Latest figures from the NHS show more than half (54 per cent) of adults living in England have participated in gambling-related activities in the last 12 months. The NHS also estimates that there are over 400,000 people in England with an addiction to gambling and a further two million people at risk of developing the condition. Shockingly, the Gambling Commission also estimates 55,000 children are classed as having a gambling problem.
And while gambling might not immediately spring to mind as a public health issue, the NHS says it is facing a rising tide of gambling-related ill health as more betting addicts than ever before are being taken to hospital.
Data released by NHS England in December 2019 showed that the number of gambling-related hospital admissions has more than doubled in the last six years from 150 to 321, with a record number of admissions in 2018 related to gambling addiction, including care for severe mental health conditions such as psychosis. In addition, 171 patients were admitted for so-called pathological gaming last year, where a patient’s addiction to gaming is so severe that it can lead them to crime to fund their addiction – some of which involves aspects of gambling (see box).
There has also been an increase in the number of young people that are affected by gambling related harm. Some 46 people under the age of 25 attended a hospital as a result of their addiction last year, with one person as young as 15 receiving treatment. This is compared to 37 people under 25 receiving treatment the year before – an increase of a quarter.
So why is gambling-related ill health increasing? John McCracken, director of commissioning at GambleAware – a leading charity in the UK committed to reducing gambling-related harms – says it could be because “gambling is increasingly recognised as a serious public health issue” so “there is greater awareness of gambling harms”.
Another reason is that more people are gambling because it is so easily accessible through apps and online. “We know that children, young people and vulnerable individuals are exposed to gambling on a regular basis, be it through promotions online, on the high street, or through family and friends”, says John.
For many people gambling is not a harmful activity, but for some it can become a real problem. The stress caused when gambling gets out of control can cause serious mental health problems for those stuck in its grasp.
“Negative impacts on mental health and wellbeing are major impacts of gambling problems, with around 45 per cent of gamblers who speak to us on the National Gambling Helpline reporting issues such as anxiety, stress, isolation or suicidal thoughts”, says a spokesperson for GamCare – a leading provider of support and advice for people with gambling issues. “Additionally, negative impacts can also be felt by a gambler’s family and friends, with 41 per cent of affected others calling the National Gambling Helpline mentioning impacts on their mental wellbeing last year.”
The number of gambling-related hospital admissions has more than doubled in the last six years
Despite the data showing the size of the problem, most people with gambling issues are not getting the help they need. According to John there are “around two million people who experience some level of gambling harm in Great Britain, but just three per cent of these receive treatment for their gambling”.
In response to this, NHS England has demanded that gambling firms take urgent action to tackle betting-related ill health. NHS mental health director Claire Murdoch has ramped up pressure on companies to take action, following reports that gambling giants continue to nudge losing punters into more betting by offering hospitality tickets, VIP treatment and free bets to people who regularly lose large amounts of money.
“The links between the sporting industry and gambling are deeply disturbing, and the tactics used by some firms are shameful”, says Claire. “Our NHS is fighting back against a rising tide of gambling-related ill health as more people than ever before are being egged-on by shameless gambling firms, not just to take a chance with their money, but with their health too. The NHS cannot be expected to put out fires caused by other parts of society playing with matches, which is why we need the gambling industry to up its game”
Bookmakers are currently encouraged by the Gambling Commission to donate a combined £10 million to charities that help victims of gambling addiction – but that’s just 0.07 per cent of what gambling companies currently receive from punters.
NHS mental health director Claire Murdoch has warned video game firms that they risk “setting kids up for addiction” by building gambling tasks into their games.
Concerns have been raised about children playing video games that involve spending significant amounts of money – often without parents’ knowledge or consent – on so-called loot boxes, which are virtual collections of in-game purchases and other add-ons. To progress in the game, players can collect extra items and content, but do not know what items they will be given until they’ve paid, which encourages them to keep spending and playing.
The Gambling Commission does not regulate some loot boxes due to a loophole meaning it is not classed as gambling. Under current gambling legislation, this is because there is no official way to monetise what is inside of loot boxes. Claire says: “Frankly no company should be setting kids up for addiction by teaching them to gamble on the content of these loot boxes. No firm should sell to children loot box games with this element of chance, so yes those sales should end.”
Part of the NHS Long Term Plan’s annual £2.3 billion investment boost to mental health services, coupled with the steady rise in gambling-related hospital admissions, has also prompted the NHS to commit to opening 14 new problem gambling clinics by 2023/24 to tackle addiction and the mental ill health that excessive betting can cause, alongside the first ever gambling clinic aimed at young people, which opened earlier this year.
Once referred to one of the new clinics, psychiatrists and clinical psychologists will work with people who could have a range of complex problems including persistent gambling, compulsive behaviours, development disorders and difficulties earlier in childhood that underlie addiction.
In the meantime, GambleAware is working closely with NHS England to promote access to treatment and to develop care pathways. Currently, the National Gambling Treatment Service works with, and alongside, the NHS and is free at the point of delivery, providing telephone, online and face-to-face treatment for individuals and groups across the country.
Self-referrals through the National Gambling Helpline are the main route for accessing the treatment, which is provided by a network of NHS Trusts and voluntary sector organisations.
GambleAware has recently launched a campaign to promote awareness of the service across England, Scotland and Wales, based on promoting confidence that treatment is easy to access and will help people overcome their struggles with gambling. The campaign is also seeking to reach primary healthcare teams to encourage them to signpost people to the National Gambling Helpline if they identify a person has a gambling problem.
Around 45 per cent of gamblers who speak to us on the National Gambling Helpline [report] issues such as anxiety, stress, isolation or suicidal thoughts
This is a much-needed conversation, and one in which pharmacy teams can play a vital part. John says: “We know that people can be reluctant to seek treatment for gambling problems and may spend significant time contemplating treatment before taking the first step [but] evidence suggests if there was more awareness of the support available, it would motivate people to seek treatment.”
Pharmacy teams can help by displaying information about the National Gambling Treatment Service and the National Gambling Helpline, which provides confidential information, advice and support for anyone affected by gambling problems, 24 hours a day. Displaying information about GamCare’s moderated forum and daily chatrooms so that people can speak to others experiencing similar issues and seek support can also prove useful.
GamCare runs free workshops and training for healthcare professionals on how to identify potential gambling harms and how to support a brief intervention to ensure that customers can be signposted to the most appropriate support.
There is a role for everyone in the healthcare sector in working to minimise gambling-related harms by helping people properly understand the risks associated with gambling and, if things start to go too far, helping them access timely advice and support to prevent a problem developing.
Pharmacy teams should be particularly aware of the risk of impulse control disorders, including gambling disorder, as a potential side effect of dopaminergic medications for Parkinson’s disease. People who experience these behaviours can’t resist the temptation to carry out an activity – often one that gives immediate reward or pleasure.
The reason for this is thought to be related to dopamine stimulation in the brain. Dopamine controls movement and is the chemical messenger depleted by Parkinson’s disease. Parkinson’s medication helps to ease movement symptoms and restore dopamine levels. But taking Parkinson’s medication can also overstimulate other parts of the brain, which can lead to impulsive and compulsive behaviours.
If pharmacy teams are concerned about someone with Parkinson’s disease, they can be advised – or their carers or family members – to talk to their specialist about their medication regime. Sometimes a simple adjustment to their dose, or changing a dopamine agonist prescription to levodopa or another type of medication, can control these behaviours.