Out of all the CHOs surveyed, email replies were received from seven of the nine services (77.8%). Of the remaining CHOs, the Local Health Offices within that CHO were contacted. Combined with the CHO results, this equates to responses from 28 of the 32 Local Health Offices within the HSE (87.5%). No data were collected from one CHO, so the results below are based on the remaining eight CHOs. In relation to services offered for gambling disorder, four of the CHOs surveyed (50.0%) offered some form of service for gambling disorder as a part of their general adult team. In most cases, this involved a referral to a Clinical Nurse Specialist in Addictions working within the MDT of the community mental health team. One CHO that offered detailed feedback on the local services provided by each team demonstrated that services can vary greatly within CHOs. As an example of this, only one of the local Community Mental Health Teams (CMHTs) within the CHO offered treatment for gambling disorder, with the other local teams within the CHO referring these patients to residential treatment facilities, primary care, or local self-help groups (for example, Gambler’s Anonymous). Of note, two CHOs surveyed offered a comprehensive service for gambling disorder. Both CHOs had addiction counsellors treating gambling disorder as part of each of their community mental health teams, with one CHO stating that they had a service level agreement (SLA) to fund a residential treatment facility offering a 30-day treatment for gambling disorder.
Of the CHOs that did not offer services for gambling disorder, responses varied from referring patients to local addictions services, to primary care services, or offering no service in relation to gambling disorder. When referred to addiction services in these areas, there was no specific service available for gambling disorder but, if gambling disorder was identified as a co-morbidity in relation to another addiction, it would be treated in a similar fashion to other addictions. When referred to primary care services, patients were recommended to attend residential treatments and local counselling services in their area. Of note, when gambling services were not available in any form within the CHO, there was an addiction service present but the addiction counsellors therein did not provide any services for gambling disorder.
Responses were received from 8 of the 24 Regional and Local Drug Task Forces in relation to gambling disorder. Four of the Drug Task Forces offered a service for gambling disorder as part of their overall service. In all but one Drug Task Force, onward referral to either a residential programme or self-help organisation was offered to these patients. One Drug Task Force offered counselling, group work, key working, family support, structured day programmes, and aftercare for all addictions, with staff trained specifically in brief intervention for gambling disorder. Of the Drug Task Forces that did not provide services for gambling disorder (n = 4), it was reported that gambling disorder either did not fall under their remit or had not been identified as a major issue in their own internal audits of their service.
Primary care services stated that they were unaware of any general practitioners (GPs) specifically trained in gambling disorder and that there were no specific primary care services assigned to gambling disorder. They did offer comprehensive reading material as well as information around residential and self-help organisations around the country. One CHO and one Drug Task Force referred to treatment of patients aged under 18 years for gambling disorder. In each instance, these patients were referred to appropriate counselling services for addiction. Of the other CHOs offering services for gambling disorder (n = 3), these services were offered to patients over 18 years only.
Three CHOs offered data on the number of referrals received for gambling as the primary reason for referral. The number of referrals varied between 10 and 39 referrals in a 12-month period per CHO. However, there was a noted variation even within CHOs, with one district receiving 32 referrals compared to another district receiving two referrals within the same CHO for gambling disorder. One Drug Task Force also reported six referrals for gambling disorder as the main reason for referral. As a comparison, Saoirse, a specialist provider of addiction counselling and programmes (including gambling disorder), received 11 referrals for gambling disorder as the primary reason out of a total of 441 referrals in a 12-month period (2017).