A series of practical resources to enable leaders and professionals with direct reach to communities and an established, trusted relationship, for example community leaders, social prescribing link workers and faith leaders, to support their communities to reduce their risk of becoming seriously ill from Covid-19

1. Date 22nd October 2020
Part of the BHealthy webinar series
Unhealthy habits: Gambling
Prof Jim Orford - University of Birmingham / Visiting Professor of Gambling
Studies, King's College London
Rob Burkitt – Gambling Commission
Andrea Neville – Aquarius

2. Agenda
12:30 – 12:35
Welcome, introductions and housekeeping -
Stacey Gunther
Public Health, Birmingham City Council
12:35 – 13:15
Speakers
Prof Jim Orford - University of Birmingham / Visiting Professor
of Gambling Studies, King's College London
Rob Burkitt – Gambling Commission
Andrea Neville – Aquarius
13:15 – 13:30
Q&A and Discussion

3. HOUSEKEEPING
Please stay muted and turn your cameras off during this webinar.
Please turn off any VPNs (e.g. Netmotion, Cisco, etc.) to save bandwidth.
Please use the chat function to ask questions for the Q&A or you can email
your questions to healthybrum@birmingham.gov.uk
To make this webinar available to those that are unable to join us, today’s
webinar will be recorded. The recording, with both audio and visual will be
shared next week via email and online platforms.

4. BHealthy
A series of practical resources
to enable leaders and
professionals with direct
reach to communities and
an established, trusted
relationship, for example
community leaders, social
prescribing link workers and
faith leaders, to support their
communities to reduce their
risk of becoming seriously ill
from Covid-19
Webinar bookings via:
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-
19/2247/bhealthy

5. Gambling
Recognising a Major Public Health Problem
Jim Orford
Emeritus Professor of Clinical and Community Psychology, the University of
Birmingham/Visiting Professor of Gambling Studies, King's College London
Contribution to webinar, Unhealthy Habits – Gambling, Birmingham Public Health
October 22nd 2020

6. Forms of Gambling Old & New
• Sports betting and bingo
• The National Lottery
• Casinos and casino resorts
• Gambling machines A, B, C & D
• Fixed odds betting terminals
• Poker clubs
• Spread betting
• Online gambling

7. Tricks of the gambling trade (some of them)
• Advertising emphasises wins, winning and winners
• Return to player (RTP) is misleading
• Volatility masks losing
• Losses disguised as wins (LDWs)
• Complex and in-play bets
• Illusion of skill and control
• Free bets and bonuses

8. Big Gambling and a big gambling problem
• Gross gambling yield (GGY) $400 billion annually worldwide in 2016
(Britain $18 bn)
• Gambling advertising increased by 1,400% from 2005 to 2012 (up to
30 bn person impacts for adults or 630 per person in 2012, 1.8 bn for
4-15-year-olds)
• Estimated 350,000 adults and 55,000 under 16s with gambling
problems in 2016 (and 550,000 adults at risk)

9. Gambling’s harm: the public health approach
Harms to the person who gambles Finances
Work and education
Health and well-being (incl. addiction, mental ill-health, suicide)
Homelessness (incl. rough sleeping)
Crime
Harms to family members and others Financial
Relationships
Health and well-being
Harms to communities Local communities (incl. character and control of high-streets)
Harms to society Normalisation of gambling
Contributes to inequality

10. Family members are affected in three main areas
(McComb et al., 2009)
• Financial: harms ranging from the pilfering of small amounts of money
right through to the whole family being put at serious financial risk due to
large losses and debts.
• Relationships: Relationships between family members and their gambling
relatives are often undermined by the secrecy of their relatives’ gambling,
and by arguments, and worse, when the seriousness of the gambling
becomes apparent. Loss of trust is usually a big factor.
• Health (both emotional and physical): Being highly stressed, family
members are themselves at heightened risk of mental and physical health
difficulties, particularly anxiety and depression.

11. Wives of Problem Gamblers
Some of the things they talk about
• Being in the dark about the extent of the gambling
• Finding out about it; suddenly or slowly
• Trying to get back control of family finances
• Feelings of anger and mistrust, but feelings mixed
• Other family members and relations not very helpful
• Doctors and other professionals don’t know what to do

12. Children may be particularly vulnerable
In the few studies carried out, children have often
reported being caught in the middle of family tensions,
taking on the role of peacemaker, often experiencing
disappointment due to broken promises, feeling sad,
hurt, angry, depressed, confused and ashamed, even
taking the blame for family difficulties stemming from
the problem gambling.

13. Set up by families bereaved by
gambling related suicides to:
• Raise awareness of the suicide risk of gambling;
• Campaign for tougher regulation of the industry;
• Campaign for hugely expanded treatment for
addicts and support for families, integrated with
the NHS
Jack (age 24) Chris (age 25) Daniel (age 35) Ryan (age 27) Joshua (age 23) Phil (age 30)

14. Treatments for gambling disorder
• Cognitive behaviour therapy (CBT)
• Motivational interviewing (MI)
• Brief advice
• Gamblers Anonymous (GA)
• Medication
• Residential support and treatment
• NHS special clinics; GamCare local treatment; Charity sector;
telephone or online

15. Interventions involving affected family members (AFMs)
A. Working with AFM(s) to encourage the drinking
relative to engage in treatment
B. Joint engagement of AFM(s) and drinking relative
C. Working with AFM(s) in their own right

16. The 5-STEP Method
Listen non-judgementally
Provide information
Discuss ways of coping
Explore sources of support
Review and arrange further help as needed

17. Reasons to be cheerful!
• All Party Parliamentary Group on Gambling Related Harms
• House of Lords Select Committee on the Social and Economic Impact
of the Gambling Industry
• Social Market Foundation on Gambling Review and Reform
• Public Health England Gambling Evidence Review
• Government Review of the 2005 Gambling Act to be announced

18. Gambling
Commission
Advisory
Board for
Safer
Gambling
Gamble
Aware
Gambling Industry Government
Advertising regulators,
Accountancy and legal
firms
Service providers and
academics

19. References
Jim Orford (2020). The Gambling Establishment: Challenging the
Power of the Modern Gambling Establishment and Its Allies,
London: Routledge.
Rebecca Cassidy (2020). Vicious Games: Capitalism and Gambling,
London: Pluto.
Pekka Sulkunen et al. (2019). Setting Limits: Gambling, Science and
Public Policy, Oxford: Oxford University Press.
Justyn Larcombe (2014). Tails I Lose: The Compulsive Gambler Who
Lost His Shirt for Good. Oxford: Lion Books.
Liz Karter (2013). Women and Problem Gambling: Therapeutic
Insights into Understanding Addiction and Treatment.
London: Routledge.

20. BHealthy webinar - gambling
• Rob Burkitt – October 2020

21. What are the facts and figures?
• 1.2% of gamblers were classed as problem gamblers (0.7% of the population) – this is
statistically stable, and consistent with both 2012 and 2015 reports
• 2.4% of people were classed as low risk gamblers, and 1.1% of people as moderate risk
gamblers
• Problem gambling was more prevalent among people who had participated in multiple
gambling activities in the past year, than those that had just participated in one
• 57% of adults (aged 16 and over) in Great Britain had gambled in the past year – this is down
by 6% compared to 2015
• Men (62%) are more likely to participate in gambling than women (52%)
• Most popular gambling activities were: National Lottery draws (41%), scratchcards (21%) and
other lotteries (14%)
• Gambling participation (excluding National Lottery draws only) was highest among 25 – 34
year olds
• Gambling participation was lowest among non-drinkers (36%), followed by those who drank
up to 14 units of alcohol per week (59%) and were highest for those who drank more than 14
units per week (69%)
• Problem gambling rates were higher among those with probable mental ill health than those
that indicated no evidence of probable mental ill health

22. Young people and gambling
• 14% of 11-16 year olds had spent their own money on gambling in the past week,
this is up from 12% in 2017
• This compared to 13% who had drunk alcohol in the past week, 4% who had smoked
cigarettes and 2% who had taken illegal drugs
• The principal forms of gambling are placing a private bet for money with friends (6%),
National Lottery scratchcards (4%), fruit/slot machines (3%) and playing cards for
money with friends (3%)
• Young people who have gambled spent an average of £16 on gambling during this
period
• Over the past 12 months, 39% of 11-16 year olds have spent their own money on
gambling
• 6% have gambled online using a parent or guardian’s account
• 31% have ever opened loot boxes in a computer game or app, to try to acquire in-
game items, while 3% claim to have ever bet with in-game items (so called ‘skins’
gambling)
• 59% agree that gambling is dangerous
• 1.7% of 11-16 year olds are classified as ‘problem’ gamblers, 2.2% as ‘at risk’

23. Issues to consider
• It’s a hidden issue, think alcohol and drugs 10 years
ago
• No physical signs
• Stigma and feeling of personal embarrassment/blame
• I never hear about it or get complaints or concerns
• Why should I care? (ratio of 1:6/10)
• What’s the Gambling Commission doing?
• What should I do?

24. Work
and
Study
Personal
Problem
Gambling
Community
Services Financial
Interpersonal Legal
Job Loss
Absenteeism
Poor Performance
Loads on
charities
Loads on public purse
Stress
Depression and
Anxiety
Poor Health
Suicide
Financial
Hardship
Debts
Asset losses
Bankruptcy
Neglect of Family
Impact of Others
Loan Sharks
Theft
Domestic or other
violence
Figure 1: The Impacts of harmful gambling on those who are gambling and their wider social
networks and society source: Thorley et al, 2016

25. Coronavirus and gambling
• 2.7% of the population did not gamble before lockdown but then went on to gamble
online during lockdown. Between lockdown easing and when fieldwork took place, the
majority of this cohort returned to non-gambler status, but smaller proportions retained
online gambling behaviours or started in-person gambling.
• 2.0% of the population gambled in-person before lockdown and shifted channel to
online during lockdown, with more than half this number continuing to gamble online
(sometimes alongside a return to in-person participation) post-lockdown.
• 5.1% of the population gambled before lockdown and shifted one or more products
online (e.g. from football betting to online slots) during lockdown, however only a
minority of this group (0.8% of the total population) maintained the new products since
lockdown.
• The Populus data shows that those who gambled pre-lockdown were more likely to
decrease their spend during lockdown than increase it, with 13% reporting an increase
in spend and 24% a reduction. Since lockdown has eased, the proportion changing
their spend has reduced, with almost three quarters (73%) reporting no change
compared to before.

26. Data sources
• http://www.gamblingcommission.gov.uk/news-action-and-
statistics/News/data-shows-the-impact-of-covid-19-lockdown-
easing-on-online-gambling-behaviour-in-july-2020
• www.gamblingcommission.gov.uk/news-action-and-
statistics/News/gambling-commission-publishes-latest-
combined-health-survey
• http://www.gamblingcommission.gov.uk/news-action-and-
statistics/News/gambling-commission-publishes-new-report-
on-children-and-gambling-trends
• www.gamblingcommission.gov.uk/news-action-and-
statistics/Statistics-and-research/Levels-of-participation-and-
problem-gambling/Young-persons-survey.aspx

27. making gambling
fairer and safer
www.gamblingcommission.gov.uk
@GamRegGB

28. Overcoming the harms caused by alcohol, drugs and gambling
Aquarius is part of Recovery Focus, a new group of charities being
built to inspire individual recovery nationwide.
Aquarius Gambling Service
Responding to the Covid-19
Pandemic
Andrea Neville
(Gambling Practitioner)

29. Who are we?
• Aquarius is a Midlands based charity with over
40 years experience supporting individuals,
families, organisations and communities to
overcome the physical, emotional and
psychological harms caused by alcohol, drugs
and gambling. We are a proud partner of
Gamcare.

30. Impacts of problem gambling and how these
have been heightened during the Pandemic
The most common impacts of problem
gambling:
1. Stress, Anxiety, Depression
2. Family difficulties/relationships
3. Financial difficulties
4. Domestic violence
5. Suicidal Ideation

31. Covid 19 and its impact on gambling
– what we know so far
The YouGov research shows that a third of past four-week
gamblers say they have tried one or more gambling activities
for the first time during lockdown.
The volume of activity on certain products appears to be growing,
albeit that within many products the number of active players are
growing faster than the number of bets. This indicates an overall
growth in the product, although implies a decrease in the average
number of bets per customer. This is not true of slots where the
average is maintained.
https://www.gamblingcommission.gov.uk/news-action-and-statistics/Statistics-and-research/Covid-19-
research/Covid-19-and-its-impact-on-gambling-%E2%80%93-what-we-know-so-far.aspx

32. New trends during the pandemic
• Increased numbers of callers to the helpline.
• Increase in clients expressing suicidal ideation and
safeguarding concerns.
• The number of ‘affected others’ (family and friends)
contacting the charity’s services rose significantly
• Increase in female callers to the helpline

33. New Trends during the pandemic
• Increase in younger
callers to the helpline in
response to this
GamCare have now
designated experienced
youth counsellors
available to work with
this younger client
group. Rise in Gaming
related gambling harms.

34. How to access support?
• Directly by calling Aquarius. 0300 4564293
• Contact GamCare Helpline 7 days a week accessible 24
Hours a day.
• GamCare Helpline facilitates the referral to the clients
local network partner. Aquarius in the West Midlands.
• Referrals can be made by the person themselves or a
relative or friend, GP, Citizens Advice, any professional
involved with a clients care. Once consent has been
given to contact the client we will then do so.

35. How to access support
• Whilst the referral is being picked up by us the
network partner. GamCare helpline will still be
in contact with the person and can liaise with
local agencies if any safeguarding or mental
health concerns arise.

36. Treatment offered
• National Gambling Helpline. Offering Advice and
support to anyone affected by gambling or a
family member or friend.
• Netline Service (Web chat)
• 1:1 interventions to both clients and family
members whether over the phone, face to face
(walk/talk) or online.

37. Treatment Referral if Required
• Referral to National Problem Gambling Clinic –
London and Leeds
• Gordon Moody for residential rehabilitation.

38. Our response to Covid-19
• Recognising the difficulties faced by clients
who now find themselves at home
• Our service aims to turn lives around from
problem gambling and gambling addiction. It
relies on therapy and face to face interaction
to do this. Once the pandemic hit we were
very quick to respond and adapt our service to
meet the needs of our clients.

39. Our response to Covid-19
• We very quickly set up our team working from
home and enabled Zoom and Microsoft teams
meetings.
• Confidentiality issues for clients were addressed.
Flexible approach to appointments.
• Walk/Talk Therapy introduced for clients and
affected others.
• Pilot women's group currently taking place.

40. Any Questions

41. Participants Discussion – How can
you enable communities to have better self-
awareness of the dangers of gambling?

42. Resources
 The Royal Society for Public Health a FREE e- Learning resource to
assist frontline staff in providing a brief intervention to address the risks
https://www.rsph.org.uk/our-services/e-learning/courses/understanding-
and-responding-to-gambling-related-harm.html
 GambleAware: A brief intervention guide for frontline workers to
address risks and harms related to problematic gambling
https://about.gambleaware.org/media/1605/gambleaware-intervention-
guide.pdf
 GamCare is the leading national provider of free information, advice
and support for anyone affected by problem gambling:
https://www.gamcare.org.uk/?cn-reloaded=1
 NHS Gambling Self-Help support https://www.nhs.uk/live-well/healthy-
body/gambling-addiction/
 National Deptline: for free and independent advice over the phone and
online call 0808 808 4000 or visit https://www.nationaldebtline.org/

43. Dr Meyer & Dr Sarwar

44. KEEPING IN TOUCH
BHealthy handouts can be found on our website
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-19/2247/bhealthy
The full list of BHealthy webinars
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-19/2247/bhealthy/2
For support with BHealthy or general enquires email
healthybrum@birmingham.gov.uk
or for Covid enquires email
BCCCovid19@birmingham.gov.uk