“Talk with me”: perspectives on services for men with problem gambling and housing instability

Abstract

BackgroundProblem gambling and homelessness are recognized as important public health concerns that significantly impact individuals, their friends and families, communities and broader society. We aimed to explore the experiences with health and social services of men who had histories of problem gambling and housing instability in Toronto, Ontario.MethodsWe used a community-based participatory approach with a multi-service agency serving low-income individuals. We conducted qualitative interviews with men (n = 30) who had experienced problem gambling and housing instability. Our interviews employed open-ended questions to elicit men’s perceptions of services related to housing instability, problem gambling and other comorbid conditions (e.g., mental illness, substance use). We reviewed relevant themes related to experiences with services (e.g., Use of and feedback on: health and social services, housing services, justice/legal aid services, substance use services, gambling services; stigma; goals; triggers; physical health; coping strategies; finances; relationships; barriers to services and recommendations for services).ResultsThe concept of person-centred engagement was identified as a main overarching theme, and seemed to be lacking in most of the men’s experiences of services. Person-centred engagement for these men entailed empowerment and autonomy; empathy, compassion and sincerity; respectful communication; and tailored and holistic life plans. While there was a strong emphasis placed on independence, the men identified the importance of positive therapeutic relationships as being critical aspects of the recovery process. Based on our analyses, several recommendations were identified: 1) Increasing general awareness of services for problem gambling; 2) Delivering integrated services in a one-stop-shop; 3) Addressing mental health with psychotherapy and pharmacotherapy; 4) Providing timely access to prevention and recovery services; and 5) Enhancing life skills with peer support.ConclusionsOur study highlighted that most of the men we interviewed were not having their health and social needs met. Services need to address the intersection of problem gambling, housing instability, and other comorbidities. Ensuring services are grounded in person-centred engagement appears to be critical for optimal service delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1583-3) contains supplementary material, which is available to authorized users.

The use of self-management strategies for problem gambling: a scoping review

“…Those who are most susceptible to PG often experience other complex health and social concerns such as homelessness, mental health issues, substance use disorders, and incarceration [ 3 – 5 ]. Existing services are often not integrated and thus are not designed to address concurrent concerns with PG [ 6 ]. Among treatment seeking individuals, there is a need to increase awareness of existing PG-related services and supports [ 6 ].…”

“…Existing services are often not integrated and thus are not designed to address concurrent concerns with PG [ 6 ]. Among treatment seeking individuals, there is a need to increase awareness of existing PG-related services and supports [ 6 ]. Further, while there are PG interventions that have demonstrated effectiveness, they can be inaccessible to many vulnerable groups due to barriers such as geographical distance, long waitlists, and treatment costs [ 6 – 12 ].…”

“…Among treatment seeking individuals, there is a need to increase awareness of existing PG-related services and supports [ 6 ]. Further, while there are PG interventions that have demonstrated effectiveness, they can be inaccessible to many vulnerable groups due to barriers such as geographical distance, long waitlists, and treatment costs [ 6 – 12 ]. Barriers to treatment of PG are reflected in low rates of treatment-seeking, as some research has found that only 1 in 10 people experiencing PG seek treatment compared to 1 in 5 people with alcohol-related disorders [ 13 , 14 ].…”

Factors related to screening for problem gambling among healthcare and social service providers in Ontario, Canada: A concept mapping study

“…This fragmentation of services in Canada was identified by Guilcher and colleagues, who reported a lack of service integration among men living with problem gambling in an urban setting. In this qualitative study, Canadian men who were precariously housed and experiencing problem gambling reported not receiving screening or combined services for their complex needs (e.g., housing instability and substance abuse disorders) through one program (Guilcher et al, ). The authors suggested that there was a need to address the intersection of problem gambling with other complex health and social needs using an integrated care plan or a one‐stop‐shop design (Guilcher et al, ).…”

How to Support Prison Workers’ Perceived Readiness to Identify and Respond to Possible Gambling Problems: a Pilot Study from Two Finnish Prisons

“…Despite the obstacles, there is some evidence that prisoners are in fact keen to receive support and treatment (Riley 2017;Lind et al 2019). Given the challenges involved in identifying addiction, it is important that steps are taken within the correctional system to address the lack of knowledge and awareness about problem gambling and the lack of services in general (Guilcher et al 2016;Hamilton-Wright et al 2016).…”