Royal College of Psychiatrists – Written evidence (GAM0091)

Introduction

The Royal College of Psychiatrists (RCPsych) is the professional medical body responsible for supporting psychiatrists throughout their careers, from training through to retirement, and in setting and raising standards of psychiatry in the United Kingdom.

Summary

The population of problem gamblers is not homogenous. What this population does have in common, however, is that they require medical treatment. The RCPsych is an evidence-based College and believes the dearth of research into the effectiveness of different treatments on gambling addictions and associated harms must be addressed urgently. We have concerns about the numbers of children and young people who already have a pathological gambling addiction at such a young age.

Recommendations

• A mandatory levy should be introduced, the proceeds of which should go towards the treatment of those who suffer the psychological harms of problem gambling to ensure a national coverage across the country with special attention to hard to reach groups. This includes women and young people who are under represented amongst treatment samples as well as Family Members.

• Fines paid to the Gambling Commission should be allocated independently of the gambling industry’s choice (not currently the case.)

• A large-scale high quality independently funded prevalence survey should be commissioned as soon as possible, to determine the current scale of the problem over a decade after the deregulation of gambling following the 2005 Act.

• A large-scale Longitudinal Survey should also be independently funded, and have 1 year, three year and five year follow ups of treatment seeking populations, as well as the larger gambling population.

• Independent Randomised Control Trials (RCT) should be undertaken to determine the most effective interventions and clinical treatments for those suffering from Gambling Disorder.

• Inpatient beds for patients suffering from significant suicidal intent are needed. A total of ten beds initially would be enough to allow high risk cases not to be sent home by underfunded NHS mental health inpatient units. Gambling treatment could take place within the hospital, then rolled to outpatient treatment after a period in Day Hospital specifically for Gambling Disorder.

• Online games using play money and imitating gambling activities should be banned.

• An Online Harms Regulatory Board is urgently needed to assess the harm potential of games currently on the market.

Online gambling

Availability and affordability remain strong drivers of excessive behaviours. Online gambling is available 24/7 and is hard to resist for people who are craving. The software available via Gamban (a gambling blocking application) for phones and computers is a core part of stimulus control and is needed to prevent relapses.

Problem gamblers are impulsive and need instant gratification. They are neurobiologically different from their peers, as they are less able to postpone gratification and more likely to fall prey to the instant gratification that online gambling offers. Apps or other measures that make online gambling harder are therefore effective because they prevent the instant access to gambling.

The genetic risks linked to problem gambling are significant. Children’s brains can be affected making them more susceptible to problem gambling[1].

Levy

In the UK there is a long-standing history of voluntary contribution by the industry towards treatment, research and education. It has long been criticised as a system because it relies too heavily on the industry being friendly. In order to maintain independence of research and education, we believe (along with many other organisations in the field) that a fixed levy would allow for that independence whilst at the same time removing the need for industry involvement in research. 

The College would be happy to contribute its expertise to any discussions about how much that levy should be, and what proportion should be going towards research, education and treatment.

• A mandatory levy should be introduced, the proceeds of which should go towards the treatment of those who suffer the psychological harms of problem gambling to ensure a national coverage across the country with special attention to hard to reach groups. This includes women and young people who are under represented amongst treatment samples as well as Family Members.

• Fines paid to the Gambling Commission should be allocated independently of the gambling industry’s choice (not currently the case.)

Research

• A large-scale high quality independently funded prevalence survey should be commissioned as soon as possible, to determine the current scale of the problem over a decade after the deregulation of gambling following the 2005 Act.

This annual survey would need to be significantly larger than the 2010 British Gambling Prevalence Survey and ensure that hard to reach populations such as the homeless will be included.

• A large-scale Longitudinal Survey should also be independently funded, and have 1 year, three year and five year follow ups of treatment seeking populations, as well as the larger gambling population.

There is very little currently happening in the UK in terms of research. GambleAware funds are not deemed to be independent, and so high-quality research will not accept such funding. It would be best be to hand over money to reputable research bodies such as the Medical Research Council to conduct the research.

Gambling by children is illegal and no further research is needed to acknowledge this fact. The research on young people and gambling could alternatively focus on vulnerabilities and impulsivity and determine who would be most at risk.

Education

Whilst education is important, it is not the highest priority within a Public Health approach. We know that actual interventions work best. For example, removing Category D gambling machines will have more of an impact than telling children not to gamble. Finally, with a new strategy in place, the responsibility will no longer be on the individual.

Acknowledging the superiority of tangible interventions will remove the need for large investment in educational projects that Public Health England or the World Health Organisation have deemed to be less successful than interventions at a more societal level.

Availability of gambling rather than education is an area on which to focus far more. We are in favour of removing as many environmental stimuli that may lead people to online harm as possible. We believe protecting the public by monitoring exposure will be a better intervention than education.

Treatment

• Independent Randomised Control Trials (RCT) should be undertaken to determine the most effective interventions and clinical treatments for those suffering from Gambling Disorder.

High quality research by experts into the links between gambling and suicide is needed to understand, amongst other things, whether certain types of gambling are linked to self-harm more than others.

Over the course of the last year, major changes have occurred at a national level in the provision of NHS funded treatment for problem gamblers, and the College is grateful for the NHS England decision to include the treatment of problem gambling in the NHS Long Term Plan.

The fourteen new centres that are due to open go a long way in addressing the need of a population currently still unknown in quantity as the last evidence based large scale prevalence survey took place nine years ago.[2]

• Inpatient beds for patients suffering from significant suicidal intent are needed. A total of ten beds initially would be enough to allow high risk cases not to be sent home by underfunded NHS mental health inpatient units. Gambling treatment could take place within the hospital, then rolled to outpatient treatment after a period in Day Hospital specifically for Gambling Disorder.

• An Online Harms Regulatory Board is urgently needed to assess the harm potential of games currently on the market.

Advertising

The College feels strongly that, considering there are already at least 55,000 children who are problem gamblers with many more undetected, gambling adverts should be banned from any daytime TV.[3] The watershed should be increased to 11 o’clock, and certainly no gambling adverts at any time near sporting events.

The consensus is that gambling adverts are normalising gambling behaviour in children. When these children are older, they will see gambling as one more recreational activity and not as the dangerous one that it is in relation to youngsters’ impulsivity.

Gambling and sport

As above, the College believes there should be no gambling TV adverts at any time near sporting events

The Royal College of Psychiatrists believes the closeness between the industry and the football clubs is deeply concerning. There needs to be far more scrutiny, as well as a serious discussion of a ban on all merchandise carrying gambling logos.

Gambling by young people and children

Some online games have often normalised behaviours and neurobiological processes that are then replicated within gambling online games. Online games using play money and imitating gambling activities have been deemed to be “priming” agents allowing for gambling to be normalised in young people in later years.

• Online games using play money and imitating gambling activities should be banned.

The legal availability of certain forms of commercial gambling to under-18s in Great Britain is unusual by international standards and has been described as an ‘historical accident’. Young people between 16 and 18 should not be able to purchase National Lottery products, including draw-based games, scratch cards and online instant wins. There is no room for gambling in a young person’s life.

The evidence for this submission was prepared by Dr Henrietta Bowden-Jones, Behavioural Addictions Lead (Royal College of Psychiatrists).

23 September 2019