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The Responsible Gambling Strategy Board’s advice on the National Strategy to Reduce Gambling Harms 2019–2022

The Responsible Gambling Strategy Board’s advice on the National Strategy to Reduce Gambling Harms 2019–2022

  1. Contents
  2. Part 4 - Treatment and support
  3. Recent developments in treatment

Recent developments in treatment

GambleAware has made a number of important changes in relation to treatment during the current strategy period. Among other things:

  • it has improved its contracting process and begun to define treatment pathways for clients with different levels of need.55 It has also begun to collect and report data on the immediate effect of treatments using problem gambling screens,56 though little is known about longer-term impact. The governance of GamCare and other subcontractors has been improved
  • it will be funding a second regional treatment clinic opening in Leeds in 2019 to add to the existing clinic in London. The new clinic will be hosted by the Leeds and York Partnership NHS Trust.57 A GamCare Problem Gambling Support Team will also be based in Leeds, focusing on early identification, screening and support and intended to improve access for under-represented groups. Options are being explored to increase further the geographical coverage of services provided by GamCare and to boost its online offering through the addition of e-based Cognitive Behavioural Therapy
  • it has commissioned research on alternative treatment models and gaps in provision –including opportunities for innovation online.58
  • it has started a pilot project with the aim of improving the ability of GPs, social workers, employment advisors, probation officers, debt advisors and others to identify gambling-related harms, to give initial advice and to signpost appropriate support.59
  • it has set up a local area pilot in Aberdeen to build awareness of the National Problem Gambling Helpline and promote its use;60 and has begun work to improve aftercare and relapse prevention, e.g. through on-going peer support.

A number of important issues, however, still need to be addressed:

  • there is a significant amount of unmet need. Numbers currently accessing treatment account for only two to three per cent of the total number of people in Great Britain estimated to be problem gamblers.61 We do not know how many people would benefit from which sort of treatment. But this statistic compares badly with equivalent figures for those being treated for alcohol or drug addiction.62 Average spend on those who receive treatment is also lower than in other areas of addiction treatment (see Figure 5)63
  • the reasons for poor take-up are only partially understood. But they are likely to include stigma, shame, pessimism about treatment effectiveness, inadequate awareness of what is available, gaps in provision, and the fact that, unlike other addictions, gambling has no obvious physical symptoms – which has the effect of making it a more hidden problem
  • GambleAware does not commission any services at all for those under 18, on the grounds that their needs are likely to be different to those of adults and best dealt with by NHS-provided Child and Adolescent Mental Health Services (CAMHS).64
  • very little is yet known about those who do not at present come forward for treatment, who may have different needs to those who do, about which forms of treatment are most effective in treating people at different points in the disorder spectrum, including how best to identifying and target people at risk of suicide, or about the effectiveness of self-help groups delivering mutual aid
  • quality assurance of commissioned services is still at an early stage.

Treatment spend on different addictions in England 2016/1765

A graph showing the treatment spend on different addictions in England 2016-2017

It is our view that, despite the progress that has been made, GambleAware as a small, independent charity does not have the scale of expertise necessary to commission specialised services, assure their quality and safety and deal with these other issues in the most effective way. Nor is it reasonable to expect it to do so, particularly when the relevant framework and expertise already exists elsewhere, on a much greater scale. It would make much more sense for the national, comprehensive and fully quality-assured service we believe to be necessary for the treatment of gambling-related harms to be part of the NHS and social care architecture, with overall responsibility resting with GB health departments and public health agencies.

In saying this we are not intending to diminish the role of local partners in the voluntary sector and elsewhere. Such partners can be catalysts for change, particularly where there is an appetite for more coherent local strategies for prevention and treatment combined. Our belief is that these networks would be more effective if they were commissioned, funded and monitored by the GB health departments, either directly or through local authorities, in the same way as other addiction services.

The details of how best to organise gambling-related harm treatment services in the NHS requires further thought. There are obvious issues of inter-relationships, legal framework, finance etc. which would have to be addressed through the review we have suggested.


55 Research programme 2018-22 - In support of the National Responsible Gambling Strategy (PDF) (opens in a new tab), Gambling Commission

56 Annual Review 2017/18 (PDF) (opens in a new tab), GambleAware

57 Leeds and York Partnership NHS Trust website – news (opens in a new tab)

58 Treatment delivery gap analysis (a needs assessment for treatment services), Research Brief (PDF) (opens in a new tab) Responsible Gambling Strategy Board, May 2018

59 RSPH launches free access e-learning (opens in a new tab) GambleAware, November 2018 and GambleAware invests £1.5million in partnership with Citizens Advice (PDF) (opens in a new tab), September 2018

60 GambleAware announces initiative to promote services across Aberdeen (PDF) (opens in a new tab), GambleAware, November 2018

61 In 2017/18 around 8,800 individuals received treatment for their gambling problems from GambleAware-funded providers (GambleAware Annual Review 2017/18 – page 20) (PDF) (opens in a new tab). This represents approximately 2.6 percent of the 340,000 who are classified as problem gamblers in Great Britain in the latest data published (PDF) by the Gambling Commission in September 2018. Some others may, however, be accessing help in other ways, for example through self-help groups like Gamblers Anonymous

62 6 percent of people with alcohol dependence receive treatment, and 30 percent of people with drug dependence. 2016-17. Prevalence statistics from: Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing 2014 (opens in a new tab), NHS Digital, September 2016. Treatment statistics from: Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS), 1 April 2016 to 31 March 2017 (page 5) (PDF) (opens in a new tab), Public Health England, Department of Health, November 2017

63 Treatment expenditures statistics from: 2016-2017 Alcohol and Drugs Treatment Commissioning Tool – Guidance Document (PDF) (opens in a new tab) Public Health England

64 However, NHS research on this client group does not currently cover gambling-related harms and so there is a risk that their needs are not adequately being understood or addressed. Mental Health of Children and Young People in England 2017 (opens in a new tab), NHS Digital, November 2018

65 All alcohol and drug dependence figures are based on England 2016/17 only (adults aged 18+). Problem gambling treatment spend is based on Great Britain 2016/17 (adults aged 18+) Problem gambling prevalence figure is based on Great Britain 2016 (adults aged 16+)

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Treatment and support
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Other aspects of a new treatment strategy
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