Context

Context

Liberalisation of gambling laws in 2005, the advent of online gambling and the ease of access to addictive gambling products, as well as ubiquitous advertising and marketing, has created an environment in which gambling that harms is an increasing problem.

The Gambling Survey for Great Britain (2023) reported that 2.5% of the population aged 18 years and over living in Great Britain participate in 'problem gambling' (defined as a Problem Gambling Severity Index [PGSI] score of 8 or more), with an additional 12% of the survey population participating in gambling with an elevated risk of harm (PGSI score 1 to 7). Consequences from an individuals' own gambling is also reported for participants who had gambled in the past 12 months. Overall, 2.8% of participants who had gambled in the past 12 months reported experiencing at least 1 severe consequence. Rates were higher among male participants and were also higher among younger adults (those aged 18 to 34) than older adults (those aged 55 and over). Relationship breakdown because of gambling was the most reported severe consequence: 1.6% of participants who had gambled in the past 12 months experienced this. This was followed by losing something of significant value, experience of violence or abuse and committing a crime. Male participants were more likely than female participants to report losing something of financial value and to experience violence or abuse. All participants reported their experience of suicidal ideation or attempts, and whether this was related to their gambling. Overall, 11.4% of all participants reported that they had either thought about taking their own life or attempted to do so in the past 12 months.

In addition, it is estimated that 7% of the population of Great Britain (3.8 million adults, children and young people) are 'affected others' and have personally experienced negative effects from another person's gambling. However, there are a variety of different methods used by other organisations to obtain prevalence data and so these figures are only estimates. People who participate in gambling that harms may present with both physical and mental health conditions (in particular, depression, anxiety and suicidal ideation). The Office for Health Improvement & Disparities (OHID) has estimated (based on international evidence due to a lack of official UK data) that between 117 and 496 people die by suicide each year as a result of gambling.

Gambling can lead to social problems for the person and their family, including violence, family breakdown, neglect of children and homelessness. It can also have financial consequences, both for individuals and their families, and for society in general. It may lead people into crime such as theft. There may be substantial costs to health services (predominantly mental health), welfare and unemployment services, housing services and the criminal justice system. The excess costs to the NHS, wider public sector and society have been estimated to be between £1.05 to £1.77 billion annually in 2021 to 2022 prices, according to an OHID report.

Only a small proportion of people receive treatment and currently most treatment is delivered by services outside the NHS. However, the NHS gambling service is expanding, and there are now 15 specialist gambling treatment clinics in place. As set out in the government response to the consultation on the structure, distribution and governance of the statutory levy on gambling operators, the new statutory levy will provide a significant increase in investment for support and treatment services for gambling-related harm. This is likely to result in an increase in the amount of NHS-provided and NHS-commissioned services. However, there is still a lack of coordinated systems for early identification and intervention. Also, health and social care services do not routinely identify or refer people at risk of, or experiencing, gambling that harms for treatment, with most referrals into services being self-referrals.

There are currently no national guidelines on diagnosing or treating gambling that harms in the UK. Treatment pathways are unclear and unknown by many, with limited poor-quality data to accurately assess outcomes. Current gaps in care include poor provision of treatments aimed at specific groups of people (for example, different age groups, different ethnic groups and people with comorbidities) and a lack of follow-up and ongoing care. Most treatments are offered on a short-term basis and relapse is common. There is also a lack of identification and support for affected others, such as family members and friends.

This guideline provides advice on the identification and assessment of people 18 years and over who gamble and affected others of all ages. It provides evidence-based advice on the support and information that should be offered to these people, recommendations to increase access to treatment services and guidance on the most effective and cost-effective treatments. The guideline takes an 'all harms' approach, focusing on the needs of all those experiencing gambling-related harms, including affected others. However, there was a lack of evidence for interventions or support specifically for affected others and so more research is needed. It also provides guidance to commissioners on the future shape and standards of gambling treatment services.

The guideline does not cover the primary prevention of gambling, legislative interventions to reduce the supply of gambling (for example, limitations on advertising, sponsorship, inducements, licensing of betting), or interventions to reduce the uptake of gambling (for example, public health campaigns about potential harms of gambling, school or college-based educational outreach and employer-based initiatives).