In Silver Blaze Sherlock Holmes investigated the theft of a racehorse The clue that clinched it was what didn’t happen, The watchdog didn’t bark as it would have done had strangers approached the stable.
The moral of this tale is that we sometimes need to attach importance to what isn’t there. We’ll look at some silences, on this page.
As we are thinking of dogs, let’s broaden our enquiry to ask whether the tail wags the dog or the dog wags the tail. While we’re at it, let’s think about barks and bite We’ll add a page on these after this one with the help of our canine friends.
What isn’t There
The beauty of this section is you don’t have to spend time reading rafts of material, because it isn’t there!
Some of the things not in Scotland aren’t in other places either. So what’s not here or there?
Attention to Gambling
There are many activists, several organisations including health and social care statutory bodies, looking to raise awareness of gambling harms, and pushing for urgent policy action at government level. Yet this has been the case for many years and little seems to get done. Nothing to read here!
Mental health campaigning as a whole has fought for mental health to be treated equally with physical health. The campaigning must continue for the goal is still a long way off.
Unfortunately, mental health campaigns appear to have a reluctance to give much space to ‘addiction’. For instance, search the web for anti-stigma addiction campaigns. It won’t take you long at all because there is nothing there.
Government policies and provisions relating to gambling are sparse.
Necessary expertise such as found in England’s NHS gambling clinics is not available. Instead, what treatment is available heavily relies on 12-step methods which, intrinsic to their nature, can never be evaluated. Other treatment is industry funded, and you won’t need to spend much time reading evidence-based evaluation reports.
Although not a uniform situation, many if not most primary, secondary and teritiary health staff lack awareness and training. This is true across the board, including social care staff, social workers, police, the justice system, debt advice and more. There are signs of increased awareness, the Citizens Advice Bureau being a good example.
NHS Scotland has no resourcing for experise and capacity building, education and trining. Various long or medium term policy documents from statutory and third sector organisations contain little or no reference to gambling harms, or indeed addiction in general.
Hey! A new acronym for you! Just what you need. Well, there is an acronym that’s been around a while. RET or Research, Education, Treatment. These three are the central pillars found in many discourses, particularly in the gambling industry who voluntarily give a very small part of profits to them.
Most researchers seek in vain for funding which is not tied to industry as it isn’t there.
Education in Scotland includes Fast Forward which provides innovative projects across many areas including gambling. Such initiatives are rare. The whole subject of personal, social, health and economic (PSHE) education in schools is in great need of development. Certainly, schools provide in highly varying ways education about drugs and alcohol, but attention to gambling is rarer. There are UK based education providers such as DEMOS and YGAM that provide materials and/or teacher training. However, where implemented actual school sessions tend to be isolated short inputs, perhaps as little as one session. Educational experts recommend a whole-school approach in which an expertly desined pastoral curriculum would see integration of risky behaviours, mental health, financial acumen, digital and political literacy; subject areas such as maths and English would includes cross-curricular PSHE themes. Such a curriculum would be regularly evaluated and developed.
So what’s PRET? It is the main missing thing clue. Prevention of harms. While industry is happy to fund a few educational flagships, it is happy to emphasise the claim that ‘education’ is the main way to reduce harms. That education provision is extremely patchy is one point; another is that there is nothing resembling consensual evidence and evaluation of what works and doesn’t. Some research has pointed to what certainly doesn’t work as an educational strategy, and indeed may cause harm.
As Scotland is largely tied to Westminster policies in relation to powers around gambling, its focus on public health frameworks will be important. For instance powers to prevent ‘clustering’ of gambling outlets in deprived areas would be one redress to harm. Powers to limit or ban completely adverrtising, to disallow harmful gambling products, to stop harmful industry practices such as VIP schemes, free bets enticements and aggressive social media micromarketing, cannot be considered with Scotland’s current devolved powers. The present review of the 2005 Gambling Act presents an opportunity for everybody in Scotland to capitalise on any regulatory changes that will allow for preventibe measures.
This is not peculiar to gambling. Every aspect of social care and health seeks improved integration of services. However, as with other severe mental health complexes, the needs of an individual afflicted with gambling distress – which will vary considerably – require particular attention in designing and implementing support pathways. This can only be achieved at a local level supported by statutory provisions, and fuelled by the will of staff. Locality is crucial to consider too because each community is different, and what works well in one area cannot simply be parachuted in to another.
Focusing upon the medical dimensions, what’s also missing throught the UK is a satisfactory protocol for handling co-morbidities. A person with ambling issues will inevitably have factors such as debt increasin stress, shame, anxiety and depression. But some patients will have undiagnosed health issues such as biploar disorder which puts them at greater risk of running into gambling troubles. Many voices have identified how their gambling problems coincided with udden stresses, or how they used gambling to [self medicate’ loneliness, depression, anxiety. A high proportion of excessive gambling is also related to addiction to one or more substance dependence.
The Fence and the Ambulance
A public health approach tries to prevent health harms arising. An old saying is that it’s much better to have a sturdy fence at the top of the cliff than an ambulance below
From The Fence or the Ambulance by Joseph Malins, published in the Iowa Health Bulletin, 1912
While most emphasis in medicine is upon curing illness, a public health approach seeks to prevent illness arising in the first place.
Illnesses related to gambling are inadequately treated across populations. There is little emphasis currently on prevention.