GamCare – Written evidence (GAM0063)

Summary of contents:

-          Introduction

-          Education
Risk Reduction
Young People

-          Treatment
National Gambling HelpLine
Treatment Services
Our Model of Care
Treatment Outcomes
Expanding Our Provision

-          Problem Gambling and Suicide

-          The Gambling Industry

1. Introduction

GamCare is a charity that specialises in the provision of education, support and treatment for those affected by gambling related harm. We have been in existence for 22 years, and have developed extensive expertise in working with this cohort. On this basis we are responding to the call for evidence in respect of these areas of work, as they are the areas where we believe we can add significant value to the select committee process.

2. Education

According to the most recent health survey for Great Britain, (2016), there are up to 450,000 problem gamblers nationally, and up to 2 million ‘at risk’ gamblers, yet only a small proportion of those access help and support each year. GamCare is the leading provider of support and treatment for problem gamblers and their loved ones across England, Scotland and Wales. We operate the National Gambling Helpline, as well as delivering treatment both directly and via a network of partner agencies.

3. We receive around 30,000 calls a year from people seeking support via the HelpLine, and our treatment services saw around 10,000 clients last year. Although these figures are rising year on year, they represent a small proportion of those impacted by gambling problems, notwithstanding ‘at risk’ gamblers, suggesting the need for further public awareness both of the risks associated with gambling, as well as the availability of support and treatment.
4. We have observed that the people who contact our support services tend to present in crisis. This may take the form of significant debts, a relationship breakdown, risk of losing housing or work, and at times even with suicidal thoughts or a plan to take their own life. There is a particular need for wider discussion around the risks posed by isolation when someone is struggling with gambling problems. We hear from many individuals who still feel that there is a sense of shame or stigma which holds them back from speaking openly with their friends and love ones regarding their gambling behaviour. We fully support public awareness and education campaigns which aim to change this.
5. Organisationally, we work across the spectrum of needs, from education and prevention, through to targeted support and treatment services. This is reflected in our three year strategy which can be accessed here: https://www.gamcare.org.uk/news-and-blog/news/gamcares-strategy-for-2018-2021/

Our prevention programmes are described in more detail below.

6. Risk Reduction

We currently focus our risk reduction and education programmes in the following areas, particularly where there is evidence to suggest that particular cohorts may be disproportionately affected by gambling-related harms, or are underrepresented in our services:

7. Supporting women and girls; less than 1% of female problem gamblers access help. We have received funding through the Tampon Tax Fund overseen by DCMS to deliver outreach and training to teams which are already supporting women, so that they can spot signs of gambling-related harms earlier and encourage both female gamblers and those affected by another’s gambling to get the support they need.
8. Reaching those in the criminal justice system; those in the CJS are disproportionately likely to be affected by a gambling problem and it may be the root cause of the crime they committed. Our current work across Hertfordshire is funded by the Police and Crime Commissioner, and seeks to raise awareness of problem gambling across the system as well as to join up identification and support for those affected, ensuring that the right support can be delivered in custody suites, prisons and through probation services. Our work aims to reduce reoffending connected to gambling as well as other gambling-related harms, and ensure early detection of issues related to gambling so that harms do not escalate. One of our partner agencies, Beacon Counselling Trust, has delivered screening across custody suites in Cheshire, a project which identified a higher rate of problem gambling among this cohort than the general population, and won a Howard League Award.
9. Supporting local authority services; problem gambling intersects with the issues local authorities deal with on many levels, such as licencing, community safety, children and families and housing/homelessness. We provide training and outreach to local authorities across Great Britain, as well as providing data from our services to illustrate how gambling impacts on their local services, and we can provide a holistic support service for those who are affected. Again, our training focuses on early detection of issues connected to gambling harms, so that we can prevent these form escalating and ensure individuals, families and communities receive the support they need.
    
10. Young People

Education delivered to young people across Great Britain, whether in formal or informal settings, is a vital way to increase understanding and strengthen resilience regarding gambling and the risks of gambling-related harms developing in later life.

11. Recent figures from the Gambling Commission (2018) shows that 14% of 11-16-year olds in Britain gambled in the previous week and 1.7% are already classed as problem gamblers. More young people currently participate in gambling behaviour on a weekly basis than drink, smoke or use drugs.
12. International evidence indicates that young people are disproportionately at risk of developing problems with gambling, as well as experiencing harm resulting from the problematic gambling of family or friends (see Valentine, 2016). Despite this heightened risk, only around 1% of callers to the National Gambling HelpLine each year tell us that they are under 18 (where age is disclosed), meaning more needs to be done to reach that cohort and connect them with the appropriate support services.
13. In 2012 GamCare launched a pilot education programme in Bristol and the South West together with our partner agency, ARA. This provided training to the workforce directly supporting young people and ran gambling awareness workshops in schools and FE colleges, inviting young people to think critically about gambling, understand its signs and symptoms of problem gambling, and to know where to go for help. This ran for three years.
14. GamCare commissioned an independent evaluation of this programme in 2016. The evaluation showed that the programme was highly effective in developing young people’s understanding of, and capacity to recognise, problem gambling, as well as professionals’ confidence in interacting with a young person around problem gambling. It also revealed that the programme provided the most extensive reach via its delivery of training to the front-line workforce, of whom each trainee interacted with an average of 11 young people on the subject of problem gambling a year after training.
15. As part of this initial strategy we also launched a youth-specific website, (www.bigdeal.org.uk), where young people can learn more about the risks associated with gambling and the player protection tools available, so that they can make informed choices about gambling. This website is also a repository of information for parents and teachers on how to explore the subject of problem gambling with a young person, and a link to the National Gambling HelpLine if they require help and support. We subsequently relaunched the site in 2017, and more than 36,000 people have used this resource since.
16. Our pilot programmes formed the first initiatives of their kind in the UK, putting gambling awareness and education on the youth agenda, and providing clear and targeted information directly to young people in new and innovative ways. While these programmes have been successful, GamCare is clear in its view that still more needs to be done, and as such we have expanded our programmes into more areas of the UK than ever before.
17. Taking into account the combination of outcomes from our evaluation, international research, anecdotal examples and feedback from market research we conducted with youth charity The Mix, GamCare formulated a strategy to work towards a reduction in gambling related harm for young people, delivering workshops and training directly as well as  alongside our partner agencies. We have been responsive to demand, and expanded the programme first to five, and now to eight regions across England, Scotland and Wales. Our programme has so far reached more than 10,000 young people and a further 3,200 youth-facing professionals.
18. The programme has been externally evaluated and we have continued to develop our offer in response to feedback. Outcomes of the work include a reported 97% of professionals feeling the programme had increased their ability to identify the signs and symptoms of a gambling problem as well as their confidence to interact where they saw it at work. Additionally, 93% of young people left sessions with a better understanding of the risk factors associated with gambling and 88% felt more confident in their understanding of the services available to help. The full results of the evaluation are available at https://www.gamcare.org.uk/app/uploads/2019/07/2017-2019-GamCare-Youth-Outreach-Programme-Evaluation-with-LKMco-FINAL.pdf.
19. In the classroom, young people are polarised in their opinions about gambling. On one side, some young people feel gambling is something that is a casual leisure activity that cannot become a problem. They may have gambling highly normalised in their family culture and believe it to be a bit of fun which is not likely to get out of hand. These young people may struggle to appreciate the inherent risks of gambling.  Alternatively, some young people we speak to indicate that they see gambling as morally abhorrent or sinful. They may disengage with the facts on the topic because they feel it ‘will never become a problem for them because they will never do it’. Both cases call for balanced education outlining both the availability and the risks of gambling as well as awareness about how to stay safe if one does wish to participate.

20. We firmly believe that each young person aged 11-19 should receive at least one gambling awareness session (ideally more), and that the youth facing workforce should have access to high quality materials to deliver education on gambling and problem gambling, with clear referral routes to further, age appropriate help and support if needed. Our work also aims to encourage meaningful conversations about gambling between parents and children, particularly as the gambling and gaming landscape in the UK is changing rapidly.
21.                     Treatment

GamCare has provide help and support to people affected by problem gambling for 22 years.
GamCare delivers:

• The National Gambling HelpLine (over the phone and via live chat), answering upwards of 30,000 calls per year
• An online Forum for peer support, with over 30,000 registered users
• Daily online chatrooms, which are live peer support groups delivered through text chat
• A range of treatment services for problem gamblers and affected others directly across London as well as online and over the phone, with a model of care based on cognitive behavioural therapy (CBT).

22. GamCare is also the Lead Provider for a network of 13 partner agencies (see www.gamcare.org.uk/about-us/our-partner-network/) currently providing treatment in over 120 locations across England, Scotland and Wales, with around 10,000 people per year treated across the system.
23. While we are currently working to expand the locations where we can provide face to face treatment interventions, it is important to note that the range of telephone and online treatment interventions our services provide not only means that can reach individuals where a face-to-face location is not available, but that we can provide greater client choice where these services are preferred.
24. We also have a range of self-help resources available via our website, including a workbook based on our recovery course content, which can be used independently of treatment as well as helping to guide treatment sessions and outcomes.
     
25. National Gambling HelpLine:

Our team of trained Advisers provide a confidential service for both gamblers and their family and friends. We can offer practical information and advice, as well as emotional support and referral to longer-term treatment. We provide both brief and extended brief interventions through the HelpLine, including through call-backs. These are provided where vulnerable callers are reluctant to engage with structured treatment, or as part of the seamless service into structured treatment, or for callers who need less intensive support and would prefer not to be referred to local services.
 

26. Since 2013, the number of target calls (i.e. calls from people seeking help for themselves or someone else) we have received has increased year on year:

*Figure for 2018/19 does not include the 1,979 outbound calls also made by our Advisers.
 

27. We have increased the capacity of the HelpLine to answer more calls and chats, however demand continues to grow significantly. From October 2019, we will provide a 24-hour service via the HelpLine, thanks to increased funding from GambleAware. This will help us reach people who may be gambling online overnight, or callers who are feeling in need of support during difficult night hours and wish to talk to someone specifically in relation to their gambling problems.

28. Treatment Services:

GamCare provides treatment directly in London and Home Counties, and via 13 partner organisations across the country whom we fund as Lead Provider for the network and train to deliver our model of care in their local area.

The benefits of delivering in this way include:

• Localisation of treatment, as locally embedded organisations are used in each area
• Delivery of the same Model of Care nationally, ensuring consistency of provision
• Delivery of an integrated governance structure, so quality can be assured across all providers
• Delivery of clear and integrated care pathways nationally, which are consistent wherever the service user lives
• National collection of the same data set and outcome measures, so we can monitor treatment effectiveness on a national scale
• Regular meetings and forums so information and intelligence can be shared across all partners, and plans to develop the system can be discussed and agreed

29. Our partner network delivers a range of short- and longer-term treatment options, either over the phone, face-to-face or online. Clients may receive one-to-one support, or they may take part in group courses, which gives them an opportunity to connect with others in similar situations and build a support network. This can be incredibly valuable in recovery. Our treatment services are available for anyone affected by problem gambling across England, Scotland and Wales for anyone aged 16 and over.
30. Our practitioners are specially trained and can give clients the safe, confidential space they need to discuss how gambling affects them, and our team work with each client to find strategies to help them move forward in a positive way. Our practitioners provide treatment that is tailored to the individual’s needs and goals for recovery.
31. GamCare and partner network practitioners can help clients understand both their gambling behaviour as well as the thoughts, feelings and circumstances which may have led to it. Our practitioners help clients to develop strategies to deal with difficult situations in ways which don’t rely on gambling addressing triggers and so that triggers are better understood, and we provide guidance on relapse prevention when motivation to stop gambling may wane.
32. All partners also provide advice and treatment for family members and others who are affected by a loved one’s gambling behaviour, even if the gambler does not wish to seek support yet themselves. This essential treatment focuses on the ‘affected other’ themselves to ensure they are protected and supported first and foremost. From that standpoint, the individual is also better able to support the gambler as and when they seek to take control of their gambling.
     
33. Our Model of Care

Our treatment and support have a recovery focus, which builds on the individual’s strengths, instilling hope that change is possible, and we encourage people to build supportive networks, including others with lived experience, to help them sustain treatment gains.
 

34. Service User Choice:

GamCare and partners ensure that service users can make informed choices regarding the range of options open to them at every step of their treatment journey. The service user’s goals and decisions are central to the care plan. Our aim is to give service users healthier options regarding how they respond to situations and their internal triggers to gambling.

35. Evidence Based Practice:

Our interventions are based on the available evidence around what works. Utilising a cognitive behavioural approach, we focus on goal setting, the identification of internal and external triggers, relapse prevention and management and the identification of alternatives to gambling. The use of opportunities to develop and practise skills is integral to this approach.

36. We encourage support from family members, as well as providing support to family members in their own right. All of this is underpinned by a motivational way of working within a recovery model, which is also a specific, evidence-based way of working.

37. Safe, Effective Services:

We work within a robust network governance framework to ensure the delivery of safe, effective services. Our priority is the safeguarding of our service users, their families and others who may be vulnerable to harm because of problem gambling. GamCare have been awarded the Helpline’s Partnership accreditation and are organisational members of the British Association for Counselling and Psychotherapy. We also have organisational ISO9001 accreditation and are working with CQC with a view to developing an inspection framework for problem gambling treatment services.

38. All engagement with service users is driven towards helping them to achieve their desired outcomes. Our governance processes define and manage an agreed set of quality indicators and outcome measures against which we benchmark the effectiveness of our services through audit and continuous improvement. 

39. Stepped Care:

It is important that we provide our service users with the right level of care for their needs. This ensures that we maximize the impact of the resources available to us, and ensures we neither under-treat, nor over-treat.
 

40. Our service offers both low- and high- intensity courses of treatment through a stepped-care model of service delivery. At the point of delivery, the steps are seamless to the service user. We aim to offer the right service at the right time.
     
41. Treatment Outcomes

Our treatment outcomes are currently assessed against the Problem Gambling Severity Index (PGSI) and Clinical Outcomes in Routine Evaluation 10 (CORE-10) measures. On average, over 70% of clients complete their treatment plans successfully and see a significant reduction in gambling-related harms.

42. The Problem Gambling Severity Index (PGSI) measure has the following guidelines:

CORE-10 (Clinical Outcomes in Routine Evaluation) measures wider wellbeing indicators and has the following guidelines:

CORE-10 specifies: ‘The client must improve by 6.0 or more from pre- to post-therapy to be able to say that they have made reliable improvement’.

43. Expanding our Provision

Our face-to-face treatment provision is growing year on year. We had 76% national coverage in 2018/19 year (based on availability of service in each local authority area), rising to over 90% this year as we proactively work to make geographical coverage more equitable across regions, but we are very clear that numbers in treatment need to increase in both the short and long-term, and significantly more investment and awareness would be needed to achieve this.
 

44. We anticipate that in the current year around 3% of problem gamblers will be seen in treatment. We have developed a clear five-year strategy to increase this to 10%, and hopefully to 15% over the longer term. We have a vision that integrates well with the NHS provision and would deliver integrated, flexible and consistent care. We have costed the model, but currently lack funding to deliver it. Expanding treatment capacity, ensuring this is equitable nationally, and developing a truly national treatment system are our highest priority.
     
45. Over the last 18 months we have transformed our delivery of treatment across the network and are now well positioned to develop this further. We have a good set of data about current and comparable costs that we can use to do this, and we are working closely with Gordon Moody Association and the National Problem Gambling Clinic to ensure that this takes a whole-system approach. Our vision also includes the much-needed provision of treatment for under 16s who are affected by their own gambling, or someone else’s.
     
46. We are also seeking to expand our services to people who don’t traditionally seek treatment through the addition of guided online treatment modules (computerised CBT modules), which can be accessed independently or with remote support from a GamCare practitioner. We are also seeking to enhance our provision in ways that help to reduce gambling related harms through supplementary services such as financial wellbeing advice.
     
47. We have worked with the gambling industry to ensure that, where gambling issues are identified through a customer service team, customers can reach our services quickly and seamlessly via a warm transfer service, without having to hang up and redial. We are also increasing our delivery of training to industry staff and have developed a module which includes expertise in the handling of challenging conversations, as well as skills in Motivational Interviewing to support ambivalent customers to take the next step and reach support.
     
48. The newly commissioned Leeds Community Gambling Service, working alongside the Leeds and York Partnership NHS Foundation Trust (LYPFT) and our local partner agency NECA, supported by Leeds City Council, will be providing a range of training and prevention services as well as providing a range of treatment interventions. We will be able to refer directly into services provided by LYPFT for those with more complex needs and co-morbid addictions, and LYPFT can likewise refer directly into our services.

49. We are also working closely with the Department for Health and Social Care and we are part of the steering committee working on developing gambling support as part of the NHS Long Term Plan so that third sector and NHS treatment will be fully integrated going forward, including clear treatment pathways for clients with co-morbid conditions so that there is ‘no wrong door’ for someone seeking support.
50. While we are not currently assessed against CQC standards, there is positive collaboration across the whole treatment system to continue to improve governance and due diligence, for example through improved data systems across all services. An evaluation of the treatment system currently being commissioned by GambleAware will give an increased insight into provision nationally. We are also in discussions with CQC in respect of the development of an assessment framework for our services, and would welcome this development in the future.

51. Although the involvement of statutory services (such as the NHS) is both welcome and needed, we believe there is a significant, impactful, value for money role for the voluntary sector in providing education, prevention, support and treatment activities for those affected by gambling-related harms, as demonstrated in treatment systems for other conditions such as mental health, substance misuse, sexual health, learning disabilities and children’s services.
52. We also believe that there is a significant role for peer support to play alongside and after treatment, and we are currently working with a range of stakeholders to design pathfinder programmes which can support this and can be sustainably scaled up across the country. Initially, we are working in partnership with BetKnowMore UK to launch a new peer support service called Peer Aid. The project will provide peer led one to one and group support to people harmed by gambling.
53. Overall, we believe we have undertaken extensive work to develop and deliver increased capacity, greater client choice, and improved governance across our service portfolio. We also have a clear and costed vision for the development of the treatment system over the next five years. We do not, however, have a secure source of funding to deliver this, and the external environment remains uncertain where this is concerned. More work is needed to significantly increase capacity and availability of treatment nationally without delay, and we are keen to progress this work as quickly as possible, alongside the development of NHS services, increased education and research to improve the evidence base in this field.
     
54.                     Problem Gambling and Suicide

GamCare would support a proposal for Coroners to record instances of suicide relating to problem gambling where an explicit link is established, although we understand that suicide is a complex issue usually involving multiple factors. This would have the potential to improve our understanding of the frequency and circumstances of gambling-related deaths and could also improve communication around available treatment and support services.
 

55. GamCare and our partners recognise that thoughts of suicide and at times plans to take their life can affect problem gamblers at times due to the mostly hidden and therefore isolating nature of the problem. We are committed to helping people keep safe during times of crisis and develop strategies to overcome difficulties. We will contribute to the emerging evidence base by ensuring that we collect information related to suicidal thoughts and plans, whether disclosed via the National Gambling HelpLine or in national treatment services.
    
    The Gambling Industry
56. GamCare delivers training to the gambling industry to enhance the knowledge and confidence of staff to identify and engage meaningfully with those affected by gambling harms. Our experience working with those affected day to day means we are well placed to skill staff for challenging conversations, and to support customers who are ambivalent to take the next step and reach support where it is desirable. We delivered training to over 30 gambling operators and over 1,000 delegates in 2018/19.
     
57. GamCare has also developed the Safer Gambling Standard, a set of best practice standards for the gambling industry designed to drive up safer gambling practice across the sector. The Standard is comprised of 10 areas, covering everything from organisational culture to simplicity of use of safer gambling tools. The product is grounded in academically evidenced good practice, the Gambling Commission’s Licensing Codes and Conditions of Practice, and the direct experiences of our service users. It has been enhanced by input from the British Standards Institute and GamCare is undertaking an accreditation with the UK Accreditation Service (UKAS). For more information on the Safer Gambling Standard, please see https://www.gamcare.org.uk/our-work/for-gambling-operators/safer-gambling-standard/

6 September 2019