Supporting older people experiencing gambling-related harm:

Insights from practitioners

Stephanie Bramley (stephanie.bramley@kcl.ac.uk)

Caroline Norrie

Jill Manthorpe

NIHR Health and Social Care Workforce Research Unit

King’s College London

Outline

1. Gambling in the UK

2. Overview of our research

3. Findings 1. - Scoping review2. - Interviews with key informants3. - Interviews with practitioners

4. Conclusions

1. Gambling in the UK

What is gambling?

• Gambling Act 2005 definition: “Betting, gaming or participating in a lottery”

• Six sectors: arcade, betting, bingo, casino, lotteries and gaming machines

• Industry has grown from £8.3bn in 2008 to £14.4bn in March 2018

• Tax revenue = £2.86bn between April 2017 - March 2018

Legislation

Gambling policy has changed dramatically in the UK since the 21st Century:

2005 Creation of the Gambling Act 2005

2007 Gambling Act 2005 came fully into force:- online and mobile gambling- advertising- high street gambling environments (e.g. betting shops)

2017 Govt consultation on gaming machines and social responsibility

2019 Reduction in maximum stake on FOBTs, to be implemented in April

How many older people gamble?

• 48.6% of adults aged 55+ participated in gambling in 2018• 16.7% of adults aged 55+ gambled online in 2018

Generally popular gambling activities include:

27.6% 18.4% 11.2% 10.8%

Impacts of gambling-related harm

HealthWellbeing

Individuals

Families

Communities

Society

Types of gambling-related harm (Langham et al., 2016)

At-risk gambling • Over 2 million adults are problem gamblers or at risk of addiction

• 5.1% of adults are at-risk gamblers

• 1% of 55+ year olds are at-risk gamblers

Problem gambling

• Defined as “gambling to a degree that compromises, disrupts ordamages family, personal or recreational pursuits”

• Approximately 430,000 UK adults are PGs.

• 0.2% of 55-64 year olds and 0.1% of people aged 65+ are PGs.

Gambling & vulnerable people

• “vulnerable people” not defined within the 2005Gambling Act

Older people as a vulnerable group

Wardle et al. (2015)

Older people and gambling

Gambling may be brought to the attention of adult social services:

1. Older people experiencing gambling-related harm

2. Alleged cases of abuse or neglect towards such older adults

• Under the Care Act 2014 local authorities are responsible for promoting well-being

• Local authorities are also responsible for safeguarding with other agencies

• Mental Capacity Act 2005– do adults at risk have the mental capacity to participate in gambling?- best interest decisions required?

Appeal of gambling to older people

Pension freedoms and

“Binge gambling”

Potential risks to older people from other people’s gambling

Financial abuse

Theft from services

2. Overview of our research Aims:

1. Improve the understanding of gambling-related harm for older adults

2. Examine what key informants know about harmful gambling among olderadults and their understanding of the risks to older adults arising fromtheir own or others’ gambling participation.

3. Examine what practitioners know about harmful gambling among olderadults, their understanding of the risks to older adults arising from theirown or others’ gambling participation and their management of cases ofgambling-related harm.

Methodology

Scoping review

Interviews with key

informants

Interviews with

practitioners

Telephone/face-to-face

interviews conducted with

23 key informants

Telephone/face-to-face

interviews conducted with 21 practitioners

65 pieces of literature

Three phases:

Phase 1: Scoping review findings

Literature relating to older people

Main themes:

1. Risk factors (e.g. financial

vulnerability, life events, gambling to

escape anxiety/depression)

2. Gambling as a social activity

3. Concern that older people may not

fully understand potential risks

4. Legal frameworks

Phase 2: Interviews with key informants

23 key informants interviewed including GPs, nurses, employees ofgambling charities, social work lecturer, trainer, employees of debtorganisations, autism charity employee, head injury charity worker.

Data organised into 4 themes:

1. Gambling-related harm as a public health problem

2. Uncertainties about the nature and prevalence of gambling-relatedharm

3. The hidden nature of gambling-related harm

4. Professional activities around harm minimisation

Phase 2: Key findings Theme 1: Gambling-related harm as a public health problem

- Loneliness- Gambling with benefit/pension payments - Harms include depression and financial difficulties- But gambling can be a positive activity - Shared responsibility- Duty of care

Theme 2: Uncertainties about gambling-related harm- Who is vulnerable? - Lack of data

Phase 2: Key findings Theme 3: The hidden nature of gambling-related harm

- Lack of discussions with clients about gambling- Few overt signs of gambling problems

Theme 4: Professional activities around harm minimisation- Spotting cases of GRH- Raise public awareness of GRH- More knowledge of gambling-management tools - More signposting

Phase 2: Findings relating to older people

Appeal of gambling:

“if they go into a betting shop and get a smiling face from

someone, and they don’t see anyone else, then they

might well go back because they’re going to get a smiling

face and maybe a few coffees as well”

(Older People’s Charity Employee)

Phase 2: Findings relating to older people

Risks of experiencing gambling-related harm:

“bereavement, loss of employment through

retirement … loss of their status in society …

feeling depressed because they’re lonely, isolated”

(Psychiatrist)

Phase 2: Findings relating to older people

Older people who gamble may need support:

“every day he (client) wanted to go into a betting shop

and spend £5 and bet, and we had an interesting

conversation in the office because what we couldn’t do

was…tell him that he couldn’t do it, obviously. The guy

still had capacity … and the worry was that actually if

things got worse for him, that could well extend to

spending £50 or £100”

(Older People Charity Employee)

Phase 2: Findings relating to older people

Capacity assessments:

“I've never heard of anyone doing a capacity assessment

in relation to gambling, but it would be an interesting

question; does this person have the capacity to make an

informed decision?...presumably, if it shows they don't, you

have to make a best interest decision, and then would you

decide it's in somebody's best interests to gamble?”

(Social Work Lecturer)

Phase 3: Interviews with practitioners21 practitioners working within social work, safeguarding, charitiesand gambling support services

Data organised into 4 themes:

1. Concerns about the pervasiveness of gambling and its appeal

2. Lack of knowledge of gambling-related harm

3. Uncertainty about how to support older adults who gamble

4. Desire for professional development activities

Phase 3: Findings relating to older people

Availability and accessibility of online/mobile gambling:

“I think more and more, older people, especially with socialisolation are, you know, you’ve got your phone, you can have aquick bet. Then we may find in the future that more and morepeople have got that mobile phone and use that as, assomething to do when they are isolated”

(Senior Social Worker 3)

Phase 3: Findings relating to older people

Lack of understanding of the risks associated with gambling:

“she didn’t really know whether she was winning orlosing I don’t think half the time, she just didn’tunderstand, yeah so she was kind of gambling for thethrill of it, she must of known whether she was winningor losing but she didn’t kind of really recognise thedamage that she was doing”

(Mental Health Outreach Worker, Gambling Support Charity)

Phase 3: Findings relating to older people

Potential for financial abuse:

“She’s under such stress though, she quite understandablycrying for help. So I think it was partly that, but she said shewas suffering from stress and just, she just couldn’t resist”

(Social Worker 5)

“so allegedly this chap, they both had mental health problems.He was exploiting her financially and interfering with prescribedmedications”

(Social Worker 7)

Phase 3: Findings relating to older people

Support for individuals to make ‘Unwise decisions’:

“it’s their choice at the end of the day and it’s trying tosupport them with that choice to offer payment plans,managed bank accounts…in some ways it’s easierwhen the person doesn’t have capacity”

(Social Worker 2)

Phase 3: Findings relating to older people

‘Best interests’ route to support individuals:

“if he didn’t have capacity it would be a very different issue. Imean, obviously we could go down the best interests route…Imean Court of Protection money management, would also bean option and then with a package of care to enable him tomaybe partake in low level sort of activities…so he’s notexcluded from his hobby, maybe supported to do occasionalgambling with carers…but with a limited amount of money”

(Senior Social Worker 1)

Conclusions

• Potential for older people to experience gambling-related harm

• Older people may find it difficult to discuss their gambling participationand access gambling support services

• Concerns that some older people may not understand the risks

• Some practitioners are unsure how to support older who gamble

• More training and professional development needed for practitioners

Publications Bramley, S., Norrie, C & Manthorpe, J. (2019). Gambling risks: Exploring social work

practitioners’ experiences of clients presenting with risks of gambling-related harm,Practice: Social Work in Action. https://doi.org/10.1080/09503153.2018.1545015

Bramley, S., Norrie, C. & Manthorpe, J. (2018). Gambling-related harms and homelessness:findings from a scoping review, Housing, Care and Support, 21(1): 26-39. doi:https://doi.org/10.1108/HCS-02-2018-0003

Manthorpe, J., Norrie, C. & Bramley, S. (2017). Gambling and adult safeguarding:connections and evidence, The Journal of Adult Protection, 19(6): 333-344. doi:https://doi.org/10.1108/JAP-03-2017-0014.

Manthorpe, J., Bramley, S., & Norrie, C. (2017). Gambling-related harms and social workpractice: findings from a scoping review. Practice: Social Work inAction. https://doi.org/10.1080/09503153.2017.1404563

Bramley, S., Norrie, C & Manthorpe, J. (under review). The nature of gambling-related harmfor adults with health and social care needs: An exploratory study of the views of keyinformants.

Selected referencesBramley, S., Norrie, C. & Manthorpe, J. (2017) 'The nature of gambling-related harms for adults at risk: a review', London: Social Care Workforce

Research Unit, Policy Institute at King's College London.

BBC News (2018). Woman who robbed care homes to fund gambling addiction is jailed. Accessed June 27th, 2018, from

https://www.bbc.co.uk/news/uk-scotland-glasgow-west-44071302

Conolly, A., Fuller, E., Jones, H., Maplethorpe, N., Sondaal, A. & Wardle, H. (2017). Gambling behaviour in Great Britain in 2015: Evidence from

England, Scotland and Wales. Accessed January 3rd, 2018, from http://www.gamblingcommission.gov.uk/PDF/survey-data/Gambling-

behaviour-in-Great-Britain-2015.pdf

Davies, R. (2017, August 24). Number of problem gamblers in the UK rises to more than 400,000. The Guardian. Accessed January 31st, 2018,

from https://www.theguardian.com/society/2017/aug/24/problem-gamblers-uk-gambling-commission-report

Docking, N (2016, September 27). Gambling addict stole nearly £5,000 from autistic pensioner under his care, Liverpool Echo. Accessed July 3rd,

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Financial Times (2017). UK retirees using ‘pension freedoms’ for alcohol and gambling. Accessed June 27th, 2018, from

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ITV Report (2019, February 12). Kay Smith jailed for stealing thousands from elderly friend to fund gambling addiction. Accessed February 20th,

2019, from https://www.itv.com/news/wales/2019-02-12/woman-jailed-for-stealing-thousands-from-elderly-friend-to-fund-gambling-

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Langham, E., Thorne, H., Browne, M., Donaldson, P., Rose, J., & Rockloff, M. (2016). Understanding gambling related harm: A proposed definition,

conceptual framework, and taxonomy of harms. BMC Public Health, 16:80. doi: 10.1186-s12889-016-2747-0.

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older adults, Journal of Behavioral Addictions, 7(1). https://doi.org/10.1556/2006.7.2018.18

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doi: http://dx.doi.org/10.1016/S0140-6736(17)32333-4

Wardle, H., Reith, G., Best, D., McDaid, D. & Platt, S. (2018). Measuring gambling-related harms: A framework for action. Accessed July 24th,

2018, from http://www.gamblingcommission.gov.uk/PDF/Measuring-gambling-related-harms.pdf

Thanks for listening! (& thanks to study participants and funders)

Get in touch:stephanie.bramley@kcl.ac.uk Twitter: @stephbramley

caroline.norrie@kcl.ac.uk Twitter @caznozjill.manthorpe@kcl.ac.uk Twitter: @JillManthorpe

NB. The views expressed in the publication are those of the author(s) and not necessarily those of the funders of this research.