody’s Paul Dent addresses the challenge of mental health converging with problem gambling, placing a closer analysis on the organisation’s data and that of recent GambleAware reports for comparison.
Dent is a Strategic Engagement Lead and Trauma and Addiction Counsellor. He has presented at conferences worldwide regarding the therapeutic aspects of the Gordon Moody treatment programmes – which have been developed over many years and support the increase in service users presenting with comorbidities.
GambleAware recently published two reports, the first, presenting the findings of the “Annual GB Treatment and Support Survey 2022”, explores the usage, demand for advice, support, and treatment amongst those who gamble along with affected others.
The second, “Gambling and Mental Health”, drills down to further explore possible associations between gambling behaviours as measured on the Problem Gambling Severity Index (PGSI), various measures of mental health conditions, and suicidal thoughts amongst adult gamblers in Great Britain.
The aim of this article is to give a brief overview, draw out some of the key themes whilst making a comparison with data and trends we experience at Gordon Moody (GM). However, it is beyond the scope of this brief synopsis to explore the relative merits of each of the reports or indeed the validity of the PGSI tool itself which is so widely used. (See Currie et al, 2013, Merkouris et al, 2020 for further discussion).
Cross-relating the findings in relation to GM’s data:
The results from the Mental Health Survey demonstrate “a significant association between higher rates of gambling harms and worsening mental health”. Further, for every unit increase in PGSI score there is a three percent increase in the probability of someone having a diagnosed mental health condition. This is hugely significant as both studies were predicated on PGSI scores of 8+ equating to three percent of the population or 1.5 million people. This is defined as “gamblers who gamble with negative consequences and a possible loss of control”.
From our experience this may have a ‘transient’ element, being closely related to resources – actual funds to gamble with or a support network. If either (or both) are exhausted, then the possibility of negative consequences is greatly raised. Equally if funds or personal circumstances change in a positive way, PGSI scores may fall, possibly also related to the lack of validity at the lower ends of the scale (Currie et al, 2013). Hence, we deal with an “ambivalent population” where recovery is not necessarily the first “priority” of the gambler at a particular point in time (Theory of Change). The average PGSI score on application to GM is 22.
In comparison with the GambleAware data, which states that 47% of those that struggle with the most serious gambling harms (classified as PGSI 8+), are likely to have a severe (K10 score greater than 30) mental health disorder, such as feeling depressed. Across all applications to GM, 70% of those struggling with serious gambling harm (classified as PGSI 8+) would say that they are currently experiencing problems with their mental health, 13.7% had an actual mental health diagnosis and of those, 41.7% were likely to have a severe condition.
However, over the last 12 months (Aug 22 – Aug 23), the period embracing when GM took on the Complex and Comorbidity Contract, of the 457 assessments completed, 54% had a mental health diagnosis (52 no answers so the figure could be higher) and 65% had current mental health problems (60 no answers). Further, 80% of female (classified as PGSI 8+) and 83% of LGBTQ+ (classified as PGSI 8+) applicants are diagnosed with a severe mental health disorder.
This reflects both the severe and complex nature of the clients who present for treatment at GM and the time it takes to reach us – on average 12 years for men and 11 years for women from onset of problematic gambling. This is borne out by the data in the first study which explores “early exposure” with three in five (59%) saying they were exposed to gambling before the age of 18 and most worryingly, the 6-11 age bracket was the most common age at which people reported having been first exposed to gambling.
Implications in terms of the report findings and GM data:
The Mental Health Report highlights that gamblers in the PGSI 8+ category are more likely to have a severe mental disorder than non-gamblers (47% vs. 16%). These include ADHD and intermittent explosive disorder. Links were also made to seeking excitement or risk-taking behaviours. However, it is the connection to debt, in particular “rent debt”, that has the highest correlation with a propensity to have mental health diagnosis – replicating findings by Vandenberg et al (2021) with older adults and gambling.
A basic human need is to have secure shelter and accommodation without which we find it very difficult to function. Once this becomes threatened through actions of ourselves or perceived others, then PGSI scores begin to rise to the levels we see at Gordon Moody. It is this onset of a comorbid condition that can compound any efforts to identify individual markers of harm. We now very rarely see someone presenting with just gambling issues. It is often at this point that suicide ideation becomes a real issue. Our data shows that in the last 12 months for those with scores of PGSI 8+ (and who gave an answer), 31.3% felt suicidal, 29% had attempted suicide with 25% currently experiencing suicidal thoughts.
Whilst there has been some research in this area, much more is required particularly around the effects of comorbidity and suicide. In their qualitative review of literature on gambling and suicide Marionneau and Nikkonnen (2022) highlighted the two main processes of indebtedness and shame. However psychiatric conditions, personality traits, and life conditions played a major role which seem to emerge because of gambling. They conclude by stating that more effective prevention is needed in the form of a comprehensive public health approach with “population-level interventions”.
Moving Forward in Collaboration:
With adherence rates of over 70% (some as high as 80%) across all programmes and PGSI scores of 3+ on completion, there is no doubt GM is best placed to treat those most severely affected by gambling harm. This does not happen overnight and working in collaboration with partner organisations, such as Adferiad to treat those suffering from drugs and alcohol before entering treatment, is the way forward as we see it.
Through our rehabilitation programmes, GM undoubtedly changes people’s lives and, in many cases, saves them. Through our new work with affected others, we are focusing more on how we can put families back together. Mental health issues can destroy in so many ways, particularly through isolation brought on by debt and poor financial decisions.
However, we fully realise we do not operate in isolation and only deal with a small percentage (3%) of the gambling population reaching out for support. GPs in the form of the Primary Care Gambling Service, the NHS Gambling Clinics, and the National Gambling Support Network (NGSN) all have hugely important parts to play in understanding how mental health impacts on gambling harm. The data put forward in these reports, supported by our own, can move that discussion forward so that we can work together to support even more people that are or may go on to suffer from harm from a pastime that the majority enjoy safely.
As to the Research, Education, and Treatment (RET) Levy, that obviously is a very political decision. Money is needed to provide greater education alongside greater funds to provide treatment for the numbers highlighted by these reports. Should this remain a closed loop whereby Industry is the main source of funding or should the public purse be used to support those with mental health issues who also have a gambling problem? Many in society, considering the underfunding in all our services, may view the former as the best way forward.
One would hope that those currently responsible for driving forward this process would have read and taken on board the implications of both these reports, particularly as they were commissioned by the Regulator. Undoubtedly more funding should be made available for research in this area – particularly in exploring both “Pathways to Addiction” and the “Journey to Recovery”.
How can operators adjust their approach when dealing with problem gamblers who are facing serious mental health issues?
With reference to the time it takes service users to finally make applications to us, many will have multiple accounts with multiple operators and will have tried all the Responsible Gambling toolset. They may be possibly on their ‘last chance’, particularly with romantic partners, who would not take them back if they relapsed or continued to have a gambling problem. Throw in the challenges of having a mental health disorder, possible comorbidity, and then the logical pathways and decision processes are not necessarily going to be followed. Depending on financial situation and resource collateral, many people at PGSI 8+ and above may well be chasing losses, looking to pay off debts or “loans” to various organisations and very much be “surviving day to day”.
Many of the service users we support are living with mental health issues using gambling as a maladaptive coping mechanism. One could therefore argue that these are people that should not be in the gambling ecosystem until they have the resources to deal their own health issues. Therefore, the key question becomes at what point, PGSI score or other measure, is it ethical to allow people to continue? Identifying those who sit on the boundaries is undoubtedly a challenge. Is “sustainability” for the benefit of the industry or being used as an inducement to those individuals struggling with their mental health to keep gambling?
This is why GM believes Recovery, Outreach, and Affected Other programmes are so important and why we are investing so much time and effort into them.
The data on Affected Others from the reports is hugely valuable – highlighting, not just numbers but the stress and toil it takes being in a relationship with someone struggling with mental health issues. All have a huge part to play here supporting those who are just starting on their journey of recovery for the rest of their lives.
Conclusions:
This article does not aim to provide the solutions but highlight the issues of those gambling whilst suffering with mental health issues. Just as we now have greater understanding of how women gamble, and that more support is required for those within ethnic minorities, we need to focus on those struggling to make the right choices both for themselves and those around them.
We see an opportunity for positive collaboration with the Industry – sharing of data particularly around those most at risk. AI undoubtedly has a huge part to play in identifying problem gamblers, but can it highlight those most at risk, in the realms of what we see at GM. As we move down a pathway of relying more and more on technology with even more complex interactions, how does this fit with someone who has chronic or acute mental health disorders and is using gambling to escape “their world”.
We deal with small percentages but those who are most at harm – to themselves, their family and friends and to the Industry, in terms of the fines and negative headlines. These reports, which we fully concur with in terms of our data, are a challenge to everyone. We cannot continue to operate in a bubble believing that as an industry we are immune from those issues that trouble society – mental health being a major one.
