3. Counselling and support services
   1. Australia’s world-leading gambling losses are causing increasingly widespread and serious harm in our communities. The Committee heard that counselling and support services are unable to keep up.
   2. Gambler’s Help and Gambling Help Online are state and national telephone and online counselling services for gambling that are delivered by Turning Point. These services have received a significant increase in calls relating to online gambling, which accounts for about 45 to 50 per cent of calls.[1]
   3. This chapter considers the adequacy of current counselling and supports available to Australians experiencing gambling harm. It examines evidence of low levels of awareness and understanding about addiction and gambling disorder, both in the general community and in health and social services, barriers to help-seeking, such as shame and stigma, and whether current services are meeting peoples’ diverse needs.

Gambling disorder

3.4Gambling disorder is an identified psychiatric condition in the International Classification of Diseases (ICD-11) as a disorder due to addictive behaviours and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a category of behavioural addictions.

3.5The Royal Australian and New Zealand College of Psychiatrists (RANZCP) and Royal Australasian College of Physicians (RACP) said that the categorisation of gambling disorder reflects research suggesting that ‘gambling disorder is similar to substance-related disorders in clinical expression, brain origin, comorbidity, physiology and treatment’.[3]

3.6Gambling disorders are linked to other health and social issues such as an increased risk of substance abuse and disorders, depressive symptoms and disorders, family breakdown, domestic violence, criminal activity, disruption to or loss of employment, social isolation[4] and homelessness.[5] Individuals with mental health and behavioural disorders, adolescents and children, and Aboriginal and Torres Strait Islander people who gamble may be more likely to experience gambling disorder and addiction.[6]

3.7The Australian Psychological Society (APS) reported that gambling disorder presents in patients when there is a ‘persistent and recurrent preoccupation with gambling that leads to clinically significant impairment or distress’, and explained:

This may be associated with a need to gamble with increasing amounts of money to achieve the desired excitement or restlessness or irritability when attempting to cut down or stop gambling.

People with a gambling disorder may also make repeated unsuccessful efforts to control, cut back, or stop gambling and subsequently continue to gamble when feeling distressed. This may result in a pattern of ‘chasing losses’, with an urgent need to keep gambling…[7]

3.8During the inquiry the Committee heard powerful testimony from witnesses with first-hand experiences of addiction and gambling disorder that developed from online gambling. For example, Mr Gavin Fineff was diagnosed with gambling disorder and explained that early exposure to gambling through childhood gaming and ‘exposure saturation’ of online gambling were the key factors in developing gambling disorder later in life.[8] Mr Fineff said that individuals with gambling disorder ‘will cause destruction’ as they find more ways, including illegal activity, to fund their addiction.[9]

3.9Mr Fineff told the Committee that recovering from gambling disorder has taken over three years in ‘inpatient rehabilitation, well over a hundred psychiatry sessions and hundreds of various support group meetings’.[10] Mr Fineff emphasised the importance of recognising that gambling disorder is different from how other people experience gambling harm:

…it's so important that we do not make the mistake of thinking that the regulation for a person with a problem works for a person with a disorder. To that point, the psychology of someone with a problem is different to someone with a mental illness. And the destruction continues because conflicted stakeholders in the gambling industry do not acknowledge gambling disorder to its full extent.[11]

Barriers to seeking help

3.10There are several important reasons why people experiencing gambling harm do not seek help:

• Seeking help for gambling issues is highly stigmatised.
• People who gamble may not recognise they are experiencing harm until it affects other aspects of their life.
• People who are experiencing gambling harm may not know where or how to look for support or may have had a negative experience with services.
• Many people have poor access to the internet and smartphones.
• The cost of services and transportation to access services can be prohibitive.
• There are constraints on peoples’ time, such as work or caring for children.
• Services may not be culturally or linguistically appropriate for all people.[13]
  11. The Australian Institute of Family Studies’ Australian Gambling Research Centre (AGRC) reported that ‘only a small proportion of people experiencing harm from gambling ever seek counselling or support services, and many only do so when problems have become severe’.[14]
  12. In New South Wales, less than one per cent of people who gamble had sought help for problems related to their gambling, in the Northern Territory the estimate was 1.5per cent, and in the Australian Capital Territory it was two per cent.[15] AGRC noted the importance of affected others having access to counselling, as it ‘can improve coping by other affected persons, as well as facilitate access to treatment for the person who is gambling’.[16]

Shame and stigma

3.13Many people feel intense shame about their gambling and its impact on the people they love. They may feel a loss of pride and self-worth, embarrassment and guilt, or a fear of being rejected.[18] They may interact with others who are uninformed and have biases about gambling harm or addiction, or they may encounter labels like ‘problem gambler’, which is stigmatising and places the blame on the individual.

3.14Shame and stigma prevent people from accessing the help they need.[19] In 2015, 80per cent of Victorians experiencing gambling harm reported that they kept their gambling harm a secret because of shame and stigma.[20]

3.15Many people will seek help from financial counselling services first, rather than treatment services, because this may be easier than admitting to themselves and disclosing to another person that their gambling has become so damaging it requires therapeutic treatment.[21]

3.16Shame and stigma arise because many people associate gambling harm and addiction with poor self-control or decision-making, or criminality, rather than as a health issue.[22] A lack of knowledge and understanding of gambling disorder and addiction leads to negative public attitudes that contribute to shame and fear of disclosing gambling behaviour.[23]

Vulnerable Australians

3.17Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse (CALD) backgrounds and people living in rural and remote communities are:

• at a higher risk of experiencing gambling harm
• less likely than other Australians to seek help due to shame, stigma, fear of judgement, and barriers such as language or the absence of professional assistance that is culturally informed and safe.[24]
  18. The National Aboriginal Community Controlled Health Organisation (NACCHO) stated that harmful gambling can lead to ‘devastating health impacts’ in Aboriginal and Torres Strait Islander communities, such as:

poor mental health, stress, trauma, grief, depression, as well as poverty – substandard housing, homelessness, inadequate nutrition and food insecurity, shorter life expectancy and higher death rates.[25]

3.19In the Northern Territory, where Aboriginal and Torres Strait Islander people make up around 25per cent of the adult population, they experience over 40percent of gambling harm. SRTS Consultants stated that Aboriginal and Torres Strait Islander people are five times more likely to gamble harmfully and about three times more likely to be affected by other people’s gambling than the non-Indigenous population.[26]

3.20Despite these statistics, almost half (44 per cent) of regular Aboriginal and Torres Strait Islander gamblers do not think they have a gambling problem.[27] NACCHOadded that ‘only 5.4percent of gamblers receive any kind of gambling help, including from informal sources such as family and friends’.[28] Instead, Aboriginal and Torres Strait Islander people opt for self-help strategies.[29]

3.21The Committee heard that better education is required to reduce stigma, increase awareness about gambling related harms and bring about culturally safe behavioural change, including supporting friends and family members to better help those who are experiencing gambling harm.[30]

3.22APS recognised it is important for psychologists working with Aboriginal and Torres Strait Islander people to be ‘well-versed in family and kinship interventions, financial literacy training and financial counselling, and community resilience building’.[31]

3.23In CALD communities, there can be additional stigma about engaging with gambling services. Victorian Arabic Social Services (VASS) said it can be hard for people to admit having a gambling problem when some cultural or religious groups prohibit gambling, which can make it challenging to find a service they can trust. VASSexplained:

…we specialise in doing in-language gambling harm support for service users, and a lot of them might have come to us because they haven't felt comfortable about approaching mainstream services. They may have not even looked at approaching them because of that initial level of discomfort…there's still a huge amount of difficulty just stepping over the threshold and coming to talk to someone and admit that it's an issue.[32]

3.24VASS reported that its gambling harm program often operates at capacity as people from CALD communities are more likely to seek help from someone who has ‘a lived experience of cultural and community factors’ and specialist in-language qualifications.[33]

3.25A lack of resources available to people in rural and remote areas who are seeking help for gambling harm is a significant issue. Relationships Australia explained that people living in regional and remote areas ‘live with pressures, complexities and uncertainties not experienced by those living in cities and regional centres’.[34]

3.26APS argued that Australian Government support is needed ensure that psychologists are available in communities of need. APS noted that although vulnerable people are ‘often unable to change their behaviours without external intervention and professional support’, there are ‘few or no services available for them to access’.[35]

The hidden nature of gambling harm and suicidality

3.27It can be difficult for loved ones to know when a person’s gambling has become a harmful addiction and offer help. This is because of shame and stigma and the private nature of online gambling, which normally takes place on a person's mobile device, often in secret.[37] For example, Mr Fineff described online gambling as:

…invisible to family, friends, employers—no-one can see it. So, because it's so hidden, the escalation of its progression into problem gambling and then to gambling disorder goes unnoticed by the customer and everyone else. For that reason, it's very dangerous.[38]

3.28Significantly, it is difficult to know when a person experiencing gambling harm is at risk of suicide. Despite there being a clear link between gambling harm and the risk of suicide, gambling-related suicides are underreported, largely because of shame and stigma.[39] One individual explained they were only made aware of their partner’s gambling harm ‘when all funds had been lost and my partner at that time attempted to commit suicide’, and said it is ‘extremely hard to offer help until it is too late’.[40]

3.29While one in five people presenting to an emergency department with suicidality also reported experiencing gambling harm, the numbers are likely to be much higher. Underreporting of the relationship between gambling harm and suicidality means that there is a lack of a reliable data and framework for data collection. This makes it difficult to respond with treatment and prevention frameworks.[41]

The effectiveness of counselling and support services for people experiencing gambling harm

3.30Given the potential for addiction and gambling disorder, harmful gambling must be treated as a health issue with treatment offered by appropriately trained health professionals.[42] However, the Committee heard there are often few or no services available and some health care workers lack relevant training. Inadequate funding also affects the availability and effectiveness of services.

3.31Support services specifically for gambling harm have low uptake.[43] Poor mental health, suicidality, or alcohol and substance use issues may be people’s more urgent consideration, even though gambling is the root cause.[44] People experiencing gambling harms are grossly over-represented in primary care, alcohol, and other drug, and/or mental health treatment settings, with up to 30 per cent of treatment seekers experiencing gambling problems. It is important that, in all support and treatment settings, gambling harm is identified and treated early to ensure beneficial outcomes.[45]

3.32Turning Point and the Monash Addiction Research Centre said that the lack of a public health framework for gambling creates a ‘siloed approach to gambling that sits outside the health sector’ and explained:

When we are talking about tobacco, alcohol or illicit drugs, we have a very strong public health framework. We don't have a public health framework for gambling. We don't consider it as a health issue. Because of that, it's not surprising that our health practitioners, more broadly, don't see it as a health issue or don't feel equipped to be able to deal with that.[46]

A lack of integrated treatment services

3.33Integrated services that provide treatment and support for people experiencing gambling harm as well as the mental health, suicidality or drug and alcohol challenges they are experiencing, are critical to ensuring people receive appropriate treatment.

3.34There is a need for greater support for integrated treatment services[47] and better staff training, so that earlier interventions can be delivered to clients experiencing gambling harm. AGRC stated that early interventions play an important role ‘for people in the early or intermediate stages of experiencing harm,’ for example in encouraging them to set deposit limits, to prevent gambling from progressing to a more harmful stage.[48]

3.35Patients often present to their medical practitioner with other mental health concerns or multiple complex issues linked to their gambling.[49] Banyule Community Health said that gambling harms ‘can work like a domino effect…making it more difficult for people to figure out where to start with their journey to recovery’.[50]

3.36Currently, screening for gambling harm occurs infrequently and inconsistently. Turning Point and the Monash Addiction Research Centre found that only ’10percent of clinicians are aware of screening and assessment tools for gambling harm, and most gambling screening that does occur is on an ad hoc basis’.[51] When asked why screening is not conducted for gambling harms, clinicians explained that ‘…doing so is not an organisational requirement, gambling is not part of standard intake assessments, and they lack knowledge about and training in gambling harm screens’.[52]

3.37There was strong support for standard intake assessments and information kits for healthcare providers, especially general practitioners, that provide screens for gambling harms by default to improve treatment outcomes for people experiencing both mental health conditions and gambling harms.[53]

3.38The Australian Medical Association (AMA) recognised that medical practitioners have a role to play in talking with patients about gambling harms in various settings where people present with symptoms that appear unrelated to gambling. This is outlined in AMA’s 2013 position statement Health Effects of Problem Gambling.[54]

3.39Care Incorporated emphasised that all healthcare professionals should also ‘have access to referral pathways to gambling support services’ and services should be ‘embedded in or more accessible from mainstream organisations’.[55]

3.40Alliance for Gambling Reform suggested that an ‘independent gambling harm national services directory’ would be useful for medical and health professionals.[56]

Training

3.41The effectiveness of services can be undermined by insufficient staff training. This means that people seeking help may not be receiving best practice treatment and support, and some staff may have biases about people experiencing gambling harm, which can contribute to stigma.[57]

3.42Financial Counselling Australia reported that, in 2022, only 57 per cent of specialist gambling financial counsellors had completed gambling-related training.[58]

3.43Callers to gambling, crisis and financial counselling helplines who are experiencing both gambling harm and suicidality may not be adequately supported because there is no established best practice model of care in Australia to assist them.[59] This means that:

• some gambling helpline counsellors may not be trained to provide best practice suicide prevention
• some crisis support helpline counsellors may not be trained to provide best practice gambling harm support
• some financial counselling helpline staff may not be trained or supported to enquire about and to appropriately assist clients at risk of suicide
• people experiencing gambling harm disengage from help seeking because of disjointed care.[60]
  44. Turning Point recommended a best practice suicide prevention model of care be developed for gambling helplines and that the helpline workforce be upskilled through ‘national online skills-based training’.[61] Similarly, Suicide Prevention Australia (SPA) argued for crisis support helpline counsellors to be ‘trained to have conversations about gambling and know how to refer callers to specialist gambling assistance services.’[62]
  45. Banyule Community Health suggested further investment in diverse options for support such as ‘peer support, groups, care coordination and long and short-term rehabilitation services’, which are ‘often not accessible for people experiencing gambling harm’.[63]

A lack of appropriate support services

3.46There are often few or no appropriate services available for people who try to seek help for gambling harm. There may be no services available to access, services may be unresponsive, or it can be difficult to make appointments. Some people may have had poor experiences with services in the past. Many find they have no continuity of care.[64] Some providers may put the onus on the person seeking help and their family to come up with solutions to the issues they face.[65]

3.47A parent told the Committee their son was unable to access counselling and support services ‘quickly enough’ and, at times, their son did not know ‘if taking his own life would be a better option than having to live with the knowledge of the harm that he has experienced and caused to his family’.[66]

3.48Some people who are experiencing gambling harm do not know where to look for support as there is often little awareness of the available services among people who gamble and their families’.[67] A survey conducted in the Australian Capital Territory in 2019 found that one in ten people who were experiencing gambling harm did not know where to look for support. When asked where they would seek help, almost half nominated the internet, 15 per cent nominated a gambling helpline and 11.6percent nominated family or friends.[68]

3.49There was support for online or telephone helplines that operate around the clock. These services can overcome barriers by allowing people to access anonymous support anytime and anywhere in Australia.[69] AGRC noted that, given the nature of online gambling participation, traditional modes of counselling, such as land-based counselling, ‘may not be as effective for some sub-populations’.[70] AGRC said that online gambling counselling is ‘especially valued by people experiencing feelings of stigma and shame’ and explained:

the online mode offers a degree of anonymity that traditional modes do not…young people in particular report feeling comfortable using relatively anonymous counselling via instant messaging services. This supports earlier research that found online counselling is appealing because of its anonymity, convenience, ease of access, and the opportunity for ‘typing rather than talking’.[71]

3.50Wesley Mission noted that online counselling is ‘not appropriate for everyone, for cultural or technical reasons’.[72] For example, in the Fairfield Local Government Area in the west of Sydney, gambling has a ‘significantly high’ impact but ’25 per cent of households do not have access to the internet at home’.[73] WesleyMission argued that ‘funding should ensure adequate face-to-face assistance remains, and culturally specific counselling is easily obtained’.[74]

3.51Queensland University of Technology suggested that ‘stronger promotion of counselling and financial counselling support services’ would assist in greater awareness of the availability of services and support.[75]

3.52SPA said it was important for banks, gambling companies and other organisations that interact with people who may be experiencing gambling harm to have ‘protocols for correct referral of customers with gambling issues who are at risk of suicide.’[76]

3.53The Gambling Treatment and Research Clinic, University of Sydney (GTRC), noted that patients who are experiencing harm related to interactive games also have difficulty finding support. It reported that ‘mainstream government-funded psychological support services for young people frequently turn away such clients as they feel they are also unable to support them’.[77] GTRC explained there are ‘few referral options for anyone who contacts the clinic for support in this area, as few support services are available’, due to ‘very few evidence-based treatment options’.[78]

Funding issues

3.54The Committee heard that increased and more targeted funding would help address the lack of appropriate services available for people experiencing gambling harm and improve training for frontline staff.

3.55In 2022-23, the Department of Social Services was allocated $5.55 million to support financial counselling for those experiencing gambling harm, and $3.18million for the NationalDebt Helpline.[79]

3.56Currently, only a small proportion of online gambling revenue collected by the states and territories is directed towards gambling treatment and support. For example, when New South Wales increased its point of consumption tax on online gambling from 10 to 15 per cent in 2022, the state government indicated it would not increase the $5 million a year allocated to addiction support services above inflation.[80]

3.57A lack of appropriate funding affects the availability of both in-person services and gambling support services offered online. Most services are funded by the states and territories and are typically targeted towards geographic regions where there is the greatest concentration of electronic gaming machines. GTRC noted that, since online gambling can be accessed anywhere, gambling support services may not map as neatly and suggested that postcode-level data of those accessing services should be monitored.[81]

3.58There was support for increased investment in research into screening, assessment, targeted early intervention and treatment services for at-risk groups and communities, including harnessing the online environment.[82]

3.59GTRC recommended specific funding for financial counsellors to provide appropriate support to individuals and families experiencing gambling harm.[83] SPA called for ‘increased investment in treatment and support initiatives’ including ‘funding for integrated treatment facilities for people experiencing the harms of gambling at-risk of suicide’.[84]

Committee comment

3.60Australia’s rapid take up of online gambling has resulted in the world’s worst online gambling losses, which is having devastating consequences on those impacted. Our support services, where they are appropriately targeted, are overwhelmed. They have neither the resources nor staff capacity to respond to demand. There is no evidence-based protocol for supporting people at risk of suicide who are experiencing gambling harm. Health professionals are often unaware that gambling is the cause of the issues they are treating. Australia needs to recognise that gambling disorder is a mental illness that requires more appropriate and targeted treatment.

3.61Where services exist, shame and stigma and disjointed services are driving people away. There should be no wrong doors for people experiencing gambling harm to seek help. This requires raising awareness in the general community, and critically, among frontline services, that gambling harm is a health issue that can involve addiction and gambling disorder.

3.62A national strategy on online gambling harm reduction and a dedicated ministerial portfolio, as recommended in Chaptertwo of this report, will ensure that Australia applies a nationally consistent, public health approach to reducing gambling harms.

3.63The national strategy will support research to develop a set of standard indicators of risk and harm, prevalence studies and research into vulnerable groups, best practice interventions, treatments and supports, and research about gambling-related suicides.

3.64The national strategy will help counter the damaging narrative generated by the responsible gambling paradigm that places all the onus for gambling harm on the person who gambles, and which reinforces stigma by turning a health issue into a moral judgement. Efforts to reduce stigma should further increase demand for treatment and support services, which will need to be considered in the allocation of future funding.

3.65The national strategy will improve the coordination of state and territory activities. The imposition of a harm reduction levy on online WSP would provide a dedicated revenue stream to assist the national regulator to work with all jurisdictions to ensure that their funding and support is appropriately directed towards providing the treatment and support people experiencing gambling harms need, particularly the most vulnerable.

3.66It is concerning that many financial counsellors lack training to support clients who are experiencing gambling harm, including suicidality, and that many gambling-specific financial counsellors have not completed gambling-related training. Funding should be directed to train financial counsellors and improve their capacity to assist people seeking help for gambling harms, including suicidal ideation.

3.67The Committee recommends that the levy for online gambling harm reduction support the national regulator to work with all jurisdictions on best practice prevention, detection, early intervention, treatment and rehabilitation programs for people experiencing gambling harms, including:

• better training for staff working in health, community and financial counselling services, and crisis and gambling helpline staff, to identify gambling harms, comorbid issues and suicide risk, to minimise stigma, and to provide best practice treatment and support
• support for Aboriginal and Torres Strait Islander community-controlled health organisations and other organisations that assist culturally and linguistically diverse clients or patients
• increased availability of integrated treatment services
• enhanced referral pathways to specialist treatments and peer-based support services, including at the end of a self-exclusion period
• the development and implementation of screening tools for gambling harm in all mental health and drug and alcohol assessments.
  68. Banks, payday lenders, and licenced online wagering service providers (WSPs) all have a role to play in providing appropriate referrals to services for customers experiencing gambling harm or who are at risk of suicide.

3.69The Committee recommends that the Australian Government develops industry guidelines for the banking and financial sector, online WSPs and other relevant organisations to educate staff about gambling harm. The guidelines should include protocols for the referral of customers experiencing gambling harm who are at risk of suicide.

3.70Much of the gambling harm that occurs in the community, including gambling related suicides, remains hidden and unseen. Recommendation five would resource AGRC to take on the role as a national clearinghouse for gambling research. This will improve access to and the coordination of data and research about this critical topic. Recommendation six would require WSPs to disclose de-identified customer data on gambling participation, risk indicators, interventions and harm to the regulator and approved researchers on a consistent and systematic basis. Improved data collection and reporting is critical to ensuring that governments, researchers, and industry have a clearer picture of the effects of gambling, to fill evidence gaps, and to develop treatment and prevention frameworks for gambling harm.

3.71The Committee recommends that the Australian Government, in cooperation with the states and territories, establish a national data collection program on gambling harms and suicides. Data should be systematically collected from health and other practitioners and support services that interact with people who experience gambling harm, including emergency departments and coroners. The data collection should include de-identified customer data provided to the regulator by online WSPs.

Footnotes

[1]Professor Shalini Arunogiri, Chair, Faculty of Addiction Psychiatry, Royal Australian and New Zealand College of Psychiatrists (RANZCP), Committee Hansard, 7 March 2023, page 4.

[2]Mr Gavin Fineff, Committee Hansard, 21 March 2023, pages 2-3.

[3]Royal Australian and New Zealand College of Psychiatrists and Royal Australasian College of Physicians (RACP), Submission 110, page 3.

[4]Australian Psychological Society (APS), Submission 109, page 2; Australian Medical Association (AMA), Submission 83, page 5; Banyule Community Health, Submission 75, page 3.

[5]Wesley Mission, Submission 85, page 5; Name withheld, Submission 161, page 17.

[6]Miss Nidhi Rao, Submission 57, page 2.

[7]APS, Submission 109, page 2.

[8]Mr Gavin Fineff, Submission 7, pages [4] and [7].

[9]Mr Gavin Fineff, Submission 7, pages [4] and [7].

[10]Mr Gavin Fineff, Committee Hansard, 21 March 2023, pages 1-3.

[11]Mr Gavin Fineff, Committee Hansard, 21 March 2023, pages 1-3.

[12]Professor Dan Lubman, Executive Clinical Director, Turning Point, and Professor of Addiction Studies and Services, Monash Addiction Research Centre, Monash University, Committee Hansard, 1March2023, page45.

[13]Wesley Mission, Submission 85, page 6.

[14]Australian Institute of Family Studies, Australian Gambling Research Centre (AGRC), Submission 76, page5.

[15]Australian Institute of Health and Welfare, ‘Gambling in Australia’, September 2021, www.aihw.gov.au/reports/australias-welfare/gambling.

[16]AGRC, Submission 76, page 5.

[17]Mr Ken Wolfe, Committee Hansard, 5 December 2022, page 9.

[18]Care Incorporated, Submission 45, pages 3-4; Wesley Mission, Submission 85, page 6; ProfessorDanLubman, Turning Point and the Monash Addiction Research Centre, Committee Hansard, 1March 2023, page 45.

[19]Banyule Community Health, Submission 75, page 3; Suicide Prevention Australia (SPA), Submission 41, page 7.

[20]Care Incorporated, Submission 45, pages 3-4.

[21]Mr Kieran Hough, Senior Social Worker & Win Back Your Life Program Coordinator, Victorian Arabic Social Services (VASS), Committee Hansard, 14 February 2023, page 6; Gambling Treatment and Research Clinic, University of Sydney (GTRC), Submission 65, page 12.

[22]Mr Rick Loos, Manager, Telephone & Online Services, Turning Point, Committee Hansard, 1March 2023, page 47; AMA, Submission 83, page 3.

[23]Mr Gavin Fineff, Submission 7, p 4; Turning Point and the Monash Addiction Research Centre, Submission68, page 9; Queensland University of Technology (QUT), Submission 91, page 3; GTRC, Submission 65, page 4; SPA, Submission 41, page 7.

[24]Dr Catriona Davis-McCabe, President, APS, Committee Hansard, 7 March 2023, page 2; NationalAboriginal Community Controlled Health Organisation (NACCHO), Submission 70, page 7; MissNidhi Rao, Submission57, pages 2 and 4-5; APS, Submission 109, page 3.

[25]NACCHO, Submission 70, page 4.

[26]STRS Consultants, Submission 28, page 4.

[27]NACCHO, Submission 70, page 6.

[28]NACCHO, Submission 70, page 6.

[29]NACCHO, Submission 70, page 7; Miss Nidhi Rao, Submission 57, page 4.

[30]NACCHO, Submission 70, page 7; Miss Nidhi Rao, Submission 57, page 5.

[31]APS, Submission 109, page 3.

[32]Mr Kieran Hough, VASS, Committee Hansard, 14 February 2023, page 8.

[33]VASS, Submission 71, page 2.

[34]Relationships Australia, Submission 93, page 1.

[35]Dr Catriona Davis-McCabe, APS, Committee Hansard, 7 March 2023, page 2.

[36]SPA, Submission 41, page 7.

[37]Mr Nick Tebbey, National Executive Officer, Relationships Australia, Committee Hansard, 10February 2023, page 2.

[38]Mr Gavin Fineff, Committee Hansard, 21 March 2023, page 7.

[39]Mr Matthew McLean, Deputy Chief Executive Officer, SPA, Committee Hansard, 10February2023, page 16; Mx Caitlin Bambridge, Senior Policy Adviser, SPA, Committee Hansard, 10 February 2023, page 17.

[40]Name Withheld, Submission 131, page 1.

[41]Mr Matthew McLean, SPA, Committee Hansard, 10 February 2023, page 16; ProfessorShaliniArunogiri, RANZCP, Committee Hansard, 7 March 2023, page 4.

[42]Dr Stephen Robson, President, AMA, Committee Hansard, 7 March 2023, page 1.

[43]Care Incorporated, Submission 45, page 4; Banyule Community Health, Submission 75, page 7; TurningPoint and the Monash Addiction Research Centre, Submission 68, page 8; RANZCP and RACP, Submission 110, page 5.

[44]Care Incorporated, Submission 45, page 4; Banyule Community Health, Submission 75, page 7; TurningPoint and the Monash Addiction Research Centre, Submission 68, page 8; RANZCP and RACP, Submission 110, page 5; Financial Counselling Australia (FCA), The explosion of gambling harm and the need for urgent training for financial counsellors, May 2022, www.financialcounsellingaustralia.org.au/docs/‌gambling-harm-and-training-for-financial-counsellors/, viewed 30 May 2023.

[45]Turning Point and the Monash Addiction Research Centre, Submission 68, page 8.

[46]Professor Dan Lubman, Turning Point and the Monash Addiction Research Centre, Committee Hansard, 1March 2023, page 46.

[47]RANZCP and RACP, Submission 110, page 5.

[48]AGRC, Submission 76, page 5.

[49]Banyule Community Health, Submission 75, page 7; Turning Point and the Monash Addiction Research Centre, Submission 68, page 8; Care Incorporated, Submission 45, page 4.

[50]Banyule Community Health, Submission 75, page 4.

[51]Turning Point and the Monash Addiction Research Centre, Submission 68, page 8.

[52]Turning Point and the Monash Addiction Research Centre, Submission 68, page 8.

[53]Turning Point and the Monash Addiction Research Centre, Submission 68, page 8; Care Incorporated, Submission 45, page 4; SPA, Submission 41, page 9; Alliance for Gambling Reform (AGR), Submission 48, page18; AMA, Submission 83, page 2.

[54]AMA, Submission 83, page 2.

[55]Care Incorporated, Submission 45, page 4.

[56]AGR, Submission 48, page 3.

[57]AGR, Submission 48, page 15.

[58]FCA, ‘The explosion of gambling harm and the need for urgent training for financial counsellors’, May 2022, www.financialcounsellingaustralia.org.au/docs/gambling-harm-and-training-for-financial-counsellors/.

[59]Turning Point and the Monash Addiction Research Centre, Submission 68, page 7.

[60]Turning Point and the Monash Addiction Research Centre, Submission 68, pages 7-8.

[61]Turning Point and the Monash Addiction Research Centre, Submission 68, pages 8-9.

[62]SPA, Submission 41, page 9.

[63]Banyule Community Health, Submission 75, page 7.

[64]Dr Catriona Davis-McCabe, APS, Committee Hansard, 7 March 2023, page 2; QUT, Submission91, page 3.

[65]QUT, Submission 91, page 3.

[66]Name Withheld, Submission 112, pages 1-2.

[67]QUT, Submission 91, page 3.

[68]Care Incorporated, Submission 45, page 3.

[69]Turning Point, Submission 68, page 7; Wesley Mission, Submission 85, page 5; AGRC, Submission 76, page6.

[70]AGRC, Submission 76, page 6.

[71]AGRC, Submission 76, page 6.

[72]Wesley Mission, Submission 85, page 5.

[73]Wesley Mission, Submission 85, page 5.

[74]Wesley Mission, Submission 85, page 5.

[75]QUT, Submission 91, page 3.

[76]SPA, Submission 41, page 9.

[77]GTRC, Submission 65, page 12.

[78]GTRC, Submission 65, page 12.

[79]Department of Social Services, Submission 87, page 12.

[80]FCA, Submission 152, pages 3 and 51.

[81]GTRC, Submission 65, page 12.

[82]RANZCP and RACP, Submission 110, page 4; AMA, Submission 83, page 3.

[83]GTRC, Submission 65, page 12.

[84]SPA, Submission 41, page 9.