Complex treatment at the crossroads

by Leith Hillard

The name says it all: the Alfred Mental Health and Gambling Harm Program addresses comorbidity. In clinical terms, that’s the simultaneous existence of two conditions.

‘But it’s often impossible to determine which one comes first when it comes to gambling and mental health issues,’ says Vicky Northe, senior social worker at the Alfred. ‘It’s the chicken and the egg. The stress from gambling losses co-exists with several mental health disorders. Some clients say that gambling provides an escape even from psychosis.’

Vicky is the leader of a clinical assessment team made up of a social researcher, family therapist, clinical psychologist, occupational therapist, consultant psychiatrist and psychiatric registrar.

Working across Victoria, the team supports frontline services such as Gambler’s Help with complex case discussions, diagnostic clarification and treatment planning of clients with comorbid mental health and problem gambling disorders.

‘The stress from gambling losses co-exists with several mental health disorders.’ - Vicky Northe, Alfred Mental Health and Gambling Harm Program

The team was established in 2010 in response to research conducted at the Alfred that found 17.6 per cent of mental health patients who had either attempted suicide or had suicidal ideation had been affected by gambling.

They’re a wholly collaborative, short-term service only activated by, and working alongside, services that offer longer term assistance.

It’s a partnership of great benefit to the clients referred by Gambler’s Help Southern counsellor Gretta Daley.

‘I’m really proud of the work we do, but it can be very heavy,’ says Gretta, who has a caseload of 40 clients, many with past trauma. ‘We work with people with very complex lives and this team approach with the Alfred often brings greater clarity and improved outcomes.’

The full Alfred team is available for assessments and treatment conducted alongside the Gambler’s Help counsellor over four or five sessions. Also on offer is a family therapy session attended perhaps by a couple and their child. Two Alfred family therapists facilitate the session, which is observed via video link by one other Alfred team member and the Gambler’s Help counsellor. They join the family at the end to offer positive observations on the family dynamics.

‘Some of these families are experiencing conflict and may be contemplating separation,’ explains Gretta, ‘but one or both partners might be wary of couples counselling. This approach highlights relationship issues that might be reinforcing the gambling.

‘The clients can see everyone working in their favour right before their eyes.’

But that’s not all.

The Alfred team has the expertise to clarify mental health diagnoses and may explore medication treatment options such as Naltrexone. This addiction medication, which some studies have found effective for the treatment of problem gambling, may be prescribed when Gambler’s Help counselling is ongoing.

The program also strengthens inter-service links, building the capacity of Gambler’s Help services to deal with mental health issues, and mental health services to deal with gambling issues. Clients may manage severe psychotic symptoms, such as auditory hallucinations, outside a residential mental health facility, for example, but out in the community their issues with gambling remain. Bridges between the specialist services are therefore vital.

‘Their second opinion and psychiatric insight is invaluable.’ - Gretta Daley, Gambler’s Help Southern

‘They come to know our clients’ histories and issues, so their second opinion and psychiatric insight is invaluable,’ continues Gretta.

‘Hospitals are often strict about their criteria for access to public mental health services, but the Alfred team’s psychiatrists have supported our clients to access those important services that are just beginning to acknowledge gambling harm.’

Vicky agrees that the team plays an important role in advocacy, putting gambling harm front-of-mind when it comes to assessing mental health disorders.

Vicky also praises the sensory profiles done by the team’s occupational therapist. These profiles acknowledge that we experience the world through our senses and each of us has different sensory preferences – tastes and smells we love or loathe; too much noise for one person might be too quiet for another, for example. These preferences affect our behaviour and mood.

‘These profiles are fed back to Gambler’s Help to integrate into their work with that client,’ says Vicky. ‘They also link with therapeutic approaches such as mindfulness, where clients learn to be in touch with the present moment. Self-awareness supports connection with choices related to gambling.’

Also integrated into long-term counselling by Gambler’s Help are the insights gained from the Alfred team’s neuropsychology assessments. Clients’ cognitive abilities are evaluated with recommendations passed on to counsellor and client that might range from ensuring repetition of key points to encouraging clients to write things down or keep a diary.

‘Self-awareness supports connection with choices related to gambling.’ - Vicky Northe, Alfred Mental Health and Gambling Harm Program

An estimated 90 per cent of clients are referred to the Alfred team through Gambler’s Help while others come through mental health, drug, alcohol, housing and hospital inpatient services, general practitioners and psychiatrists.

Working around Victoria, they also run rural outreach clinics and offer clinical assessment support via video link to regional Gambler’s Help branches.

‘We’re flexible and adaptable with what works for services and clients,’ says Vicky. ‘Gambler’s Help provides an amazing service, taking their clients along an often long road to recovery.

‘We’re proud to play our part alongside them.’