Secrets, Lies and Fraud Auckland Clinical Team The Problem Gambling Foundation of New Zealand 2009
Social theory "Every Private trouble can be related to a public issue" Mills. C. W. (1959) The Sociological Imagination.
Aim Case study approach Explore links between: Clinical interventions with gambling affected families Public health interventions with community agencies Method Describe case study - gambling related fraud Identify factors relating to: Self control Risk management Relapse prevention Legal proceedings, outcome pending, lengthy delay Aim and Methodology
Fraud & Gambling • Overall amount fraud increased since 2006 • Gambling is major motivator for fraud • 44% total value fraud attributed to gambling • Fraud recovery 11% Down from 37% 2006 • Reduced recovery rate closely related increase gambling motivated fraud • Average value $1.1m per fraud • More than threefold increase since 2006 survey • Substantial economic costs for society KPMG Forensic Fraud Survey Australia & NZ 2009
Sentencing Problem Gamblers in NZ • Problem or pathological gambling is invisible as a mitigating factor in criminal sentencing • Failure to recognise gambling in sentencing decreases the likelihood of rehabilitation • Increases the likelihood of re-offendingMinchin 2006 • Does not address risk management
Continuum Approach –Evidence based Intervention • Our clinical practice and intervention plans place people on a sliding scale. • People can change their gambling behaviour over time. • People are affected by the range and interaction of risk and protective factors • Individual • Social systems levels • Couple relationships • Family • Community • Society • Identify factors amenable to change Develop optimally effective interventions Thomas, S & Jackson, A Beyond Blue National Depression Initiative 2007 SHORE Whariki Assessment Social Impacts of Gambling 2008 Important evidence for developing continuum approach
Basic Risk and Protective Factors Model - Evidence based Source: SA Thomas and A Jackson Risk and protective factors, depression and comorbidity in problem gambling. URL http://www.beyondblue.org.au/index.aspx?link_id=6.718&tmp=FileStream&fid=1041
Protective factors “Protective factors are influences that modify, stop or alter a person’s response to some hazard which predisposes the person to a maladaptive outcome.” Rutter 1990
Risk factors “a risk factor is a variable that is associated with an increased risk of a condition. It does not suggest a causal relationship…” Thomas & Jackson 2008 Identification high risk factors leads Identification of high risk groups Target early intervention and or prevention. Interaction of risk factors important Thomas & Jackson 2008
Relative risk data Thomas & Jackson 2007
Co morbidities that are risk factors for problem gambling • Problem gamblers have high rates of psychological disturbance, hazardous alcohol use, smoking and depression in combination with other social and family problems. Complex clients create a need for new evidence based clinical interventions Risk Management Assessment Prioritising solutions together
Gambler: female 40 years European, middle class payroll clerk, 3 years Mode: Keno @ local dairy De-facto relationship 17 yrs Partner: truck driver Two children: 18 months and 5yr Families of origin: physical distance plus lack of support “Keeping up appearances” dominant pattern Employer – medium sized family owned company Detection – fired – made bankrupt – caveat mother’s house and partner’s cars Lengthy period waiting to be charged, then another lengthy period waiting to be sentenced. Case study
Secretive gambler, partner knew fraud charges not about gambling. Gambling known only to mother, sister Fraud $400 000 – amt concealed from partner, clue from bankruptcy Legal aid advice – Home D likely outcome. Partner not prepared to look after dependents on own and didn’t attend court hearing. Gambler sentenced to custodial sentence Partner finds out about gambling after imprisonment Where is the baby? What is happening? After imprisonment: co owner of Company took out security over partner’s cars, tried to manoeuvre partner to take cars. Case study: Layers of concealment
Protective factors Individual • Strong sense of capability Relationship • Stable, long term, wish to be together after shock & devastation. • Mutual love of children, positive parenting skills
Protective factors: environment • Referral for gambling assessment and counselling by legal representative. • Pre sentencing assessment & crisis management of identified risk factors • Ongoing regular counselling support • Clinical interventions that strengthened personal resiliency • Pre sentencing report for Probation services • Counselling & advocacy for partner during custodial sentence • Gambling counsellor as expert witness for High Court panel of judges • Secret disclosed - two trusted family members
Risk Factors - individual • Egotistical self belief “can beat the system” • Anti social personality • Moderate depression • Poor coping skills • Over responsible family role • husband under functioning • Cognitive defences & distortions Maintaining secrecy by calculating & cunning ways Over intellectualisation Make up for deficit emotional coping skills "More money will fix it!" wish fulfilling fantasy "I am a winner" Keeping up appearances
Risk factors - Relationship • Lack of intimacy - emotional and physical (“really relating”) • Negative communication patterns • Power and control • Diminished self disclosure & openness • Fragmented self • Over responsible façade versus hidden emotional I am not going to risk accepting or offering anything in this relationship because I am doing the dirty on you "to be honest with you I pick a fight so I can go gambling"
Risk factors - environment • Legal – no money no effective representation • Court – Judge’s attitude sympathetic to defamatory statements of company – worst sentence outcome for client • Middle class family encounter with social agency systems lack flexibility for support & resource options • Result • Blind to children’s safety & care • Blind to partner’s coping skills Justice is blind
Risk Factor: Social Capital • Problem gamblers have low levels of social capital (Thomas and Jackson) • Social capital is evidenced by: • Level of interaction with others in the community • Quality of relationships • Examples of community involvement: Church, community groups • Examples of positive family/whanau interaction: regular social activities that support positive identification.
Pre sentence Period Risk assessment & Crisis management Development two clinical goals with broader plan support Sentence & Probation Period Risk assessment & crisis management for partner & family Advocacy – community agencies Continuum Approach –12 -24 months service contact Environmental risk are better managed by long term public health interventions.
Goal 1 – self control Strengthen resilience Increase self understanding: Hearing story Reframing to create safety and awareness Goal 2 – relapse management Making connections between F/T/B Work toward self acceptance Ability to move forward to rebuild life Risk Management ongoing clinical intervention Outcomes Diversify coping skills: reduce impacts from risk factors Home D not imprisonment Increase impacts from protective factors Ongoing commitment to improve communication and quality of openness and trust in relationship Shared understanding of problem and improved coping skills to manage Risk Management - Goals & Outcomes Words found for concealed thoughts, fears, feelings
Public Health Interventions • Reduce environmental risk factors • Increase visibility of problem gambling as a factor in social policy development in large organisations such as: • Will require developing a comprehensive education package based on the new evidence Justice system Cyfs corrections Winz
Recommendations Service planning & funding • Closer attention needs to be paid to new approaches using risk and protective factors that allows for measurement of clinical outcomes • Evidence based approaches need to be applied to existing funding models to deliver adequate resourcing that takes into account case complexity. • As opposed to an individualised medical approach • Current electronic information systems do not capture the range of assessment and interventions we are implementing to minimise risk and maximise protective factors.
Contact details Jenny.firstname.lastname@example.org Cheryl.email@example.com Michael.firstname.lastname@example.org Narelle.email@example.com Problem Gambling Foundation 09 368 1520 128 Khyber Pass Grafton Auckland.