1. The Royal College of Psychiatrists is the statutory body
responsible for the supervision of the training and accreditation
of psychiatrists in Britain and for providing guidelines and advice
regarding the treatment, care and prevention of mental and
behavioural disorders.
2. In the course of their work, psychiatrists are faced with
people needing help who are in difficulty as a result of excessive
gambling. The interest and concern of The Royal College of
Psychiatrists about the new legislation regulating gambling in
Britain are therefore the impact this is going to have both on
children and on the incidence of excessive gambling. Our comments
will therefore be confined to these aspects of the Consultation
Document.
GAMBLING AND CHILDREN
Paragraphs 1.7 & 1.8, Commentary and Questions 9 to 13
3. The Royal College of Psychiatrists has consistently taken the
view that, since gambling, by its nature, is an adult activity,
access to all types of gambling should be prohibited to children.
The fact that the Gambling Act permits children to gamble on
Category D gaming machines is a manifest anomaly. While some
Category D machines are "Teddy bears given as prizes", which are
clearly quite innocent, the Category D gaming machines are
identical to those found in casinos apart
from a smaller stake and jackpot. Only commercial considerations
would allow children to have access to such machines. The evidence
that they are harmful to children, especially those at risk of
antisocial behaviour, is considerable.
4. It is vital that this situation should be monitored very
carefully. However, The Royal College of Psychiatrists finds the
following statement by the Gambling Commission in the Commentary to
paragraphs 1.7 to 1.8 unacceptable:
"We expect to work with RIGT to ensure that there is research on
whether such gambling gives rise to harm or exploitation."
5. The Responsibility in Gambling Trust (RiGT) is not an
appropriate organisation to fulfil this task. The general reasons
for this are given in paras. 40 to 45 of this submission. However,
in relation to Category D gaming machines, these objections are of
particular relevance. It is vital that this research and monitoring
function regarding the impact on children should be totally
independent of all vested interests connected with the gambling
industry and its promotion.
6. This is especially so since there is a reserve power in the
Act to introduce an age limit for certain Category D machines.
Serious consideration should be given to using this for these types
of gaming machines.
7. The Royal College of Psychiatrists is also concerned that, in
relation to remote gambling, the fact that "some legitimate players
may be deterred by the checks that are necessary to verify age"
(Consultation Commentary to paragraphs 1.7 to 1.8) should not, in
any way, be used to reduce the standards of verification. The
protection of children must be the over-riding requirement.
8. In the absence of a public policy encouraging moderation,
educating about gambling will have a very limited effect. The
experience in relation to alcohol, where there has been a far
greater attempt at education has shown this to be the case. Thus,
in a recent survey, nearly two-thirds of motorists indicated that
they thought they were "fine" to drive when over the legal limit of
alcohol.
EXCESSIVE GAMBLING AND THE
"VULNERABLE"
Paragraphs 1.9 to 1.12, Commentary and Questions 14 to 19
9. In a discussion of these matters, it is vital to have a clear
appreciation of the various factors involved. It is especially so
since there are many misconceptions about them. The most important
issues that need careful consideration are the nature and
characteristics of excessive gambling and the aspects of commercial
gambling that encourage excess. Therefore, these aspects will be
discussed in more detail in order to set the situation in
context.
Nature and characteristics of excessive gambling
10. In the past, disorder resulting from gambling has been
referred to as compulsive gambling. However, it is not a true
obsessive-compulsive state and this term should therefore be
abandoned.
11. The World Health Organisation ICD-10 Classification of
mental and behavioural disorders : Clinical descriptions and
diagnostic guidelines 10 refers to this condition as pathological
gambling, under 'habit and impulse disorders'. It is an
heterogeneous group of behavioural disorders, characterised by
financial, social and/or psychological disorder resulting from
gambling, which is usually excessive. The term problem gambling has
been used but has not achieved international acceptance as a
technical name for this condition and is therefore best avoided in
an area where there is a high level of semantic confusion.
12. The experience in various jurisdictions has shown that the
incidence of pathological gambling in a population is directly
related to the accessibility of gambling and the commercial
pressures to take part. Thus, at a particular level of
accessibility, the amount of gambling occurring will vary within a
given population. It will do so along a spectrum from those who do
not gamble at all, at one extreme, to those who gamble to such a
degree that damage results, at the other. The gambling behaviour of
the majority of the population will fall between these extremes.
While some will only gamble rarely and others will do so frequently
with varying regularity, most in this group will do so
occasionally. These subgroups are not rigid and people can move
from one to another, as a result of a variety of factors. Paramount
among these is the accessibility of gambling facilities.
13. If the facilities for gambling in the population are
increased, the total amount of gambling also increases. It does so
in all the subgroups above, as follows:
- Some, who had previously not gambled, start doing so, so that
the number of those who do not gamble goes down.
- The amount of gambling of the majority, while still varying in
the manner indicated in para. 12 above, increases.
- The number of those who gamble to such a degree that damage
results increases.
14. Greater accessibility therefore affects the whole
population. Whatever the level of previous gambling, the amount of
this will increase. Clearly, those who had previously gambled
frequently are more likely to do so excessively with resulting
damage.
15. Thus, the extent of disturbance resulting from gambling is
directly related to the amount of gambling occurring. The situation
in relation to gambling is very comparable to that found in
alcohol.
Aspects of commercial gambling that encourage excess
ORGANISATION OF GAMBLING INDUSTRY
16. Commercial gambling is organised on the basis of unequal
conditions, as far as the outcome of the transaction between the
industry and those who gamble is concerned. The commercial
interests in gambling make their profit by arranging the odds in
their favour. The facts are that, in the long-term, while a few of
those who take part in gambling win, the majority lose. This way of
organising gambling is clearly very profitable to the industry.
17. In view of the likelihood of deregulation, the gambling
industry has been attempting for some time to present a socially
aware image. In this context, the notion of 'responsible gambling'
has been promoted. An example of this is the Victoria Gaming
Machine Industry's Code of Practice, which has been more generally
adopted in gambling. In this, it is stated that,
"Responsible gaming is each person exercising a rational and
sensible choice based on his or her individual circumstance"
and
"The industry's role is to offer products and services in a way
that facilitates customers' ability to engage in responsible
gaming".
18. The implication of this is that, if those who participate
are given information and educated about gambling, then they will
be able to exercise an informed, free choice.
19. These propositions have to be seen in the setting in which they
are supposed to apply. It is increasingly agreed that, in
commercial transactions, decisions should be made in a calm and
secure place and manner and that there should be a cooling off
period available to ensure that a change in choice is possible.
20. This is not the situation in commercial gambling. While
claiming to be behaving responsibly by giving information and
advice, the gambling industry stimulates further participation by
the promotion of fantasies of wealth to be gained from gambling, as
well as by various devices such as loyalty cards. Consequently, the
incentives offered to continue gambling appear to be far greater
than the warnings given. Nonetheless, the provision of this
information makes it possible for the promoters to put forward the
notion that any harm resulting from gambling must be due to some
abnormality in those so affected.
21. All this might be acceptable in relation to a lot of
business transactions. However, the activity of gambling is not
just another commercial product. Extensive studies have shown that
the psychological and physiological effects on those who
participate in gambling encourage the chasing of losses.
PSYCHOLOGICAL EFFECTS OF GAMBLING
22. Operant Conditioning, which is learning by providing rewards,
is most effective in habit-formation on the basis of intermittent
variable ratio reinforcement. In this, the reward is presented
intermittently and, although the rate of reward overall is fixed,
its actual presentation varies unpredictably at any given time.
This schedule underlies all gambling activity. Since this
unpredictable contingency of reinforcement produces a stable and
persistent response, the long-term net gain or loss to those who
gamble is almost irrelevant to the continuation of the
activity.
23. Rapid gambling turnover, as is usually found in casinos,
restricts the ability of those taking part to apply any considered
judgment. Inevitably, gambling becomes more impulsive, easily
leading to excessive participation.
24. Assessment of probability of winning (psychological
probability) differs from the mathematical probability. At low
probabilities it is higher than the mathematical probability and at
moderate and high probabilities, it is lower. This occurs however
well informed the person taking part in gambling is.
25. Negative Recency Effect is the irrational belief, in a
gambling situation involving only random processes, that a string
of losses makes a win more likely. It is observed even in
mathematicians who are aware of the independence of the outcome of
successive events in this situation. It forms the basis of many
spurious gambling systems, especially in roulette - hence the term
'Monte Carlo Fallacy', by which it is often known.
26. Large prizes, even at very low probabilities, entice
participation because of the possibility of winning. The stimulant
effect of rollovers in the National Lottery illustrates this.
27. Skill is usually overrated and often implies an unrealistic
ability to control the uncertain event that is the subject of the
gamble.
28. Credit reduces the likelihood that those gambling will set a
limit on the amount of money staked.
PHYSIOLOGICAL EFFECTS OF GAMBLING
29. Brain activity. A gambling loss in normal subjects has been
found immediately to result in particular localised activity in the
medial frontal cortex of the brain. This is then associated with
subsequent more risky gambling choices. This would account for the
well-recognised phenomenon in gambling referred to as the Negative
Recency Effect (see para. 25, above)
30. Emotional reactions. In normal subjects, a great range and
strength of emotions are experienced during gambling decisions.
These are associated with cortical responses in the brain to the
expectation of winning. In addition, the subjects are found to lose
track of time during a gambling session.
31. Effect of alcohol. Normal, social levels of drinking alcohol
alter self-control over decision-making. The resulting effect on
those who gamble is that they find it more difficult to decide at
what point to stop, when losing.
"VULNERABLE" PERSONS
32. In this context, the notion of vulnerable individuals who
need protection and help for the harmful effects of gambling
requires more consideration. The evidence presented shows that
vulnerability to take gambling to excess is intrinsic in the
activity of gambling and this is even greater in the commercial
variety.
33. Gambling promoters, for obvious reasons, do not find this
fact acceptable. They encourage a view that, as long as protection
is provided for "the vulnerable", the rest of the population can
legitimately be allowed to exercise choice without the danger of
this leading to excess. The evidence indicates that this is not so.
We are all vulnerable to a greater or lesser degree to take
gambling to excess.
STRATEGIC APPROACHES TO EXCESSIVE GAMBLING
34. The Royal College of Psychiatrists is concerned that
commercial gambling should be recognised as an activity that has
certain characteristics, which inherently make it more likely that
it can be taken to excess. The prime aim in regulating gambling
therefore must be to encourage moderation.
35. While the new legislation regulating gambling was before
Parliament, the Secretary of State for Culture, Media and Sport, in
her Foreword to the Government's Response to the First Report of
the Joint Parliamentary Scrutiny Committee, ended by saying,
"In future we will continue to put the interests of children and
vulnerable players first, second and third."
36. Yet, earlier in her Foreword, she said,
"Gambling is a massive global industry and is entitled to a
regulatory framework that ensures continued growth".
37. In relation to gambling, these are mutually incompatible
objectives. Yet, the Gambling Act is based on this duality.
Clearly, there are therefore serious dangers that, in spite of the
many assurances to the contrary, in the implementation of this
legislation, the second objective will override the first.
38. It is vital to note that, in Australia, deregulation
resulted in one-third of the industry's total revenue being derived
from "problem gamblers" (Banks, G. The Productivity Commission's
gambling inquiry: 3 years on. Canberra: Government Press,
2002).
39. The Royal College of Psychiatrists is therefore concerned
about the approach that is being adopted to "problem gambling".
This condition is being equated with "vulnerability" and the need
to provide "treatment and education". Clearly, those in difficulty
as a result of excessive gambling need services to provide help and
advice. Equally, education about the dangers and pitfalls inherent
in gambling should be available. However, the effectiveness of all
of this will inevitably be limited if public policy does not
encourage moderation. This is particularly so if the gambling
industry is provided with "a regulatory framework that ensures
continued growth".
40. Related to this is the role to be played by the Responsibility
in Gambling Trust (RiGT) in the Gambling Commission's
decision-making process. The Royal College of Psychiatrists is
concerned that the Commission appears to have decided that the RiGT
shall have the pivotal role of leading the research, treatment and
education into "problem gambling" (Consultation Commentary on
paragraphs 1.7 to 1.8).
41. In this context, it needs to be recognised that the RiGT is
a body (previously known as the Gambling Industry Charitable Trust)
set up and still funded by the gambling industry. Moreover, many of
the RiGT trustees are senior executives of gambling trade
organisations.
42. There is a great deal of research information, which has
been gathered over many years, about excessive gambling and its
causation. While the situation needs to be carefully monitored and
further research is important, this must be led by bodies that are
completely independent of any gambling industry influence.
43. The statement in the Commentary on paragraphs 1.7 to 1.8 in
the Commission consultation document that the RiGT has "three
strands to its work: research, treatment and education" is based
solely on the RiGT having given itself this task. There is nothing
in the Gambling Act indicating that this should be so.
44. The fact that the RiGT, in its research work, has formed a
partnership with the Economic and Social Research Council (ESRC) is
of secondary importance. The vital point is that the RiGT is wholly
financed by means of voluntary contributions from the gambling
industry. Since the RiGT holds the purse strings, this must
inevitably raise questions about the independence of the work being
done.
45. In view of the nature of "problem gambling" and the
importance of future research findings in determining public
policy, the Gambling Commission needs to review its approach to
research in this area. It would be more appropriate for the
Commission to work directly with the Economic and Social Research
Council and for the cost of any future research to be covered by a
government levy on the gambling industry, based on its profits.
46. In this context, it is a matter of special concern that the
RiGT refers on its web site to the Department of Culture, Media as
Sport as "the Government Department that sponsors the gambling
industry" (www.rigt.org.uk/links.asp).
47. In the past, the relationship between the predecessor of the
Commission (the Gaming Board for Great Britain) and the gambling
industry has often been far too cosy. However, at that time, the
provision of gambling was on the basis of unstimulated demand. This
is all going to change. Clearly, the Gambling Commission's decision
making should be evidence based. Therefore, it must not compromise
its independence by delegating certain aspects of its research
activity to organisations with any links to the promotion of
commercial gambling. This is especially so in relation to the
impact on children and also on excessive gambling.
48. The Royal College of Psychiatrists would draw special
attention to the need for the regulation of gambling to be very
vigorous and often proactive. History shows that failure to observe
this invariably leads to very serious consequences for
society.
Interim arrangements
.
49. The Royal College of Psychiatrists is concerned that, at the
present time, advertisements by online gaming operators are
breaking the law by offering incentives to gamble. This is an
offence against the Gaming Act 1968, which is still in force in
this area.
50. On November 10, 2005 the Culture Secretary drew attention to
this and stated
that she and the Gambling Commission "should crack down on" the
perpetrators. (www.culture.gov.uk/global/press_notices/archive_2005/dcms153_05.htm)
Yet, this illegal activity still continues.
51. The Royal College of Psychiatrists advises that since the
Gambling Act does not come fully into force until September 2007,
when hopefully, adequate safeguards will have been set up,
immediate effective action should be taken to enforce the existing
gambling laws in relation to this matter.