GPs should ask people about gambling during consultations, in the same way they ask about smoking or alcohol use, NICE has recommended in draft guidance.
Patients should be asked during health checks, but also when they present with a mental health problem, including depression and anxiety, or with an addiction, because they may be at increased risk of harm, the recommendations now out for consultation advise.
Those who are experiencing homelessness or financial concerns may also be particularly at risk from gambling. Domestic abuse or safeguarding concerns should also flag the need to ask about gambling, NICE said.
GPs should also consider asking about gambling for patients taking some medicines including for Parkinson’s disease or psychosis or if they have a neurological condition or brain injury.
Some occupations including armed forces personnel, veterans, people working in the gambling or financial industry and sports professionals can also be more vulnerable and having multiple risk factors can have a cumulative effect.
An NHS questionnaire can be used by the patient to assess the severity of their gambling problem where a score of 8 or above indicates they may need support from a specialist gambling treatment service.
Depending on the extent of a person’s gambling problem, healthcare professionals can discuss with people whether they can use blocking software or tools to limit their online gambling or ways to restrict their access to money as well as signposting them to local support services.
If a person experiencing gambling-related harms presents considerable or immediate risk to themselves or others, they should be referred urgently to specialist mental health services, NICE said.
The guidance also notes that cognitive behavioural therapy (CBT) should be a treatment option as research shows it can be effective.
The Public Health England gambling-related harms evidence review estimated that around 300,000 adults experience ‘problem gambling’.
NHS England has opened 12 gambling treatment clinics across England since 2019, with a further three due to open in the coming months, it said.
Professor Jonathan Benger, chief medical officer and interim director of the centre or 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.’
NHS England 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.’
She added: ‘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.’
RCGP chair Professor Kamila Hawthorne welcomed the focus on the ‘growing problem’ of gambling addiction, with an ‘increasing number of people, including children’ turning to GPs for help.
As such, she said it was ‘important that GP teams are able to deliver appropriate advice and care, including signposting them to other services, to help them change their habits and reduce the associated harms’.
But she added that ‘expecting GPs to pro-actively ask patients about gambling habits as part of every mental health consultation could prove counterproductive’.
‘Some patients might choose not to disclose their gambling problems until they have built up a trusting relationship with their GP or member of the practice team over time, and any attempt to make them have these conversations before they are ready could make them more vulnerable. Patients must not feel they are being interrogated when we ask them about their lifestyles as part of a mental health assessment.
‘With the current workforce and workload pressures in general practice, it’s also hard to see how hard-pressed GPs could fit this into the standard 10-minute consultation when it is already too short and unfit for purpose.’
Instead GPs should be able to ‘ely on their clinical judgement about when it is appropriate to discuss particular issues, based on their assessment of the individual patient in front of them’, she argued.
The consultation harmful gambling: identification, assessment and management is open until 15 November.
NICE draft guidance: Harmful gambling: identification, assessment and management
- when they present in any setting with a mental health problem or concern, in particular depression, anxiety, psychosis, post-traumatic stress disorder (PTSD), personality disorder, attention deficit hyperactivity disorder (ADHD), or thoughts about self-harm or suicide at each new contact with the criminal justice system (for example, with the police, liaison and diversion services, probation services, courts and prisons)
- when they present in any setting with an addiction (for example, alcohol or drug misuse, in particular use of cocaine)
- when they are at risk of or experiencing homelessness
- when they share that they have financial concerns
- when there are concerns about safeguarding issues or violence, including domestic abuse
- when they share that there is a family history of gambling or other addictions
- a medication, for example, people taking dopamine agonists for Parkinson’s disease, or aripiprazole for psychosis
- a neurological condition or acquired brain injury
- their current or past occupation, for example, armed forces personnel,
- veterans, people working in the gambling or financial industry and sports professionals.