What’s the wellbeing problem with problem gamblers?

Ian Walker, is an economics professor at Lancaster University and recently co-authored new research on problem gambling. Here, he shares why we need to reconsider what we know, or don’t, about problem gambling and its impacts on wellbeing.

The received wisdom – if that’s the right expression for near ignorance – is that problem gambling is relatively uncommon and the damage to wellbeing is limited to the individual and perhaps their immediate family.

Around 300,000 problem gamblers in UK
What we know is that psychologists have devised a way of spotting problem gamblers by asking 10 questions and counting if they get three or more ‘wrong’.

In large and (more or less) random sample surveys it turns out that 0.7% of UK adults get classified as problem gamblers – so a tiny problem? Well 0.7% is a third of a million adults;  about the same number as the city of Sheffield has.  

So, not so small scale, but still not a worry if it’s limited in effect. But if the impact is bigger than we suspected for each individual problem gambler, it would be a really big problem for all of us.

Aggregate cost of £30bn each year for all problem gambers
What can psychologists tell us about how big a problem this is, per problem gambler. Well, it seems that nobody bothered to quantify this! The first to ask, and answer, this question is new research: How much of a problem is problem gambling.

The question is hard to answer, as are so many unanswered questions, but our estimate of the answer is that the cost aggregated across all problem gamblers is probably around £30 billion each year. Suddenly what we thought of as a small problem, is actually a huge one in economic terms.

A different approach: asking problem gamblers how they feel
So how did we go about estimating this? We adopted the methodology pioneered by Richard Layard and his colleagues in the Centre for Economic Performance at the London School of Economics. Despite economists preferring to infer how people feel from how they behave, Layard and colleagues have been busy promoting the idea that it’s worth asking people how they feel, on a numerical wellbeing scale.

The idea has gained a lot of traction in the policy arena. So much so that even hard-nosed economists, who are naturally inclined to be wellbeing sceptics, are beginning to take notice. Such wellbeing questions now find their way into many social surveys. Thanks to the Gambling Commission and David Forrest, a specialist in the economics of gambling at Liverpool University, the question was tacked onto the end of the 2010 British Gambling Prevalence Survey. This survey also asked the 10 magic problem gambling questions to about 10,000 randomly selected households, as well as asking them about their spending on gambling products.

Problem gamblers in lowest 10% for self-reported wellbeing scores
The methodology first asks what happens to self-reported wellbeing for players who get no questions ‘wrong’ for those 10 problem gambler identification questions.

The graph below shows what we found. People who give more and more incorrect answers (the so-called DSM score), correspondingly report their wellbeing to be lower and lower.

On average, those with no wrong answers said that their wellbeing was about a reasonably contented eight. About 30% score eight, and about 50% score more than eight.

But the average wellbeing for those diagnosed with a gambling problem, by the DSM score, was just over six. Less than 10% of the general population sampled were this unhappy. So this establishes how much lower is the wellbeing of problem gamblers relative to non-problem gamblers.

The relationship between wellbeing and DSM score

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Problem gambling has similar social costs to alcohol misuse
Next, we ask what the relationship between wellbeing and income looks like. It turns out that problem gamblers and non-problem gamblers are different in other ways that affect wellbeing. The difference in wellbeing between problem and non-problem gambers is 1.5 on a log scale. What does this mean? Instead of explaining log scales, let me put it in money terms: a wellbeing difference of 1.5 is about equivalent to a difference of around £90k each year. A huge difference.

So this finding shows the difference in wellbeing terms between problem and non-problem gamblers is close to three times as large as the effect of doubling income.

If we take that £90k average and apply it to the 750,000 adults identified as problem gamblers, the aggregate loss in wellbeing is equivalent to around  £30 billion. This is much bigger than we expected it to be. In effect, it’s the same order of magnitude as the social costs of alcohol abuse, and it doesn’t get much bigger than that.

When we discovered this, we had many reservations about this huge number. We worried that the rather crude way in which the survey measures problem gambling would imply that our estimate was too small. We worried that the crude way in which income is measured would mean that it was too large. We examined the robustness of this number to the reservations that we had as best we could with the data. But we could not convince ourselves that it was unrealistic estimate of the costs of being a problem gambler.

The data doesn’t match what we know from the gambling industry
So, the research tells us that problem gambling is a huge problem. But it doesn’t tell us what it is that makes problem gamblers so miserable. Nor does it tell us about how to deal with it? We would like to know what problem gamblers spend on gambling, by type of gambling and how much they lose. But, guess what? People lie about their gambling spending. The data, in most cases, doesn’t match what we know about gambling spending and losses from the industry. Only in the case of National Lottery products do we get information from the survey that matches what we know from the operator.

Our survey provides self-reported data on spending. We expect that problem gamblers underestimate their play (and losses) by (probably much) more than do recreational gamblers.

But the differences in our data are already really scary – even though they are probably underestimated to a large degree. Problem gamblers report average monthly gambling spending of £300 – fifteen times greater than non-problem gamblers.  

Problem gamblers spend around 10 times as much on scratchcards as do non-problem gamblers, and around 30 times as much on casino (online and offline) games, and around 50 times more on machines found in bookmakers that electronically mimic fruit machines and casino tables: so-called FOBTs (fixed odds betting terminals) where lots of money can be lost very quickly. In contrast, problem gamblers spend only 10 times as much on scratchcards and less than twice as much on lottery draw games as do non-problem gambers.

In one or two Scandinavian countries in the world, there is automatic collection of gambling spending by individuals in real time and better research will need such data. For the moment, in the UK all we can say is that we are confident that lotto is not the crack cocaine of this industry; and scratchcards probably play only a small role in the misery.

Researchers and regulators haven’t been aware
Such is the size of the problem gambling problem, and the size of our ignorance about how this occurs, we are left wondering how we have got into this state of affairs. It seems that researchers and regulators have not been aware of the size of the problem.

This is not surprising since the resources spent on problem gambling treatment and research is just a tiny fraction of that spent on alcohol abuse and tobacco use. And right now, we don’t have great quantitative evidence on what works for problem gambling – and some treatments, like Cognitive behavior therapy, has limited geographical availability.

Profiling people who are developing a problem will probably help a little – but apart from the problem being worse in young males the defining characteristic is excessive levels of expenditure. Self-control strategies are available but can be worked around too easily.

Schools might play a role since young people are vulnerable to risky products. Most importantly, it seems like a bad idea to have the resources available for training, treatment and research to be driven by contributions from the industry –  this is not something that we adopt for smoking and drinking, it makes no sense to adopt it for gambling.

A theory of change for community wellbeing

As well as this week’s blog, check out our latest call for evidence on joint-decision making in communities.


Professor Jane South

Jane South is a member of the Centre’s community wellbeing team and professor of healthy communities working in the field of volunteering, active citizenship and community health. In this blog she shares the thinking behind the new theory of change model the team has created after carrying out research, workshops and public dialogues.

Download the PDF slides explaining the theory of change model

Personal experience tells us that the communities we’d like to  live in are positive, safe and sociable. And, of course, research shows how much community life and good social connections matter for our health and wellbeing.

As part of the Centre, our communities evidence programme is reviewing and summarising existing evidence for what works to make communities more positive places for people to live in. To help us do this, we’ve developed a ‘theory of change’. This describes the ways change can happen to improve community wellbeing.

There has been increasing interest in the UK in using a theory of change approach to help unpack how programmes work, which in turn makes it easier for evaluations to ‘test’ the pathways to outcomes. Our theory of change describes a cyclical process of six stages with the ultimate aim of improving community and individual wellbeing. It’s our first attempt and draws heavily on what we heard from people and community organisations across the country during the engagement phase at the start of the project. You can see the results of that engagement in our Voice of the User work.

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How the process for change works

The starting point for change is community conditions (box one in the diagram). The places where we live, how we relate to others and whether we have a say in how our local area run all influence our wellbeing. But while some people are part of communities that help them flourish, others are not.

There are things that government, organisations and individuals can all do to improve community wellbeing. For the purposes of this theory of change we’ve called these interventions (box two), but this doesn’t mean they have to be initiatives ‘done to’ communities – they could be things that people organise themselves in their neighbourhood.

Mechanisms of Change (box three) are then created, such as improving living environments, strengthening social connections and making it easier for people to take part. Things begin to change at a local level and these improved community conditions then give us the best chances to live, work and play well (box four) . Eventually changes can lead to long-term wellbeing outcomes (box five) for communities and individuals, and the ultimate reason for making change happen.

Where this community wellbeing cycle works well, there are feedback loops and things keep improving as people are more connected and involved  in community life and feel the benefits. Potentially there could be net savings from improvements in community wellbeing, although this is not a necessary part of the change process. And obviously, improving community wellbeing requires investment over time.

How can you use the theory of change?

We hope that this theory of change provides a framework for understanding and improving community wellbeing. It will also be used to help us interpret evidence. Communities are of course diverse and what works in one community may work differently- or not at all – elsewhere.  This theory of change could be used and adapted in local projects as a planning and evaluation aid.  Key questions include: What is the relationship between wellbeing benefits for the individual and for the whole community? How do we measure more of what matters, such as changes in social relationships, safety, trust and belonging?

What happens next?

Over the course of this project, we will be reviewing the community wellbeing evidence for interventions related to housing, social relations and co-production. As we find answers about what works we will refine and update our theory of change, backing it up with the evidence.

But a lot of the evidence doesn’t exist in academic journals, it lies with people working on the ground. We welcome comments on this initial theory of change – does it fit into the way you already think about improving wellbeing in your area? Do you have ideas of how it could be used? Are there things that are missing, or don’t make sense for you? We’d love to hear from you, either in the comments below, on our forum, on Twitter, or via email at info@whatworkswellbeing.org.

Resource round up and Centre update

During the election period we’re not publishing any new evidence, but we’ll still have a great line up of blogs, case studies and some useful resources to make sure you get your wellbeing evidence into practice  fix.

Workplace wellbeing
If you haven’t already downloaded it and posted it up on your office noticeboard (or whatever hi-tech equivalent you’re using), here’s our handy one-page factsheet on the latest evidence for wellbeing benefits at work.

And once that’s whetted your appetite, you can dip into our briefings on learning in the workplace and designing a good quality job.

Resilience in hospices and mental health in the media
It’s Mental Health Awareness Week, and we’re sharing two case studies that link with this year’s theme of surviving and thriving. Hospice UK give us an insight into a programme to improve staff wellbeing in an emotionally demanding environment. Meanwhile, Mind’s peer education for professionals is a look an an ambitious project that successfully challenged mental health stigma by training journalists.

Share your evaluations
We’ve currently got two calls for evidence live:

We will be putting out more calls throughout the year, and you can follow us on Twitter @whatworksWB for updates when these come out.

Other resources
You can find all of our evidence, research and guidance on the following themes:

Up next
After 8 June, here’s just a taster of what you can expect:

  • new evidence reviews on dance and sport and adult learning
  • guidance for community organisations on measuring personal wellbeing
  • a one-stop set of wellbeing indicators for local authorities
  • a round up of the evidence on green space and wellbeing
  • a discussion paper on community wellbeing.

 

 

 

 

Call for evidence: visual arts, mental health and wellbeing

Deadline: 1 June 2017

How does participating in visual arts impact the subjective wellbeing of adults (18-65 year olds) who have been diagnosed with a mental health condition? We are carrying out a review of all available evidence to find out.

If you work in an organisation that runs, funds, or works in any way with visual arts for adults experiencing mental health issues, we need your evaluation reports* – whether printed, digital or visual evidence – to help us tell the whole story.

Criteria for submission and review

We will accept sources for review and possible inclusion in our systematic review using the following criteria.

  • submissions must be evaluation reports only.
  • reports submitted must have been completed in the past three years (2014-present) and include author details (individuals, groups or organisations).
  • evaluation methods may be qualitative methods, quantitative methods or mixed methods.
  • the central report objective must be the measurement of wellbeing outcomes and/or evaluation of the processes by which wellbeing outcomes are achieved in visual arts interventions or initiatives related to adults with mental health conditions.

We can only consider your evaluations if they are submitted through this call for evidence. Evidence submitted to individual researchers in the programme cannot be considered. If you have previously sent documents to the culture and sport team please re-submit through this call.

Please send your evaluations to evidence@whatworkswellbeing.org with the subject header: visual arts evidence review.

Link to PROSPERO record

*These evaluations form part of what is known as grey literature: “literature that is not formally published in sources such as books or journal articles” (Lefebvre, Manheimer, & Glanville, 2008, p. 106). This may be produced by charities, government departments, businesses, community groups and others; and may include reports, theses or dissertations, trials, and more. To find out more about why we include work not published academically and qualitative evidence, and the rigorous standards of our evidence collection, you can read our Methods Guide.

We’ve always done it, so why don’t we measure it?

Today the Centre Director, Nancy Hey, is speaking at the Healthy Stadia conference. She’ll be sharing the findings from the research of Samir Singh Nathoo, Community Development Officer at Arsenal in the Community and Clore Social Leadership Fellow. Samir spent three months as part of his fellowship at the Centre, talking to community organisations in Islington. 

SECTOR-THUMB

 

Download Samir’s sector perspective: a wellbeing lens in the third sector (April 2017)

 

When I became a Clore Social Leadership Fellow, there were two questions I wanted to answer.

Having worked for a decade and a half in education, equality, disability, health, social inclusion, heritage and charitable initiatives for mostly young people across north London, I wanted to know: How can, and why should my organisation, Arsenal in the Community, measure wellbeing?

I also spoke to the voluntary and community sector in Islington to find out whether the local voluntary and community sector consider themselves to be delivering wellbeing outcomes, even if they are not currently measuring them?

The timing for my research at the What Works Centre for Wellbeing was perfect: the first batch of evidence from the research teams at the Centre on music and singing interventions was published in November 2015, with guidance for community wellbeing due later in 2017. The London Borough of Islington is looking at wellbeing measurements for its third sector and the 2016 Department for Culture, Media and Sport strategy has wellbeing at its heart.

We’ve not been measuring what we do
To jump straight to the core of my findings: a real revelation for me is that both Football In The Community and the voluntary and community sector have not been measuring what we actually do: mainly improving wellbeing.

Wellbeing is almost too obvious an outcome for community organisations: pensioners lunch clubs, football tournaments, social action events, these all lead to increased community wellbeing. We know that, we see it in our work on a daily basis.

But we don’t measure it, especially in smaller organisations. We’ve not even realised we could measure this in a meaningful or systematic way, and ask for funding to do it.

Wellbeing seen as a ‘soft’ outcome
Community wellbeing (linked to social capital) is about, among other things: feeling safe and supported; recognised and appreciated; having a sense of belonging; opportunities and a sense of purpose; happiness, enjoyment and fun. Often, these have been assumed, and seen as inherent and ‘soft’ outcomes, compared to things like qualifications or attendance, and so we don’t measure them.

We, of course, still have to show hard outcomes, like employment rates, but we also need to measure how we got there: for example, by creating a greater sense of confidence, belonging, safety and local trust.

Wellbeing doesn’t require new questions and measurement
Outcomes measurement is nothing new, but wellbeing outcomes have been overlooked and underused, despite offering us not only a better dataset, but also a more insightful way to show our impact and tell the true story of how we make a difference. And, best of all for overstretched community sector staff and volunteers, it doesn’t require new questions and measures: they already exist in the form of the ‘ONS four’ (with guidance on how to insert them into your surveys) and other pre-existing wellbeing and life satisfaction survey questions.

A real strength of a holistic outcomes approach, as opposed to narrow traditional outputs around, for example, health or employment, is that any organisation can choose what is most relevant to their field of work or local community.

In particular, where community organisations are delivering across a wide range of themes, a wellbeing approach can be a common currency. Two very separate health and employment projects could have the same wellbeing outcomes, which allows for better comparison and integration into the wider organisational aims.

A wellbeing lens helps us re-focus on what really matters
I have long-held frustrations with our deficit approach in the community sector. It is not a ‘tackling gangs’ project that we deliver; it’s one that makes young people feel part of something, and gives models for healthy relationships, and as a consequence may give them options other than joining gangs.

Within the sector, we talk of disadvantaged young people, but this is looking through a narrow economic lens. In fact, if we use a more holistic wellbeing lens, we are working to stop them becoming disadvantaged. Likewise, we may think we are stopping loneliness and isolation when we run an older people’s lunch project. What if we considered it a ‘community spirit’ project, instead? How does that re-focus us on the bigger goals of our organisation?

A wellbeing lens can help us to focus on the positive. It’s a way to shift to a preventative approach, rather than just focussing on the problem.

Above all, viewing our work through a wellbeing lens is about looking at what really matters to the people and communities we serve.

When I talked to those working on the ground, they were enthused and excited by the idea of a wellbeing lens. This is key when evaluation and measurement has often been viewed as a cumbersome burden of reporting and box ticking, usually as part of funding requirements.

Support and leadership is needed for this from the Local Authority and within the Sport For Development sector. There are many ways to measure impact out there and the vast choice is often part of the barrier to doing this in the first place.

The Centre is a bridge between knowledge and action, and I encourage all those working with communities to consider viewing their work through a wellbeing lens and to measure wellbeing outcomes.

For the purposes of my report, I am taking Voluntary and Community Sector (VCS) to also include Football in the Community (FITC) and the Sport for Development sector. Any recommendations related to the VCS are therefore applicable to FITC.

Wellbeing training at work and wellbeing: what works?

Olga_TregaskisFollowing the publication of our recent briefing on what makes a learning at work and wellbeing , we hear about the systematic review of the evidence from Professor Olga Tregaskis, part of our Work and Learning research team at Norwich Business School, University of East Anglia.

The joy we feel when we master a new skill; the sense of accomplishment we get from ‘a job well done’; the buzz we get from helping others; or the fading of our anxieties as we see solutions yield results. This is wellbeing.

We might reasonably expect, then, that training that provides a route for employees and leaders to master their skills and knowledge base would yield dividends for wellbeing. However, in reality the evidence is conflicting.

As part of the What Works Centre for Wellbeing, we carried out a systematic review of all the available evidence on learning at work. It looked at all countries comparable with the UK, and started with an initial pool of over 4,000 studies, which we whittled down to the most relevant and methodologically robust.

The evidence tells us that what is effective is wellbeing training focusing on developing an employee’s personal resources to cope with high demands. The evidence base is robust and we know that it works across a range of industry contexts, at least in the short-term. However, we also know that when the route causes of these demands stemming from poor job quality, are not addressed then wellbeing diminishes. This makes it clear that personal resources training is not enough on its own.

The specific focus of effective studies was diverse: problem solving, psychological flexibility, sleep training, happiness training, mindfulness approaches, cognitive behavioural therapy (CBT), stress management, resilience training, meditation awareness training (MAT), relaxation training, psychosocial skills training, empowerment and life skills. Since all of these reported positive effects this would suggest that the particular focus of this kind of training is not important.

When it comes to professional training, the evidence is weaker. Much of this type of training enhances learning of specific work and professional skills; what’s lacking is spillover into enhanced worker satisfaction or reduced anxiety in work.

In the research, we looked at interventions that focussed on developing work competencies, alongside wellbeing, through improving work skills on conflict management training, psychosocial intervention training and workforce development to equip staff to deal with stress.

One of the success stories in this area studied by Leon-Perez, Notelaers, and Leon-Rubio (2016) was an example of a training program on conflict management for 258 health care workers. Staff were voluntarily enrolled in the training program which was delivered in eight three-hour group training sessions over the course of four months and a further three-hour follow up session two months later.

Participants were trained to deal with conflict at work with colleagues and patients and their families, the course involved:

  1. emotion management
  2. interpersonal communication and assertiveness skills
  3. problem solving skills.

In comparison to a control group of 243 health care employees in similar roles, the group that had received training reported less conflict with staff, patients and relatives. This was further supported by fewer recorded absences from work and fewer requests for third party mediation in conflicts at work. The training programme was also effective in reducing complaints from patients. This underlines the potential of learning interventions where professional competencies overlap significantly with wellbeing outcomes.

Perhaps the most surprising finding in our review is the unclear evidence of the impact of leadership training, or training that’s part of wider organisational change programmes. Given the strategic significance of leadership training and change programmes to organisational performance, the omission of evidence on their impact on employee wellbeing is considerable.

Two key explanations for the conflicting results with leadership training seem to lie in design and the wider context.

Firstly, the design of the programme: those  that showed an impact on wellbeing used more extensive adult learning principles. These included group-based peer to peer learning alongside self-directed learning.

Secondly, many of the leadership programmes took place in a wider context of change, where a climate of major organisational change, job insecurity and high stress/demands are cited as potential reasons why the learning intervention was not successfully implemented.

Even where the evidence showed unequivocally positive impact – i.e. developing employees’ personal resources – there are lessons to be learned on improving how training is carried out and supported.  Of the four studies that showed no effect, three of these studies used online, computer-based methods that involved self-directed learning, one of them also included some offline support but this was not really used. Poor engagement with the learning process due to a combination of the self-directed nature of the environment and competing work demands were likely to be key factors explaining the lack of impact.

Given that most of the new learning we do as adults, beyond school, takes place in the context of work, the potential for training and development to contribute to our wellbeing is a real opportunity. Yet the evidence suggests our learning programmes, whilst increase our works skills or our personal resources in the short term, are not necessarily making us happier. Can we design for wellbeing as well as learning, which could deliver sustainable workforce capability for the future.

Mindfulness in the workplace: The state of the evidence

Tim photo 1Next Tuesday 18 April the Centre will be sharing the fourth in our series looking at the evidence on wellbeing and work. Last week, we published learning at work, a briefing on different wellbeing training approaches and their impact in a range of workplaces. In this blog Tim Lomas, a lecturer in positive psychology at the University of East London, takes an in-depth look at the evidence one training identified in our review: mindfulness.

It is nearly 40 years since Jon Kabat-Zinn created his pioneering Mindfulness-Based Stress Reduction (MBSR) programme for chronic pain, and it would probably not be overstating the case to say that mindfulness has since become culturally ubiquitous in many countries.

Based on the Buddhist notion of sati, mindfulness has a potent twofold meaning, referring to:

  • a form of non-judgemental present moment awareness that can be beneficial to wellbeing
  • meditation practices designed to help people cultivate this state.

Such was the success of MBSR that it began to be used in relation to other clinical populations and issues, and soon gave rise to other mindfulness-based interventions (MBIs), such as Mindfulness-Based Cognitive Therapy designed to prevent relapse to depression. Since then, its use truly started to proliferate, used across a wealth of contexts, from schools to prisons to workplaces.

My colleagues and I looked specifically at the workplace in a new systematic review of empirical studies of mindfulness in occupational settings. Casting our net widely, we were not only interested in Randomised Control Trials (RCTs), but any peer-reviewed paper that reported on data in relation to mindfulness, including correlational and qualitative studies.

Our aim was also broad: in addition to exploring the impact of mindfulness on standard mental health metrics, like measures of stress, we also sought data on any outcome relating to wellbeing, for example, job satisfaction and performance.

An initial search yielded 721 potentially relevant papers. On closer inspection, this was winnowed down to 153 papers that met our inclusion criteria. These included 112 intervention studies – i.e. featuring participants completing an MBI – including 48 RCTs, and 41 non-intervention studies. These involved a total of 12,571 participants.

The studies covered a range of occupations, although over half, about 82, involved healthcare-related occupations. Overall, the quality of these papers was not optimal, with many failing to adequately report key details, such as the details of the MBI. What’s more, there was a great range of differences among the studies, both with respect to the MBIs used and the outcomes assessed. This made comparison difficult.

However, despite these issues, there were enough high quality trials to allow some tentative conclusions to be drawn.

Firstly, mindfulness was associated with good mental health outcomes, particularly with respect to anxiety, stress, and distress, although the results were more equivocal for burnout and depression. In addition, it was associated with a range of other metrics pertaining to wellbeing, including physical health, relationships, emotional intelligence, and resilience, as well as various aspects of job performance.

That said, it is worth noting that mindfulness may not suit or benefit everyone, and indeed may be counterproductive for some people at certain times (e.g., research has found that people dealing with particular mental health issues may have difficulty introspecting in the way encouraged by the practice, and could feel worse as a result). As such, if offering it in occupational settings, the evidence suggests that this should be done carefully, sensitively, non-prescriptively, and through skilled and experienced teachers.

In that respect, organisations interested in implementing MBIs should check the latest guidance offered by leading institutions such as the Oxford Mindfulness Centre. Despite such caveats, there is a growing evidence base to suggest that mindfulness can have real value in occupational settings, enhancing wellbeing and performance across a wide range of domains.