1. Who we are and why are we here?

2. The Victorian Statewide Problem Gambling and Mental Health Partnership Program 2009-2011

3. Who are we? Anthony Kennedy Project Manager Karen Harrison Project Officer, Training and Education Mick Field Senior Clinician, Clinical Services Evan Symonds Consultant Psychiatrist, Clinical Services Stuart Lee Evaluation Officer

4. Partnerships

5. And why are we here? A brief background of the pilot project and current research to support the need for services within the mental health and problem gambling communities

6. Problem Gambling & suicide The Productivity Commission (1999) – 9% of problem gamblers thought about suicide because of their gambling; 60% of those were in counseling Studies have reported levels ranging from 17%- 80% for suicidal ideation and 4%- 23% for suicide attempts

7. Problem Gambling & suicide Penfield et al (2006) study of attempted suicide &/or self harm episodes screened for problem gambling in A&E Dept of Auckland Hospital reported 17.1% had gambling problem. MAPrc-Alfred study (2006 & 2009), CATT presentations: 17.2% screened positive for problem gambling.

8. Problem Gambling and Suicide: MAPrc-Alfred Study 2009 50% of clients report being suicidal before they had gambling problems 50% of clients reported being suicidal after they had gambling problems

9. Problem Gambling and Suicide: MAPrc-Alfred Study 2009 80% of participants had been gambling for more than 10 years. 55% of participants had spoken to their GP about problem gambling while100% had spoken to their GP about Suicide.

10. Co-morbidity and pathological gambling: Epidemiological data 43,093 US adults participated in face to face interviews in the 2001-2002 survey. 73.2% of pathological gamblers had an alcohol use disorder 38.1% had a drug use disorder 60.4% had nicotine dependence 49.6% had a mood disorder 41.3% had an anxiety disorder 60.8% had a personality disorder Petry et al (2005)

11. Co-morbid problem gambling and serious mental illness McIntyre et al (2007) Bipolar Affective Disorder (6.3% problem gambling) Desai & Potenza (2009) Psychotic disorders (19% problem/pathological gambling;10% pathological gambling)

12. Pilot Project: Alfred Psychiatry & Gamblers Help Southern Relationship building between Alfred Psychiatry and Gamblers Help Southern. Establishment of screening and brief intervention to clients presenting to the Alfred with PG. Education and training mental health clinicians on PG. Protocols to support inter-agency liaison. Problem Gambling special interest group within Alfred Psychiatry established.

13. Screening and brief intervention referrals within the community CATT/ triage (42%) Acute inpatient units (20%) Gamblers Help Southern (10%) Community mental health/ community health (28%)

15. Our Mission: To increase knowledge and capacity within Victorian Area Mental Health services (VMHS) and Gamblers Help services (GHS) to provide optimal outcomes for clients who present with co- occurring Problem Gambling (PG) and mental illness (MI).

16. Main Aims: 1) Raise awareness… (2) Enhance accessibility… (3) Provide timely access… (4) Increase knowledge and skill capacity…

17. How the program works: This program will use a two tiered approach consisting of: education and training clinical service support

18. Training Needs and Analysis What do we want to know? What do you want to know?

19. Education and Training Development of tools to assess the capacities of the VMHS and GHS to effectively respond to co-morbid mental health and gambling problems: Mental health screening/assessment tools Managing suicidal clients Managing clients who self-harm

20. Education and Training What do you know about… High prevalence disorders Low prevalence disorders Substance abuse AND Problem Gambling?

21. What is your experience? Who are your clientele? What are their needs? How do you support them?

22. Too much or too little? Psycho-education Pharmacology and mental illness Social strategies Psychological interventions

23. Are you comfortable with… Monitoring your clients mental illness? Preparing a relapse prevention plan? Navigating the mental health service structure?

24. What is your experience with… Integrated treatment? No wrong door philosophy

25. What works/what needs work? Established partnerships/collaboration Established referral pathways Access to area mental health services

26. Tell us your stories… Real struggles Real issues Real people

27. Clinical Service Primary and secondary consultancy service Specialist support and system development Continued local partnership with Gamblers Help Southern

28. Primary and secondary consultancy Clinic staffed by a senior clinician, consultant psychiatrist, other services on a needs basis. Provide specialist psychiatric consultation to Gamblers Help services in relation to clients with co-occurring mental health issues.

29. Primary and secondary consultancy Support clinical pathways for clients with co-occurring mental health issues and problem gambling Develop and conduct training and professional development activities for Gamblers Help staff (MH portfolio positions) and MH clinicians.

30. Specialist support and system development Strengthen and enhance workforce capability Support the establishment of policy and procedures to enhance service collaboration.

31. Workforce and organisation engagement Gamblers Help managers and Mental Health portfolio workers Senior psychiatric nurse network Area mental health manager network. Primary mental health team network

32. How to contact us… For clinical services: Mick Field Office: (03) 9076 4700 Mobile: 0400047169 For education and training: Karen Harrison Office: (03) 9076 4700 Mobile: 0438371141 pgmi@alfred.org.au www.pgmi.org.au