Changing the narrative on gambling harms in the North East

Posted by Dr Andrew Richardson - Research Associate (Gambling Harms), Newcastle University; Alice Beadle, Public Health Specialist - Gambling Harms, Middlesbrough Council; and Laura Sheridan, Public Health Officer – Gambling Harms, Middlesbrough Council

Gambling is staking money, or something of value, on the outcome of something involving chance. Gambling activities can include arcades, esports and video games, betting shops, online betting, gaming machines, lotteries, bingo, casinos and other common types of gambling. Gambling harms affect thousands of people across England but the North East faces the greatest risk. National estimates suggest that 3.8% of people are at elevated risk from gambling. In the North East, that figure rises to nearly 5% of people aged 16 and over - the highest rate of at-risk gambling in the country. These people experience a range of negative consequences, from financial hardship to serious mental health challenges.

To explore the scale and impact of gambling harms in the region, read the Regional Health Needs Assessment for Gambling.

What are gambling harms?

Gambling harms are any negative consequence or side effect experienced because of gambling. They may be felt by the person who is gambling or may be experienced by those close to them, such as a family member, friend or colleague, known as ‘affected others’. For each person who experiences gambling harm, on average six others are affected - often partners and children.

Whilst anyone can be harmed by gambling, it does not affect everyone equally. The harms from gambling are varied and may also be interconnected. They include:

• Increased stress and poor mental health (such as anxiety, depression and suicide risk).
• Financial hardship, debt, asset loss and bankruptcy.
• Relationship breakdowns due to increased conflict, issues with trust and stress associated with harmful gambling. There are also links between gambling and domestic violence.
• Reduced performance and absenteeism in education and in the workplace.
• Stigma and shame associated with gambling behaviour.
• Threatening behaviour, damage to property, fraud and theft.

For many, gambling harms leave a legacy and may be experienced for many years after the event.

A public health approach

The Association of Directors of Public Health in the North East (ADPH NE) Gambling Harms Programme aims to tackle the harm caused by gambling in the North East with a coordinated regional approach. The Programme received funding that originally came from a gambling operators’ penalty but was redirected by the Gambling Commission - called a ‘regulatory settlement’.

Gambling harms are complex, and prevention approaches need to move away from ‘personal responsibility’ to population-wide social, economic and environmental interventions. Messaging from the gambling industry often sets the narrative by placing responsibility onto the individual to address harmful gambling, despite the many ways gambling products are designed to be addictive. This can lead to increased stigma and shame and create additional barriers to help-seeking behaviour.

The Regional Office, a team hosted by Middlesbrough Council, supports the 12 Local Authorities in the North East to pilot prevention approaches to help reduce gambling harms. The Programme has developed resources which include awareness raising materials and evidence summaries to support practitioners in local authority settings.

Eight key priority areas have been established under the Regional Office:

1. Support and Partnerships – Responding to requests from local authorities and wider stakeholders to support understanding of gambling harms and embed prevention activity.

2. Advocacy – Contributing to the shaping of policy at a local, regional and national level by promoting a public health approach to support those impacted by gambling harms and to build an environment that prevents future harm.

3. Media, Communications and Education – Raising awareness of gambling harms and aiming to reduce stigma.

4. Treatment – Promoting regional treatment services and referral routes for residents and professionals across the North East of England.

5. Data, Research and Evaluation – Develop and create evidence bespoke to the North East and contribute literature to the national evidence base regarding gambling harms.

6. Licensing – Supporting planning and licensing colleagues to create environments that prevent future gambling harms.

7. Protecting Young People – Recognising the risks of gambling to children and young people, and developing resources to support caregivers to reduce risks of gambling harms.

8. Lived Experience – Co-producing all outputs with the Lived Experience Forum, made up of members from across the Region. This ensures all outputs reflect real-world experiences and have maximum impact.

To learn more about gambling and gambling harms, please use the ADPH NE Gambling Harms slide deck or access free Making Every Contact Count (MECC) and Gambling Harms training here.

You may also be interested in these national resources:

• Local Government Association (LGA): Tackling gambling related harm: A whole council approach.
• National Institute for Health and Care Excellence (NICE): Gambling-related Harms: Identification, Assessment and Management.
• OHID Gambling treatment and support in England: main findings and methodology.
• Gambling Commission Young People and Gambling report.

Learning from others

The North East Programme was inspired by the Greater Manchester Combined Authority and ADPH Yorkshire and the Humber to share findings and best practice. The three regional programmes collaborated on a Language Guide to promote language choices that reduces the stigma associated with gambling.

Building the evidence

The Programme will be evaluated and this will contribute to the evidence base on actions to reduce gambling harms, which is currently dominated by gambling industry narratives. The team is working with local partners to explore the wide range of healthcare services and practitioners who may be in contact with gamblers or people affected by gambling and educational toolkits for schools and communities etc. To learn more, see this academic paper co-authored by Fuse researchers or view a free slide deck that summarises the latest research on gambling harms.

Lived experience

The Programme also facilitates a Lived Experience Forum to help shape work happening across the region. If you have experienced gambling harms, either directly or as an ‘affected other’ and are based in or from the North East, this is open to you. If you would like to influence the work being done to tackle gambling harms in the region, please email GHR@middlesbrough.gov.uk.

Stay in the loop

The ADPH NE Gambling Harms newsletter includes news about events, new research, resources like podcasts and documentaries, and ways to get involved. Join the newsletter mailing list by contacting GHR@middlesbrough.gov.uk or complete the sign-up form here. New resources can also be found on the ADPH NE Gambling Harms website.

Treatment and support

Visit the Gambling Harms MECC page to find treatment, support and blocking tools. For some people in recovery from gambling harms, treatment may be the best option, whereas peer support groups may be better for others. Professionals can refer directly into these services. This may make it easier for those needing treatment and support to take the first step on their recovery journey.

Photo by Michele Lana on Unsplash

Bridging the gap between (mental) health services and needs: negotiating power and political values

Guest post by Dr Angus Forsyth, Senior Lecturer in Mental Health Nursing, Northumbria University

As Monday was World Mental Health day, there will be familiar messages in the media about the barriers faced by people with mental health problems when seeking appropriate care and treatment. These include (but are not limited to) the difficulties that children and young people face in accessing local services, not to mention specialist services, such as support for young people who may experience eating disorders. For adults the suicide rate has increased, and there are more and more pressures on crisis services and in-patient beds. As overall funding within the NHS is further reduced, mental health services face additional financial cuts as their funding is diverted to other clinical groups whose needs have been identified as more of a priority. 

Steve McDonald (Simon Gregson) battled depression in Coronation Street

As if lack of access to mental health services is not problematic enough, people with mental health problems are also more predisposed to physical health disorders due to the combined effects of certain medications, lifestyle factors, such as smoking and lack of exercise, contributing to obesity and other metabolic disorders. This contributes to early mortality for people with long standing mental health diagnosis such as schizophrenia, having a reduced lifespan of 20 years. Despite these inequalities the Department of Health’s guidance (2011) recommended parity of esteem for people with mental health problems to have the same level of access to services as those with physical illnesses. And even this recommendation has yet to be achieved. 

On the positive side, there has been a relative increase in coverage of mental health related issues within the media and society, either through celebrities disclosing personal issues, storylines in popular TV dramas; magazines, and social media. However, there still persists a stigma associated with the experience of mental ill-health, for example that people with Schizophrenia are unpredictable and predisposed to violence (Houses of Parliament 2015).

Whilst fear and lack of understanding are factors that maintain stigmatising beliefs and attitudes, power inequalities are also evident when exploring the above barriers to meaningful services. These power imbalances can lead to the development of oppressive social systems and organisational practices where the exercise of authority or power can lead to the marginalisation of specific groups. An example of this is the implementation of government policy, for example the reduction of resources and the subsequent allocation of funding by commissioning agencies (as servants of government), can result in further disadvantaging of citizens as in the case of young people attempting to access mental health care. In the majority of these cases, care can only meaningfully be accessed when there is a serious risk to self and others and is provided under the legislative procedures of the mental health act and in locations far from the individual’s home. This example illustrates how healthcare is provided in an oppressive system.

This brief summary of the challenges in accessing comprehensive care and resources that are available to people with mental health issues highlight that as the expression of mental health becomes more dominant, service provision and resource allocation has not kept pace with increasing need and demand for services. This is particularly in light of mental and physical ill-health co-existing and becoming common bedfellows in chronic disease management. Let’s hope that World Mental Health Day not only highlights issues related to the experience of mental health but acts as a catalyst to mobilise meaningful social actions such as:-

1. Reviewing the public and political structures to include the meaningful involvement of service users at all levels of the decision making process (Rethink 2016). This would further highlight inequalities and disadvantage experienced by individuals and meaningfully influence the development of comprehensive mental health service provision.
2. Reorganise health and social care structures around the holistic needs of service users rather than in the functional silos that currently operate.
3. Use World Mental Health Day to evaluate the impact of service delivery for vulnerable groups to identify meaningful changes and clarify further challenges.

References:

• Department of Health (2011) No Health Without Mental Health, DH.
• Houses of Parliament (2015) Parity of Esteem for Mental Health. Postnote No 485.
• Rethink mental Illness (2016) News & Views: Co-production & Commissioning - how the people who decide on mental health services can partner with the people who use them. Rethink Mental Illness.