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Chapter 4
Improving prevention measures: addressing stigma and negative stereotypes
4.1
As outlined in the previous chapter, one of the key messages to the
committee was that the shame and stigma associated with a gambling problem is
one of the main barriers to an individual seeking help. The committee heard how
the focus on personal responsibility, conveyed in the variations of
'responsible gambling' messages used in public information campaigns,
contributed to feelings of shame and stigma for individuals who had developed a
problem with gambling. The key criticism was that the message heard by gamblers
is that if they can't gamble responsibly then something is wrong with them,
that the problem is their fault, and they are personally to blame. The
committee heard that this approach of placing an overwhelming responsibility on
the individual for gambling problems can shame them into silence, and create a
barrier to help seeking. Consequently the personal responsibility approach and
the stigmatising effect of this approach may be one reason why very few people
seek help. Rather, they may seek help only as a last resort, and feel
discouraged from seeking help early. Disturbingly, the committee heard that
there is greater stigma around seeking help for problem gambling than with illicit
drug use. As seen with other public health issues such as obesity, alcohol and
tobacco, the framing of problem gambling as an issue of personal responsibility
advantages the gambling industry and government as it takes the responsibility
from them and places it solely with the individual.
4.2
The committee would encourage readers to take the time to read the
personal stories provided to the committee from those who have been and are
going through an addiction to poker machines. These personal stories clearly
convey the shame and stigma.[1]
4.3
Addressing the stigma associated with problem gambling will go a long
way to facilitating a necessary shift in public attitudes towards gambling and
problem gamblers mentioned in the previous chapter. Witnesses provided a number
of suggestions to improve the messages used in social marketing initiatives
(including campaigns, education initiatives and professional training) to
address stigma and stereotypes.
The need to address and reduce stigma and stereotypes
4.4
As described by Mr Tom Cummings, former poker machine addict and
gambling reform advocate:
It is a brutal addiction, one that bears the weight of a
darker stigma than almost any other addiction or affliction in Australian
society; there was a time when I would rather have died than admit that I had a
problem.[2]
Stigma is a barrier to seeking help
and seeking it earlier
4.5
Problem gambling is a stigmatised behaviour.[3]
Witnesses pointed out that the stigma and shame associated with a gambling
problem is the main barrier to people seeking help and early intervention.[4]
Ms Christine Sanchez, Team Leader, Mission Australia, told the committee stigma
is a huge barrier to seeking help:
It concerns me that gambling has more of a stigma attached to
it than illicit drug use. People say, 'I use illicit drugs' or 'I'm a
recovering alcoholic', and everyone gets congratulated and patted on the back
and 'It's great that you're so strong'. Yet, when people say, 'I have a
gambling problem', there is still all this stigma and guilt attached to it.
When you think about it, illicit drug use, for example, comes along with a
whole heap of breaking of society's rules and legalities and it is still seen
as a better option than admitting to a gambling problem.[5]
4.6
UnitingCare Community emphasised that the stigma and embarrassment means
that people keep their problems secret rather than seek help:
Avoid stigmatising or shaming problem gamblers. The shame and
guilt drives the secrecy to gamble and this then drives the gambling behaviour
to continue.[6]
4.7
Dr Katy O'Neill, Clinical Psychologist, Gambling Treatment Program, St
Vincent's Hospital, explained how the stigma attached to gambling problems
makes them feel:
To put it really bluntly, I think gamblers feel stupid and a
lot of the public rhetoric is about the problem being located purely inside the
gambler. Once someone is in treatment...one of the things we spend a lot of time
doing is saying that the reason they have a problem with gambling is the
interaction between the human mind and typically for most of our clients the
poker machine, but that is not generally appreciated out in the public. You
hear people saying gambling is a tax on the stupid, which we definitely do not
agree with. We see a lot of very intelligent people, we see professionals, we
have seen doctors, lawyers and engineers, and they all come in saying, 'I don't
know what's wrong with me; I'm not a stupid person.' That relates to the stigma.
A drug addict knows and can understand why they are doing it even if they think
they should not be.[7]
Stigma contributes to low numbers
of people seeking help
4.8
Professor Dan Lubman, Fellow, Royal Australian and New Zealand College
of Psychiatrists, explained how the stigma feeds into the low numbers of people
seeking help:
It means that, unlike other health disorders where we say to
people that there are a whole range of reasons people are vulnerable to
developing problems and come to a health practitioner to get help, we are
essentially saying that people with addictions have some sort of moral failure
within them in controlling their behaviour. People then fear that in presenting
to health professionals they are going to be similarly discriminated against
and ostracised. I think there is a failure in the lack of understanding that
there are effective treatments available for people in the community.[8]
The 'responsible gambling' message
contributes to stigma for problem gamblers
4.9
All those who spoke to the committee from personal experience or from
dealing with people with gambling problems expressed the view that the current
key message of 'responsible gambling' contributed to the amount of stigma
around gambling problems and was ineffective, particularly for those who have
already developed a problem. Dr Samantha Thomas, a public health sociologist
from Monash University, indicated that one of the unintended consequences of
the focus on personal responsibility is the stigmatisation of individuals. This
discourages people with problems and those developing risky gambling behaviour
from seeking help earlier.[9]
4.10
The limits of the 'personal responsibility' approach were emphasised by
the Productivity Commission (PC):
...while there are reasonable social expectations that people
take responsibility for their own behaviour, that does not limit the need for
significant regulation of gambling. Moreover, to the extent that people face
gambling problems because of co-morbid conditions or unsafe features of gambling
technologies and venue environments, labelling them as ‘irresponsible’, as some
industry groups have done, risks stigmatising people who need help, while
deflecting attention away from product safety issues. A problem gambler wishing
to self-exclude or to otherwise approach a venue or some outside body for help,
may be less likely to do so if their behaviour is labelled as ‘irresponsible’.[10]
The need for de-stigmatisation
4.11
Witnesses emphasised that in order to encourage people to seek help and
particularly to seek it earlier, the stigma associated with problem gambling
needs to be addressed.[11]
Professor Dan Lubman, Fellow, Royal Australian and New Zealand College of
Psychiatrists, agreed that addressing stigma would be the key to more people
seeking help and seeking it earlier. He compared willingness to seek help for
gambling with other mental health issues:
One of the issues we have with gambling is that it is very
difficult for people to acknowledge, because of the stigma, that the gambling
is an issue. They are much happier to come forward and acknowledge, for
example, the mental health issues, on which, over the last 10 years there has
been an immense amount of work in terms of destigmatisation. Ten years ago
people probably would not have come for a mental health issue; they would have
come for a physical disorder and then we might have broached mental health.
So this just emphasises that people do seek help but they
seek help in ways that they are comfortable with. And they seek the help in
ways that they feel are less stigmatised, be that for a physical or a mental
health issue. We need to seize those opportunities then to address the
underlying substance use or gambling issue.[12]
4.12
Dr Samantha Thomas also spoke about the need to address stigma in order
to encourage more people to seek help. Dr Thomas explained that most current social
marketing campaigns are based on people seeking help if they have a problem and
that this focus on the individual creates stigma and negative stereotypes.
Instead of targeting the individual, preventative messages and preventative
campaigns would target the risks associated with the product or the industry:
I think the main barrier is stigma. So, if we seriously want
to encourage help-seeking behaviour, not just from problem gamblers but from
the huge number of individuals who may have moderate-risk gambling behaviours,
who may bounce in and out of that category, we have to tackle stigma. That
needs to happen at a whole bunch of different levels. We need to learn a lot from
mental health and from other highly stigmatised conditions. We may need to
think about running antistigma campaigns in gambling. We
also need to encourage a clearer community discussion around the issue of
stigma which takes the emphasis off individual irresponsibility and puts it
onto the problems with the industry and the products.[13]
4.13
Dr Thomas spoke about negative stereotypes created around problem
gambling:
We have created a whole range of stereotypes around what a
problem gambler looks like—that they are someone who has lost their house, they
are in jail, their relationship has broken up and they have not taken
responsibility for making correct choices with the product. In many ways we
have created this unintended consequence which is stigmatising people and
discouraging them from seeking help early.[14]
4.14
Ms Kate Roberts, Gambling Impact Society NSW, also spoke on the need to
address stereotypes:
...there is also the need for families and the community
generally to understand and reduce the kinds of stereotypes we have about
problem gamblers or people who are dealing with problem gambling in their lives
so that it is seen as a health issue. At the moment, both the industry and to
some extent government messages stigmatise and add in. Even the concept of
responsible gambling, by the alternative, suggests that someone is
irresponsible.[15]
4.15
Ms Penny Wilson, Chief Executive Officer, Responsible Gambling Advocacy
Centre, agreed and also spoke about the changes needed:
We know that messages that are negative and identify people
as problem gamblers do not drive people to seek help. The advertisements often
do not work effectively for the target audience they are seeking to engage with
because people in a problem-gambling phase do not identify themselves as problem
gamblers. The committee knows from previous inquiries that there is a lot of
fluidity between problem gamblers, high risk gamblers and moderate
gamblers—there is a lot of movement. Campaigns which encourage seeking help,
but in a much more positive way, and campaigns that locate the issue not just
with the individual but also in a wider context to make people feel more
comfortable about seeking help would probably be the No. 1 change. The No. 2
change would be about better preventative education so that people are aware of
issues and are not so frightened to seek help by the time they get to a
situation in which they need to do it.[16]
4.16
The PC acknowledged that community awareness campaigns can reduce the
shame and stigma associated with a gambling problem.[17]
Witnesses suggested a focus on reducing stigma using other successful campaigns
in areas such as mental health as a guide.
Example of beyondblue and
depression
4.17
The beyondblue work with mental health was highlighted as an
example of a public health campaign which attempts to de-stigmatise seeking
help for a mental illness. Mr Mark Henley, Member, Australian Churches Gambling
Taskforce, explained how this would work for gambling to de-stigmatise
help-seeking:
...the work that beyondblue, for example, has done with
mental health is an example of public health advertising which tries to
de-stigmatise. So, as applied to gambling, it is: 'If you're having a bit of a
problem with your gambling, there's no shame in looking for help. Talk to
friends, talk to family go to a help service.' I think that that is the sort of
fairly simple mass media message that can be really effective.[18]
4.18
Professor Dan Lubman, Fellow, Royal Australian and New Zealand College
of Psychiatrists, also spoke about lessons that can be taken from beyondblue
and the area of depression:
I think there is a lot of lessons to be learnt here from our
experience with, for example, beyondblue. Ten years ago the whole area
of depression was seen as being highly stigmatised. There was not a visible
face of depression, so it was a very silent disorder where people suffered in
silence and the general view was that people who had depression got it because
they were weak in some way and just could not cope with the everyday stresses
of life. What beyondblue has successfully done over the last 10 years
through a range of activities is educated the community around the
normalisation of depression—the successes of depression and how people can be
helped—and what it has made is a visible community of people who have recovered
and are successful.
The key learnings there for the gambling area are that for
the moment the people who suffer with gambling suffer in silence and are not
visible and the people who successfully overcome the gambling do not talk about
it—it is a shameful part of their pasts and they put it behind them—so the only
message that goes to the community is that there are winners and only a small
number of losers and that in some ways they deserve it because of their moral
make-up.
So I think there is a lot of work we can do in terms of
community awareness, and I would certainly be urging the committee to look at
the positive outcomes from initiatives such as beyondblue and to think
about how that sort of approach could increase community awareness and community
engagement and understanding of a condition that is very poorly understood and
treated.[19]
4.19
Professor Malcolm Battersby, Head of Department, Human Behaviour and
Health Research Unit, Flinders University, agreed that efforts by beyondblue
and governments in the area of depression have been successful and that the
targeted marketing using all forms of media with a systematic funding cycle has
also played a part in the success.[20]
4.20
The committee discussed using the benchmarks of help-seeking for other
mental disorders such as anxiety and depression as a target. Currently in the
area of anxiety and depression around 35 per cent of people seek support. This
compares with around 8 to 17 per cent for problem gamblers.[21]
Other campaigns to draw from
4.21
The Queensland Government is running the 'Change our Minds' campaign
addressing mental illness. It includes personal stories and 'change champions'
which in this case are sporting clubs joining the campaign to help reduce the
stigma of mental illness.[22]
It has been running since October 2011. The Queensland Government committed $8
million over four years to the campaign to get the message to the community. The
government will provide a further $600,000 over three years to the Queensland
Alliance for Mental Health to change attitudes and behaviours at a grassroots
level.[23]
4.22
Following the release of the Queensland campaign in 2011, the former South
Australian Greens spokesperson for Mental Health, Ms Tammy Franks MLC, called
on the state government to fund a similar campaign and highlighted the
benefits:
Anti-stigma mental health campaigns are proven to reduce the
costs to society of mental illness. Research from the London School of
Economics based on the Scottish See Me initiative identified that for every £1
spent on that anti-stigma social campaign there was an economy-wide saving of
more than £8. Research on the Like Minds, Like Mine campaign in New Zealand
identified a similar return on investment. Reducing discriminatory attitudes
towards mental illness would mean people would be much more likely to talk
about their mental health needs and seek support and treatment earlier. We know
that when that treatment is sought early there are significant benefits in
reduced demand on crisis point services and productivity loss. That is why New
Zealand, Scotland, England, Canada, the USA and Ireland have all seen the value
in ending the stigma and discrimination of mental ill-health with anti-stigma
campaigns.[24]
4.23
The Stigma Project is a grassroots organisation in the USA that aims to
lower the HIV infection rate and neutralise stigma associated with HIV/AIDS
through education and awareness via social media and advertising.[25]
4.24
Ms Penny Wilson, Chief Executive Officer, Responsible Gambling Advocacy
Centre, spoke about a gambling example in Canada. The problem gambling
treatment agencies in Ontario co-fund the Public Health Gambling Project.[26]
It is a long established partnership between the University of Toronto, the
Ontario Centre and the YMCA to deliver preventative gambling education to
students, parents, schools and communities and de-stigmatise the issue.[27]
Developing a social marketing campaign to address the stigma associated
with problem gambling
4.25
Drawing largely from the area of mental health, the committee supports the
development of social marketing campaigns that include addressing the stigma
associated with a gambling problem. The messages would be embedded in areas
such as public information campaigns, communication strategies, education
programs and staff training and could include the following areas.
Anti-stigma campaigns
4.26
It is important to have anti-stigma campaigns targeting individuals. Instead
of emphasising personal responsibility the messages for individuals
experiencing problem gambling would encourage them to overcome the stigma and
shame and seek help. This could be achieved by using social marketing
strategies and messages which emphasise that this problem happens, it can
happen to anyone and they should not be ashamed to seek help. The committee
heard how it would be effective to use personal stories from people who have
sought help as well as stories from high profile people who have experienced
problem gambling, sought help and recovered.
Positive messages from individuals
are needed
4.27
Witnesses advocated having more personal stories from people who have
been through the experience of problem gambling as part of advertisements and
information on gambling. Associate Professor Peter Harvey, Manager, Statewide
Gambling Therapy Service, noted:
We were recently on a radio program, not as good as a
television program in terms of coverage, with one of our volunteer recovered
gamblers. She spoke very honestly about how that process affected her and how
shameful it was and all that sort of thing. I think having more people who have
been through that experience and getting the message out into the community and
connecting with other people saying, 'Well, there is a person who has got the
same sort of background or problem I have got. They have been able to challenge
it and cope with it. They have gone to get help.' It is having them talking
like that in public, more information out there about what the risks are and
what sort of damage it does to families and the community. That is all about
promotion, about communication. We are not doing that very effectively.[28]
4.28
Ms Penny Wilson, Responsible Gambling Advocacy Centre, agreed that it is
important for individuals to hear from people who have been through a gambling
addiction:
I think the committee started out by hearing from people like
Mr Tom Cummings this morning. I have heard Tom's story in many different ways
many different times and it never fails to affect me and it is similar when I
talk to other people who are self-identified problem gamblers about what they
have gone through and what they experience. Learning from people who have faced
the problem is certainly an important thing. Then you have to apply that to
measures, policy settings, availability and access to Gamblers
Help services.[29]
4.29
In addition to individuals, anti-stigma campaigns targeted towards the
public would address negative stereotypes of problem gamblers with messages
that indicate anyone can be affected by problem gambling. Again the committee
heard that using role models and people of influence for this message could be
effective.
4.30
These campaigns should be supported by education and professional
training programs which ensure stigma is a key component.
The use of de-stigmatising language
4.31
Using negative language to describe problem gamblers such as calling
them irresponsible[30]
contributes to the feelings of shame and embarrassment they already feel. Drawing
from the area of mental health, the committee notes that sane Australia runs
sane Stigma Watch which is a service where stigmatising language in the media
or elsewhere concerning mental health can be reported.[31]
As part of an overall strategy it would be effective to challenge the use of
stigmatising language around problem gambling in the media and elsewhere
problem gamblers are given negative labels such as irresponsible.
Addressing any unintended
consequences of campaigns
4.32
It is also important to ensure any campaigns don't have any unintended consequences
by causing stigma—for example, putting blame on the individual which, as
explained above, makes people feel more ashamed and less inclined to seek help.
The committee heard repeatedly that the 'responsible gambling' message has
created this unintended consequence by stigmatising people and discouraging
them from seeking help, particularly discouraging earlier help-seeking.
Including new information formats
4.33
The committee heard how it would be useful to incorporate new
information formats such as social media into campaigns.[32]
Recent attempts at anti-stigma campaigns
4.34
In June 2012, the Queensland Government launched a campaign which asks
people to consider whether they or someone they know are 'Gambling too much'. The
messages will be available in venues and target problem gamblers. The
Queensland Government claims that it is one of the first campaigns to seek to
remove the stigma associated with problem gambling and counter negative
stereotypes. It also aims to drive behaviour change through encouraging people
to seek counselling assistance, explore self-help options or undertake
self-exclusion measures.[33]
4.35
During the inquiry a new advertising campaign was launched in the ACT coinciding
with Responsible Gambling Awareness Week, with the tagline 'Gambling. If you
have to lie, we need to talk'.[34]
It was also accompanied by an image of lips sewn together. Ms Christina Sanchez,
Team Leader, Mission Australia explained that the campaign is about getting
people to talk so that gambling is no longer a secret.
It is about having those discussions that people are too
scared or have felt too much shame and guilt to discuss and to talk about. When
we discussed the ad, we had a limited amount of funds and we have such a wide
demographic of people that are in trouble with gambling that we thought: how
can we target everyone, and what is the common theme that goes over gambling?
And it was lying: lying to yourself as well as to loved ones. The lies are: 'I
can just walk away at any time' or 'I'll just put another $20 and then I will
never gamble again in my life.' It was about once you feel that you have to lie
about a situation, then perhaps it is time you talked about it. Because people
do not lie because something good is happening; they lie because they are
ashamed or guilty about something, or there is someone they are trying to
protect. It was about: let's talk, we need to talk; it is time that we talk
about this issue.[35]
4.36
Ms Sanchez said that Mission Australia did some market research with
gamblers. While they found the image confronting they said it was how they
felt: they were scared to talk, they didn't know who to talk to or whether they
would be judged as bad people.[36]
Committee view
4.37
The committee notes the contradiction that despite the growing
normalisation of gambling in some areas such as sports wagering, stigma remains
a considerable barrier to individuals seeking help for a gambling problem and
particularly to seeking help before they reach a crisis point. The committee
heard that to a person experiencing gambling problems, the current imbalance in
social marketing campaigns which focus responsibility on the individual may be
unintentionally increasing stigma. The committee believes that more research is
needed on this issue to develop appropriate and effective messages for social
marketing campaigns.
4.38
The committee heard that campaigns and broader social marketing
initiatives need to address stigma head on with strong messages to encourage
community awareness and discussion. While recent attempts to address stigma are
well intentioned and it is encouraging to see this issue being thought about, the
committee notes it will be important to evaluate the campaigns to see how
effective they are and determine any unintended effects.
Recommendation 3
4.39
The committee recommends that the Department of Families, Housing,
Community Services and Indigenous Affairs Problem Gambling Taskforce commission
research on the complex causes and consequences of stigma and the most
effective way to address and reduce the stigma associated with problem
gambling. States could then draw on this work to develop strategies to address
stigma and include appropriate messages in their own social marketing
campaigns.
Recommendation 4
4.40
The committee recommends that gambling social marketing strategies,
particularly those claiming to address stigma, are thoroughly market researched
prior to launch and evaluated to determine effectiveness and any unintended
consequences.
4.41
The next chapter discusses other suggestions on how to address the
current imbalance in social marketing campaigns.
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