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NICE guidance calls on nurses to ask patients about gambling habits

All patients should be routinely asked about their gambling behaviours, according to new draft guidance from the National Institute for Health and Care Excellence (NICE).

It is the first national guidance on identification and  management of harmful gambling in the UK, and is being published now because the number of people experiencing harms from gambling is on the rise.

“Harmful gambling causes immense misery to all those who experience it”

Jonathan Benger

The draft NICE guidance states that the liberalisation of gambling laws in 2005, the advent of online gambling, and the ubiquitous advertising and marketing of gambling products has “created an environment in which harmful gambling is an increasing problem”.

An evidence review by Public Health England on gambling-related harms, last updated in January this year, reported that approximately 300,000 people in England participate in problem gambling.

In addition, 3.8 million adults, children and young people experience the negative impact from another person’s gambling behaviour.

Referrals to NHS Gambling Harms Services have also been increasing, going up from 775 total referrals in the year to March 2021, to 1,389 in the year to March 2023, according to figures from NHS England.

And, in July this year, NHS England announced that it would be opening seven  new centres to provide treatment for people experiencing gambling-related harms, bringing the total number to 15.

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The draft NICE guidance highlights that gambling can lead to severe social problems including violence, family breakdown, neglect of children and homelessness.

It can also lead to severe financial consequences for the individual and their family and has been estimated to result in between 117 and 496 deaths by suicide each year.

The guidance recommends that healthcare professionals should take a more proactive approach in identifying people at risk of harm from gambling, so they can access appropriate support and treatment as soon as possible.

People should be asked about gambling during health checks, when registering with a GP, or on first contact with social services, in the same way they are asked about smoking, alcohol consumption or use of other substances, said NICE.

In addition, NICE stated that nurses and other health professionals should ask people about gambling who are at increased risk of harm.

This includes people presenting in any setting with a mental health problem, in particular depression, anxiety, psychosis, post-traumatic stress disorder (PTSD), personality disorder, attention deficit hyperactivity disorder,  or thoughts about self-harm or suicide.

Patients presenting in any setting with an addiction such as alcohol or drug misuse – especially cocaine – should also be asked about gambling because they are at increased risk of harm.

Anyone coming in contact with the criminal justice system, those experiencing homelessness, people with financial concerns, experiencing safeguarding issues or violence, or who have a family history of gambling or other addictions should, likewise, be asked about gambling because of their increased risk.

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NICE added that people should be encouraged to assess the severity of their gambling using  a questionnaire available on the NHS website, based on the problem gambling severity index (PGSI).

Those with a score of eight or higher may require treatment and support from a specialist gambling treatment service, but people with a lower score may also benefit from support to reduce their gambling.

Chief medical officer and interim director of the centre for guidelines at NICE, Professor Jonathan Benger, 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 draft guideline – Harmful gambling: identification, assessment and management – is now open for consultation until 15 November 2023.

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