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Report

ABSG Progress Report on the National Strategy to Reduce Gambling Harms – Year Two

ABSG - Year two Progress Report on the National Strategy to Reduce Gambling Harms

6 - Triage and completed treatments

Despite best efforts by the partners, this data illustrates the lack of clearly agreed criteria and thresholds for movement through referral pathways that continue to present challenges in the current treatment and support system.

GamCare currently receives calls to the National Problem Gambling Helpline and, when appropriate, offer an onward referral for assessment by one of the network’s treatment providers. At this stage a second assessment is made by the provider. There is also an agreed pathway in place with the Gordon Moody Association with data sharing agreements and software portals to facilitate this.

Although the current system may work for some, a two-stage triage process is not consistent with established best practice as it means that an individual can pass through several stages until a clear referral can be made. Individuals can move in and out of harm quickly – so a timely triage system is important. Evidence from other addictions services suggests that access to highly specialist expertise at the triage stage can lead to better outcomes in the longer term140,141. Adoption of a combination of widely used standardised assessment measures are needed such as the PGSI, Enhanced Core 10, GAD-7, PHQ-9. The CORE-10, GAD-7 and PHQ-9 are routinely used within IAPT and mental health services so will align with referral routes into IAPT/mental health provision. We note that progress is being made towards agreeing use of screening and other clinical tools.

The GambleAware National Treatment Statistics for 2019/20 suggest that the number of completed treatments appears to be lower than might be expected. Overall, 26.2% of clients leave the service before the scheduled endpoint of seven sessions. Those who are unemployed have the highest attrition rate at 32% and are the least likely to complete treatment (61%)142. Affected others who use the service have a lower rate of leaving the servie before completion at 13%

Research into the treatment of alcohol and drug use, however, suggests that treatment outcomes generally improve as retention in treatment increases. Treatment completion is also linked to better outcomes143. From this research it has been suggested that if clients fail to complete treatment, attrition typically occurs early on in treatment and that retention may be one amongst a number of indicators of a mismatch between the treatment offered and the needs of the client seeking help.

An important next step in the process of developing effective treatment responses for gambling is a more joined up and integrated approach that is centrally co-ordinated by statutory services in collaboration with third sector providers, playing to each other’s strengths and with investment in a wider range of interventions such as social prescribing, bringing recovery communities together and agreeing education and training standards. Such an approach would provide improved co-ordination of services, triage and treatment retention.

References

140 The public health burden of alcohol and the effectiveness and cost-effectiveness of alcohol control policies: an evidence review (opens in new tab), Burton R, Henn C, Lavoie D, et al, Public Health England, 2016

141 Alcohol Care teams, Identification and Brief Advice, Moriarty KJ. Frontline Gastroenterology, 2020: “Alcohol assertive outreach teams (AAOTs) and specialist treatment for dependent drinkers were cost-effective; every £1 invested brings an annual return of £3, which rises to £26 over 10 years. Psychosocial interventions for dependent drinkers can save the overall UK economy £5 for every £1 invested”.

142 Annual Statistics from the National Gambling Treatment Service (Great Britain) 1st April 2019 to 31st March 2020 (opens in new tab), GambleAware, October 2020

143 Relationship between drugs treatment, retention and outcomes, Hser et al, 2004 (opens in new tab)

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Clarification of referral pathways required
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Lack of independent quality assurance
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