This weekend many people will turn to their screens to watch the Grand National. A marathon horse race in Liverpool and a national institution. On the day the NHS was born in 1948, ‘the National’ had already closed the stable doors on more than a century of races. Back then, the suggestion that gambling treatment was part of the NHS would have been discarded quicker than a used betting slip. It's only now we are beginning to see that treating disordered gambling should be part of every local NHS system.
As the government consults on and develops a new Gambling Act and we introduce integrated care systems (ICSs), there is an unprecedented dual opportunity to save lives by making gambling treatment a normal part of our national health conversation in every part of the NHS.
Gambling and the NHS
The intention of the Gambling Act 2005 was to protect children and other vulnerable people from gambling harm. While the definition of 'vulnerable' was left open, the evidence suggests that amongst the people most vulnerable to gambling harm are those we see and care for in our NHS every day. We just don't talk about it enough in those settings. Yet.
Research consistently links harmful gambling to people with mental ill health, along with other addictions and health inequalities. As the 2016 Health Survey for England found, problem gambling prevalence was much higher among those with probable mental ill health (2.2%) than those indicating no evidence of probable mental ill health (0.2%).
In NHS mental health services, we care for people more likely to be at risk of harm from gambling and the effects can be more pronounced.Internal Communications and Engagement Lead
In NHS mental health services, we care for people more likely to be at risk of harm from gambling and the effects can be more pronounced. If that wasn't incentive enough to do more, frontline clinicians say that even moderately harmful gambling can reinforce some of the mental health conditions they are helping service users to address. This chimes with studies that have found links between disordered gambling, poor mental health, substance use problems and suicidality. Recent research into the impact of the lockdown on behaviour suggests potential problem gamblers had significantly higher baseline levels of depression than other groups during lockdown.
The good news is that across the NHS we are starting to treat disordered gambling more widely through a growing network of NHS clinics. It's not as if the wider NHS has been blinkered to the impact of gambling harm. It's more that, in the past, where treatment pathways have been diverse and generally outside of the NHS umbrella, the door to earlier intervention has been difficult to open with confidence.
An expanding NHS treatment service
The government says its review of the Gambling Act 2005 will strike an appropriate balance between consumer choice and the prevention of harm to vulnerable groups. At the launch of the consultation on the review last December, it was revealed that a gambling industry commitment would make £100m available for treatment. The NHS Long Term Plan is also committed to spreading bespoke clinics beyond London and some northern cities.
The consultation paper called for NHS leaders to align and integrate the expansion of gambling treatment services across the system 'so patients get the right treatment at the right time'.Internal Communications and Engagement Lead
The consultation paper called for NHS leaders to align and integrate the expansion of gambling treatment services across the system "so patients get the right treatment at the right time". That's the work we are already looking to progress here at Birmingham and Solihull Mental Health NHS Foundation Trust. We're bringing together a range of partners to trial ways to mainstream conversations about gambling into our mental health services.
That's meant offering awareness raising to our clinicians and creating a 'recovery college for all' course with experts by experience to get our community talking about the impact of harmful gambling and how to find support. We're also looking at using routine screens to make earlier interventions possible for those most at risk who access our mental health help in a variety of settings.
An integrated way forward
As we build our approach to caring for our population as an ICS, we'll look to strengthen the links we have made with the wider public health and social care system to develop a better safety net for people harmed by gambling. We can see that leaders in other areas, notably in Greater Manchester, are also on that path.
In a world where talking about gambling as a health problem isn't a norm for clinicians and service users alike, change won't be easy.Internal Communications and Engagement Lead
In a world where talking about gambling as a health problem isn't a norm for clinicians and service users alike, change won't be easy. The more we collaborate as providers and talk about the opportunities to make the gambling conversation part of our national health conversation, the sooner we'll see those small and timely interventions making a difference. That's the integrated care we can all look to deliver alongside the welcome network of clinics promised as part of the NHS Long Term Plan.
This weekend's Grand National winner will probably be pictured in newsprint on Sunday morning. You probably won't see pictures of the vet, the farrier, the stable staff or the breeder but they will all know about their part in that winning team.
If a range of providers can work together to help build earlier and more effective gambling interventions and pathways as we develop ICSs, then the NHS can be considered a winning team in the battle against gambling harm too.