Health professionals should ask people about gambling if they attend a health check or GP appointment with a mental health problem, in a similar way to how people are asked about their smoking and alcohol consumption, according to new draft guidance from NICE.
NICE has identified that when people present at appointments with depression, anxiety, or thoughts about self-harm or suicide or in relation to a possible addiction (for example, alcohol or drug misuse) they may be at increased risk of harm from gambling and NICE recommends this needs to be identified and addressed by healthcare professionals.
People should be encouraged to assess the severity of their gambling by completing a questionnaire available on the NHS website. This is based on the Problem Gambling Severity Index (PGSI), a standardised measure for at-risk behaviour. A score of 8 or above indicates that they may need to seek support and treatment from a specialist gambling treatment service while those with lower scores may also benefit from available support.
The draft guidance recommends healthcare professionals discuss with people whether they can use blocking software or tools to limit their online gambling and that cognitive behavioural therapy (CBT) should be a treatment option. Research shows CBT is an effective treatment for harmful gambling and can be used to help people identify and manage the triggers to their behaviour, and find ways to better cope with the feelings, thoughts and urges that may precede a gambling episode.
Harmful gambling is used in this guideline to describe any frequency of gambling that results in people experiencing harm, which could include mental health problems, the breakdown of families or relationships and financial consequences.
The Public Health England gambling-related harms evidence review reported that around 300,000 adults experience ‘problem gambling’, which is scoring 8 or more on the PGSI, and an estimated 3.8 million adults, children and young people in Great Britain are ‘affected others’, people who have personally experienced negative effects from another person’s gambling.
NHS England has opened 12 gambling treatment clinics across England since 2019, with a further three due to open in the coming months.
These clinics are expected to see 3,000 people a year. All specialist clinics are fully NHS-commissioned and funded.
The draft guidance recommends that healthcare professionals consider involving a partner, family member or other person close to the person experiencing gambling-related harms in their treatment, if that is what both want.
Professor Jonathan Benger, chief medical officer and interim director of the centre for guidelines said:
“Harmful gambling causes immense misery to all those who experience it. We want those needing help or who are at risk to be identified sooner and receive appropriate help.
“The independent committee who made these draft recommendations included both clinicians and people with personal experience of harmful gambling. They scrutinised all the available evidence to identify treatments and therapies that have been shown to work and offer good value for money.
“The result is this useful and usable advice to help NHS clinics as they develop their service.”
NHS mental health director Claire Murdoch said: “Gambling addiction is a cruel disease that destroys people’s lives, and the NHS is already playing its part in treating it with four new specialist clinics opening in recent months and a further three opening later this year, so if you’re struggling, please come forward for help.
“We will work with NICE on this consultation process and while this new guidance will ensure the NHS can help even more people struggling with gambling addiction to receive evidenced based treatment, it is vital that the billion-pound industry also takes action in line with the Government's White Paper to stop people coming to harm in the first place.”
The guideline will set and support consistent best practice for the treatment of harmful gambling.
Earlier this year the government published its High stakes: gambling reform for the digital age White Paper. This includes the introduction of a statutory levy paid by gambling operators to fund research, prevention and treatment of gambling-related harm. The government will publish a consultation on the details of the statutory levy in coming weeks.
The consultation on NICE’s draft harmful gambling: identification, assessment and management clinical guideline is open now and closes on Wednesday, 15 November.