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Treatment and support

Significant progress towards truly national treatment and support options that meet the needs of current and future service users

Developing truly national treatment and support options includes availability of the right support, in the right place at the right time.

It means making treatment more accessible and relevant to those who need it, improving existing commissioning and oversight arrangements, improving care pathways via primary and social care, and support for those who have other mental health issues alongside experiencing gambling harms.

The aim is to make significant progress towards an effectively commissioned, comprehensive national treatment and support offer that meets the needs of current and future service users. There are a limited number of services available for people who are experiencing harm from gambling. These are restricted in terms of funding, geographical coverage and reach, compared proportionately to that of other addictions, though waiting lists for access to these services are relatively short. We welcome the commitment in the NHS England Long Term Plan, and the progress being made to develop in partnership with the Northern Gambling Clinic and Leeds Support Hub (the second NHS-hosted clinic commissioned and funded by GambleAware).

There is a discrepancy between the numbers of people experiencing harm and might be assumed to be receptive to treatment, and the numbers of people we know are currently accessing some form of formal treatment or support.

  • There are around 2 million adults who may be experiencing some level of harm from their gambling, including 340,000 people who are classified as problem gamblers in Great Britain, as found in the [PDF opens in new window] Gambling behaviour in great Britain report A significant number who may benefit from treatment or support may either not be aware of the options, or are not accessing those options.
  • The majority of specialist services for those affected by gambling harms in Great Britain is currently commissioned and funded via GambleAware (GambleAware seeks to commission treatment for problem gambling across England, Scotland and Wales, free at the point of delivery). This charity receives the bulk of its funds from industry donations which are made as a licence condition to provide funding to support research, prevention and treatment. The amounts and the recipients of these voluntary contributions are not specified, and therefore uncertain. This arrangement is often referred to as ‘the voluntary arrangements’.
  • Based on the data available, in 2017/18 around 8,800 people received treatment through GambleAware-funded services, and the national helpline received 30,000 calls. It is unknown how many people receive support through networks such as Gamblers Anonymous, or through smaller charitable or community support groups. This figure is about 2 per cent of those who are classified as problem gamblers. Treatment may not be needed by all of these individuals, but in contrast early brief treatment or support is often needed by a much wider range of people, such as those at risk of or experiencing moderate harm, or affected others.
  • Primary care and other NHS services are currently diagnosing and treating people for co-occurring challenges or conditions such as alcohol dependency or mental ill health, for whom gambling may be a related factor. Limited data on this method of diagnosis and potential treatment is available but is not routinely collected, so it is uncertain how many people have accessed some form of treatment or support in this way, and the extent of the role NHS treatment services already play is hidden.
  • While some people will recover without help, this discrepancy between the numbers of people in treatment compared to the potential need raises concerns about underdeveloped referral routes into treatment and support, a potential lack of awareness of the services available, for example by GPs and social workers, and a lack of national availability. There is also a knowledge gap in terms of where the unmet need is, what types of treatment and support are most effective, for whom and in what circumstances.

Treatment services across England, Scotland and Wales should provide the right mix of a broad range of options that address the identified needs. This should include: 

  • Access to a national helpline
  • Individual treatment 
  • Group treatment and support 
  • Online treatment and support
  • Residential treatment 
  • Peer support
  • Support for affected others 
treatment and support overview diagram

Collectively, we need to understand further the effectiveness of the various treatment methods for those with gambling addiction and those experiencing gambling harms, in order to identify which treatment methodologies and support options best suit different groups. We also need to understand much more about those who do not access treatment or support in order to identify the barriers to access, such as the stigma that can be associated with gambling addiction, and ways to overcome those barriers. This will inform and support future work led by others to increase the reach of treatment and for long-term sustainability. Through our research programme, the Gambling Commission is committed to driving and supporting progress to ensure that current GambleAware commissioned treatment options are evaluated and that treatment needs are assessed across England, Scotland and Wales to address current geographical barriers to access, increase the numbers receiving treatment and target treatment options to where there is greatest need. This assessment will also consider those who are not seeking treatment, to understand how their needs could be addressed.

We support the positive moves by government departments and public health bodies across Great Britain to understand the nature of gambling alongside other forms of addiction, and also the nature and impact of gambling harms. We welcome the commitment by NHS England to extend the reach of treatment. The wider work to reduce health inequalities will also need to continue in order to achieve NHS mental health and wellbeing outcomes, to develop new and strengthen existing partnerships, and to create and maintain effective transitions between mental health services and gambling treatment or care. These strategic partnerships should seek to embed treatment evaluation,oversight and inspection in ways similar to that which applies in other areas of health and social care.There are important lessons from other sectors, especially on how to involve experts by experience in the design and delivery of services.
The UK government’s referral to the National Institute for Health and Care Excellence (NICE) to consider treatment guidelines for England and Wales will be critical to inform future treatment and support, and partnership working will be key to embedding the guidelines as they progress.
Over time, clinical guidelines can work in tandem with effective standards to enable inspection of treatment services. An appropriate route for such inspection would need to be identified, along the lines of that provided by Care Quality Commission (CQC) in England, Healthcare Improvement Scotland and Healthcare Inspectorate Wales for other treatment services.
Primary care practitioners may be largely unaware of the impact of gambling harms on mental health, so education and training for the healthcare workforce will play a key role in raising awareness of gambling harms when assessing those presenting with stress or other mental health or addiction related disorders. Health Education England, NHS Education for Scotland and Health Education and Improvement Wales have a role to play in highlighting workforce needs for this population.
Professional bodies, including the Faculty of Public Health, the Royal Society for Public Health, the Royal College of General Practitioners, the Royal College of Psychiatrists and the Royal College of Nursing are well placed to shape the public health response by raising awareness of gambling harms, and educating the workforce.

Focus in year 1

Expanding the support available from NHS England for people experiencing harms from their gambling. This will commence with the opening of the NHS Northern Gambling Service in Leeds this summer, followed by clinics in Manchester and Sunderland. Overall up to 14 new clinics will be opened. NHS England will also open its first gambling addiction service for children and young people aged 13 to 25 as part of an expansion of the CNWL National Problem Gambling Clinic, which will also see increases in treatment for adults.

Developing a framework for the evaluation of all GambleAware-funded treatment and support services to assess their quality, impact and cost-effectiveness and provide evidence-based recommendations for the future. To understand how the different services function together as a coherent national system, so that people get the treatment that best fits their needs, as well as links to and from wider services to promote access and address comorbidities with gambling (e.g., primary care, mental health, addictions, housing, debt advice).

Alongside this, discussions are underway to scope and develop a pilot inspection regime for gambling harm treatment services.

Increasing the availability of help and support for people experiencing gambling harm through an expansion of the National Gambling Helpline which will be delivered 24 hours, seven days a week on a two-year trial basis.

Emerging work

Screening and developing care pathways for custody suites in five police forces in England, with the potential to extend to police forces in Wales and Scotland.

Developing a self-exclusion care pathways pilot to test and evaluate links between people who self-exclude into an appropriate level of support that reduces gambling related harms at the earliest possible opportunity.

Exploring the potential of NHS Recovery Colleges to deliver treatment and support for gambling harms.

Designing and delivering an integrated NHS community-based service for people experiencing harm from gambling.

Identified gaps being addressed

Understanding more about those who do not access treatment or support in order to identify the barriers to access and ways to overcome them.

Education and training for the healthcare workforce, particularly primary care practitioners on gambling harms, building on early steps.

Key milestones/activities

  • Announcement of further expansions to the NHS England problem gambling clinic network as part of the Long Term Plan commitment (Year 1, Q1)
  • The NHS Northern Gambling Clinic and Support Hub opens in Leeds (Year 1, Q2)
  • The GambleAware commissioned systematic review of effective treatment completes (Year 1, Q3)
  • The framework for the evaluation of GambleAware treatment and support services developed (Year 1, Q4)
  • Develop the NHS England hub and spoke model for problem gambling by NHS England with central clinics which have satellite clinics in neighbouring populations (Year 2)
  • The National Institute for Health and Care Excellence (NICE) commences its development of treatment guidelines for gambling (Year 2)