A healthcare needs assessment of gambling harm in Scotland and recommendations for a model of care

Abstract Introduction Gambling is associated with risk of harm to health and is understood as a commercial determinant of health. This healthcare needs assessment aimed to understand the need for services to address gambling harm in Scotland and provide recommendations to meet this need. Methods This needs assessment consisted of three approaches. An epidemiological needs assessment quantitatively described healthcare needs. A corporate needs assessment undertook a qualitative research process engaging with people with lived and professional experience of gambling harms. A comparative needs assessment compared healthcare needs in Scotland to those in England and Wales. Results There is evidence that gambling harm negatively impacts health, finances, families and relationships in Scotland with an impact on many public services. Harm may have a greater effect on marginalised populations. Five major themes identified from the qualitative research process detailed low awareness of gambling harms, a lack of clear pathways to support, proposed principles for development of future services, research and evaluation needs, and wider public health issues. Health needs assessments undertaken in England and Wales in echo many of these findings. Recommendations This healthcare needs assessment identified seven priorities that should be considered in the development of further services. Healthcare delivery to address gambling harms should be provided locally and integrated with existing services, flexible to ensure person-centred care, have a clear pathway to access services, be evidence based and evidence generating, designed with people with lived experience and free from the influence of the gambling industry. Therefore, we propose a model of care for a Scottish Gambling Harms Service, comprised of Local Gambling Harms Recovery Networks and a Scottish Gambling Harms Clinic aiming to provide wraparound services for anyone experiencing gambling harm in Scotland. Key messages • Gambling harm was identified as a public health issue in Scotland with a negative impact on individuals, families, and wider communities. A need for person-centred, equitable care was identified. • We provide recommendations for a Scottish service which aims to contribute to a public health approach to this commercial determinant of health and may be of interest to many European colleagues.