Transcript: Harm reduction and gambling: Building the evidence for policy development

AIFS seminar: Harm reduction and gambling: Building the evidence for policy development - 24 February 2015

Audio transcript (edited)

The following audio presentation is brought to you by the Australian Institute of Family Studies as part of our monthly seminar series in which we showcase national and international research related to the family. The seminars are designed to promote a forum for discussion and debate. They are open to the public and free of charge.

Seminar facilitated & speaker introduced by Dr Daryl Higgins.

Dr Anna Thomas

Thank you Daryl for that very kind introduction and yes actually I was reflecting on the very same things that coming from a psychology background very much emphasising that individual focus. What is it about this person and what leads them into harm or problematic behaviours in various ways? The addictions area, maladaptive behaviours has always been a strong interest of mine but my curiosity really was always about the intersections between the individual and the situation in which they find themselves. So what is it about this environment, these people that are surrounding this person, and this person? What links them together?

So in some senses it's been sort of almost a natural segue into this kind of an area, which really is about - one of the underpinnings of the Australian Gambling Research Centre is to conduct research and produce data and statistics that inform policy. That helps develop policy. So maybe it's a bit of a natural progression. But having been here for the past two years I do feel like I'm still very much on a learning curve here. So I would be really interested in discussion at the end of this about your ideas and thoughts in terms of evidence base underpinning policy and how that can occur.

Okay so yeah so that's what we'll be talking about today is this in a bit more detail and what I'm going to do is actually talk about a couple of areas of research that I've been involved in and use those as exemplars to talk about this in a bit more detail. So the pieces of research that I’ll be particularly drawing on are the evaluation of the removal of ATMs from gaming venues that occurred in Victoria in 2012. I conducted that along with some colleagues at Swinburne University and that particular piece of research was funded by the Department of Justice in Victoria and the - some unpublished reviews of research that we conducted in the early days at the Australian gambling research centre for then FaHCSIA who are now DSS. But that sort of - that research did give us some really useful information that we have that I'm going to draw on today.

Okay so just to give you an overview so you know where I'm going and when I get to the end. What I'm going to talk to you about today I'm aware that the audience here today is some people who have quite a lot of knowledge around gambling and some people who perhaps have less of a knowledge but are wanting to learn a bit more. So we'll talk about gambling and it's really it's very much an accepted activity in Australia but it can leave to extensive harm. As such there is a need for continual improvement and harm reduction in this area. Anything that's associated with harm we need to be thinking about how to reduce and minimise that harm and there are roles for both government and research within that area which is really what I'm wanting to talk about today and the importance therefore of using that research evidence to underpin policy development so we have good well informed policy development.

So in Australia gambling is - I'm sure you're all well aware living in Australia a very common activity. Quite an accepted activity within our society. Some of the latest stats that came - were collected in 2011 suggest that around 64 per cent, so just over half the population reported that they gambled in that current year. In terms of historical perspective there's actually been recent reductions in the proportion of people who are gambling. So if you look at the whole population the proportion of people gambling has started to reduce slightly. However the raw numbers of people walking through the doors are about the same. So because we've got a growing population if you look at the actual numbers of people gambling that's about the same and importantly the proportion of income that they are spending on gambling is about the same. So the expenditures seem fairly stable.

A piece of research that was produce by the Economist last year and appears if anyone is coming from the gambling area you're probably getting quite familiar with this slide. It pops up again and again and again. But it is really useful to look at because it shows that we are in fact on a per capita basis the biggest gamblers in the world. We spend more per person than anyone else in the world and that's quite a startling statistic to look at particularly if you're less familiar with the gambling world. So it is something that's important for us as researchers in Australia.

But we also need to consider the fact that not all gambling is equal. It's not all the same thing. The most popular activities that we have in Australia tend to be Lotto. Still lots and lots of people buying their weekly Lotto ticket. Scratch it tickets also very popular. Race betting and what I'll talk about electronic gaming machines or EGMs that's the technical term. Basically the pokies. Also quite a popular form of gambling in Australia. But when you look at the highest spending forms of gambling. Where's all the money going? You get a slightly different picture. Absolutely the pokies and I'll show you in a minute by well and above anything else in terms of spending but also casino games and race betting. So they're the ones where most of the money is going.
Sports betting which is one. Online gambling and sports betting very commonly talked about in the media. It is growing. Growing at a very rapid pace and growing more quickly than other forms of gambling but starting from a very low base. So you're still seeing it's actually quite a small proportion of the market in terms of gambling at the moment.

This slide I like. This was produced by a couple of people from my team. Marissa and Andrea and I thank them for this because I really like this slide because it shows you what the expenditure is like when you're actually looking at who's gambling on what. So when we talk about gambling and us being the biggest bank gamblers in the world the stat that's quoted is just over a thousand dollars per person per year. But if you look at just the gamblers and remember only about 60 per cent of people are gambling you're looking at more like $1800 per person per gambler spending in a year. Which is quite a substantial proportion of money. When you start to look at that per form of gambling, gaming machines only around 20, 22 per cent of people are gambling on gaming machines in a year. Per EGM gambler you're looking at over $3000 per person per year. With casino gambling it's nearly $1500 and then you've got the racing gambling.

So you can see quite clearly where the money's going okay when you look at something like this. So it is really important to consider the form of gambling when you're talking about gambling and not just talk about gambling as one big homogeneous blob because it isn't that and what I'll be talking to you about today in terms of harm reduction is about harm reduction measures and the evidence base in terms of EGMs 
- pokies because that is the form that we know is most associated with expenditure and expenditure of course is the thing that's related to harm and what we need to consider is that even a single episode of gambling that is more than the person wanted to spend can lead to some kind of harm. Potentially unable to pay bills and not enough money to go out. Can't go out this week 'cause I just blew all my money at the pokies or on the races or not enough for socialising. But really importantly when we're talking about extended gambling issues for someone they can lead to major, long term harm both to the gambler themselves and to people around the gambler and so it is really important that we think about gambling and the harm around it.

So it can lead to - I've got a lot of things up there that it can lead to but basically just to pick out a couple, work and relationships, domestic violence, unmanageable debt, poverty even homelessness can occur as a result of gambling. Social isolation. Mental and physical health problems. We know sometimes they can lead to gambling but also very much a consequence of too much gambling. Intergenerational transmission of gambling problems. So lots of harms that can happen. So it is a community wide issue. It's not just a problem that a few people have and we should - we should help fix them up when they get there. It's a community wide issue that we all need to be aware of.

We think according to the latest stats that something around 3 per cent of people may be experiencing moderate to sever issues with their harm. So a lot of issues that are happening with their gambling but there's a much larger proportion who are experiencing some kind of harm based on their gambling. Some kind of negative effect. Might be around 19 per cent we really don't know. The 19 per cent's really just taking our standard screen for gambling issues and looking at anyone's that ticked any of those items for any kind of consequence from their gambling. But that's a really crude measure and something that research that we're interested in terms of research into the future is to actually really capture that harm and understand that much better.
People around the gambler are also harmed. The estimates that were conducted in around 1999 by the productivity commission suggest it might be around five to ten people around the gambler but we again we really don't have a very clear picture of who it is and how many people are harmed around a gambler but we know that it's quite extensive.

When we're talking about harm the ones that are most associated with expenditure are the ones that are most associated with harm. So pokies by far the biggest cause of harm too. Consistently we're getting a picture that it's around 70 to 80 per cent of people who are presenting for treatment for gambling issues they're talking about the pokies. So that's far and away still the biggest cause of harm that we're 
- as far as we're aware in terms of gambling. Race betting also can lead to quite a lot of harm and online sport betting again a small but growing problem so something that we know is creeping up in the community and there's a lot of people taking a lot of notice at that at the moment.

Okay so when we talk about gambling issues and the cause of gambling issues very complex area, as are most of the other addictive areas. I argue to stem - we really think that they're stemming from a lot of interrelated factors. It's not one thing that will lead you to have a gambling issue it's the accumulation and interaction between a number of different factors and they can come from the person. So that psychological background that have had. There's a lot psychological research in terms of gambling and really we know that things to do - there may be some biological or temperamental vulnerabilities that sit behind a person who might have gambling issues. There may be some underlying depressive or other factors there. But there's also the social and situational area around that individual. So what's happening there around the person? Is there a partner that's gambling? Is there a domestic violence situation that's happening? What else is happening around that person? Did they grow up in a family that had gambling problems? The environment around that person in a wider context also really important.

So what's the area that they're living in like? Is it a low socio-economic area? Is there not much employment around? Do they not have much scope for actually earning money and therefore this seems like a reasonable idea that they might actually earn some money from gambling? The actual gambling environment itself. How many gambling opportunities are surrounding this person. In Australia we live other than in Western Australia an area where there are a huge number of gambling opportunities around the person and in terms of EGM or pokie gambling you know you really only have to travel about five to ten minutes to reach a venue almost everywhere in Australia. So that environmental factor.

And then we have the gambling product itself. So what is it in this gambling product, these pokie machines that could potentially be leading to harm? So the interaction between all of these different factors that may lead to someone having a gambling issue and we're conducting a research project at the moment, Gambling in Suburban Australia that's looking at the interactions between these factors and particularly around the environment and the product.

So as a researcher coming from - you know people coming from many different perspectives you may have more of an interest in the person factors or the social and situational state around the individual or the others. Someone coming as a government researcher you are more likely to be interested in the types of factors that you can have some type of an influence on. Obviously you're going to be interested in those. So in terms of a direct influence the environment and the gambling product are things that a government intervention is most likely to perhaps be able to target. Something about the environment that the person lives in. Something about the gambling environment or something about the product. They may also be able to influence harm, reduce harm indirectly through some kind of an intervention that taps to the person. So something that they can influence within the environment that may have an influence on that person. If you're talking about a very depressed area influencing the number of employment opportunities in an area may indirectly assist someone in terms of having another way of earning money therefore not thinking so much about gambling as a way of earning money. Perhaps something like that.

Influencing something to do with counselling is in an obvious area where you're talking about an indirect influence. Helping that person to overcome their issues, deal with it better and then perhaps reduce their gambling.
So the key role of government. There is a very key role of government here in terms of balancing protection and freedom of choice. So the need to reduce harm but in doing so they have this balancing act to produce. So when we're talking about gambling people have the expectation with this and any other product in our community that what's provided to us and that we're allowed to consume is safe. We have this expectation that the government is protecting us from things that are really harmful. We also have an expectation that we have a freedom of choice to do the things that we want to do. Even if we happen to be making bad choices we want to have that freedom of choice to make those choices. So there is this balancing act that needs to happen all the time in terms of protecting the community and provide - and allowing them to have that freedom of choice.

So governments when they're doing this balancing act can provide protection by enhancing gambler self-responsibility through strength in their individual capacity for informed choice. So what I mean here is you can help give people really good information so that they can make better choices and provide the products in a way that assist people to make better choices. So if we think about that in an aligned area if you think about something like alcohol you know that might be about providing people about the information about how much alcohol is in a drink. How big a standard drink is. What that actually means to you. How many standard drinks until you are over the limit when you can drive. How many drinks might be in a bottle. What are the guidelines around drinking? So we know a lot of that kind of information. That doesn't tell you how much you can drink. That gives you information to inform how much you might drink.

Similarly things can happen in the gambling area. The other way is to reduce risk by moderating features of the gambling environment that are shown to be hazardous. So that's much more a, "We think this is really quite hazardous, quite harmful and as a government we believe that we need to put some kind of an overlaying protection in place regardless of whether you really want that to be there or not." So something if we think about that in an allied area we've got things like an age at which you can start to drink. Opening hours of a pub or a club. We similarly have opening hours that are restricted in terms of gambling environments. So those sorts of things that are enacted that go across people. How much alcohol is allowed in a bottle of - in a standard drink. In a bottle of drink. Those type of regulations. So let's talk about harm reduction in that gambling space. Considering the role of the government and research evidence and in doing that acknowledging as Banks said in 2011 quite well, "Building evidence is both very very important and actually quite difficult to do." So we need to acknowledge that it is important to do this but it's quite hard to do it and in the end some kind of action's likely to have to take place with imperfect evidence. Never going to get that perfect evidence. But it is still really important to be having that evidence, building that evidence, evaluating what's coming and happening in place.

Okay so as I said we're going to use two exemplars today. Reducing accessibility to cash in EGM venues. So this was one form of a measure that was put in place in Victoria. Try and reduce the easy accessibility of cash through the removal of ATMs. And pre-commitment technology which is about assisting and helping and encouraging people to set limits on the amount of time and money they spend gambling and providing them information on their spending play patterns.
So the removal of ATMs from EGM venues. What was the context around that? So ATMs at the time that this happened in Victoria there was a daily limit, withdrawal limit of $400 that you could withdraw from the ATMs that were situated within a gaming venue and $200 per transaction and the ATMs had to be located outside of the gambling room. In other states there's different legislation in place. Not all states have a daily limit. So there some difference in those compared to here. Eftpos was available also generally in venues although very little used and often the venues didn't actually allow people to use the Eftpos unless the ATM was down. So it was there. It was happening. Also had a $200 per transaction limit but no daily limit and that remains the case.
Legislation was introduced then in 2009 that basically said that all of the ATMs had to be out of pubs and clubs but they allowed ATMs to remain in the casino and in the racecourses that have a lot of other alternative types of betting but still those ATMs had to be over 50 metres away from EGM gaming rooms. So that was the context behind it.

What was the evidence behind this decision-making? In fact there was quite a lot of evidence that sat behind that had been conducted previous to this happening. So we knew already that people with gambling problems were more likely than other gamblers to use ATMs in venues. To use them on a regular basis. To use them more than one time in a single session. They were - we know that ATMs are most often used in order to fund gambling. That is why you use and ATM in a gaming room and in a gambling area and it was more likely to be done by higher risk gamblers. Problem gamblers and counsellors also reported that that easy accessibility to money in a venue was an important contributor to gambling issues. So based on this, should work, but that doesn't guarantee success. There's always going to be ways around this type of thing. So people may choose to circumvent the system and do that in a number of ways.

So they might switch to Eftpos as a way of accessing money. As I said when this came in Eftpos remained in place so people could actually change from using an ATM to using the Eftpos facilities. They might go outside and use local ATMs within easy range of a venue. They might bring more money into a venue. So it is really important to evaluate the effectiveness of an intervention even if there's good evidence behind it before it comes into place.
Assess to see how effective it is. Does it work as a harm reduction measure for those really at risk people? Does it work as a consumer protection measure across the board for people? And also a need to measure costs and unintended consequences. So no just how effective it is. How much does it bloody cost to do it? And are there consequences that we weren't expecting to happen?

So in 2012 this evaluation happened. We used a pre/post methodology. So we collected data beforehand. We collected data afterwards. We triangulated it across multiple sources and methods. Surveys and interviews with patrons, venue managers, operators and other key stakeholders and I'm just going to touch on a couple of key messages so if you want to get some more information you can ask me later on. I can give you a massive report that you can go away and read if you like but this is just going to tap into a couple of them. Just to highlight the way that this builds evidence to support decision-making.

So I'm going to draw primarily on the pre/post surveys which were conducted with over 900 patrons and we had a really good retention rate over 80% so we're pretty confident on that and that ranged from no risk gamblers through to very high-risk gamblers. We also conducted post intervention structural interviews and with surveys with the venues. So we asked all the venues to take part in a survey. Around 164 of them did take part out of the 500 odd and we did some interviews as well. Didn't get as good a representation of the data from the venues as I wanted to but we did get reasonable information.

So in terms of effectiveness the key thing that you want to be looking at in if you're reducing the accessibility to cash is that you actually see a reduction in spending and particularly for the high-risk gamblers and that is in fact what happened. So there were significant reductions in the money spent by problem gamblers on EGMs in their typical sessions at pubs and clubs. For the hotels it was for those - that really high risk group it reduced from time one to time two by about $90 a session and about $40 a session in the club. So you saw a significant reduction on average across the two time zones for that group. Also packed in a pattern of reduced expenditure from time one to time two across the board.

Importantly those findings were also supported by a sustained reduction in EGM expenditure across the board. So when you actually looked at the EGM expenditure that's publicly available for all venues across the state there was a reduction by about 7 per cent in that spending immediately. Picked up a little bit at one point then came down. Followed the normal seasonal trends but it has sustained across the longer term. So that's really important to see and interestingly no significant reductions in spending on other forms of gambling available in the venues or on the gambling - at the gambling venues where the ATMs remained. So it really did seem to happen in the venues were the ATMs were and it was around the EGM gambling. Also saw similar reductions in - similar pattern of reductions in the amount of time spent at the venues and amount of time spent on the pokies.

So why didn't that ATM use transfer across to Eftpos use? While they did - venues did enhance the Eftpos facilities at venues going from, "No we don't really like people to use that. Use the ATM" to "Yes of course Eftpos is available. Yes you can use it." They also converted to these machines that look very much like ATM machines which they say acts a safe which it would do as well so you can fill them up with the money and can fill them up when the venues close. But it has that interaction with staff requirement that happens with Eftpos. So you have to actually go up and find a staff member, ask for some money out, put in your things and then you're either given a piece of paper or your card then works in the machine. So you can't just go off and do it by yourself and that was part of why that was allowed to remain in place because there was the expectation that having to have that interaction with staff would act with some kind of a hold on people and problem gamblers had talked about that before hand that they weren't - wouldn't really be comfortable with going up and talking to someone and doing that repeatedly.

The patron interviews provided again that sort of insight that did support that, that they found actually across the board people did not really like to go up and withdraw money using a face-to-face interaction. They like to keep that sort of thing private. Particularly weren't keen on going up and doing that multiple times. It also took a lot more time. You might've had to stand in a queue. You had to go through this two or three step process. Really people didn't like that but they really didn't like observed. As this person with gambling problems said, "You sort of don't want to go up the third time with your card. I don't know whether they'll say anything. Whether they've been trained to." And in fact under responsible service of gambling you should if you're seeing someone come up repeatedly, taking money out and going back and playing the pokies that is a sign of gambling issues and that together with other signs is something that staff would be expected to act upon so she's quite right.

Some people did bring more - there was a general pattern of people bringing a little bit more money into the venues. So some people did decide to bring more money into the venues. Some people did talk about going outside and finding local ATMs while they were in there to withdraw more money. Both of these things require some kind of planning or reflection time. So yes people can still go out and do that but they do have to actually think about it beforehand. "Okay so I'm going there. I'm going to take this much more money in." So in effect they're pre-committing to that amount of money. So it's less of that automatic impulsive process to do this. They have to think about it before hand even if they're going outside to access the ATMs. It gives them a bit of a break in play to actually go out and do that and think about whether or not they want to do that and as this person says, "Sometimes I'll go down to the petrol station and get cash and once you're out there you're out of the zone. You might think, 'Oh might as well go home now.'"
And that's something we know about EGM gambling. That continual activity of gambling gets people into the zone. They're really just focused on the machines and focused on their gambling. So if you can provide them with that sort of sustained break in play it can allow people to think this through and they're out the door and some of them were talking about going home. Not all of them. Some high risk and problem gamblers did talk about gambling at similar levels and counsellors also talked to us about a core group who were still gambling who were just saying, "Yes I didn't care. I'm just going up there getting more money out. Or I'm taking more money in with me. Or I'm going to the ATMs."

So it's not going to be a silver bullet. No intervention is likely to affect everyone. So there were some people who were doing that and there was some concern with both venue operators and with patrons about particularly the fact that there was no daily limit of the Eftpos so people could in fact go back and keep getting out money and some high risk gamblers were in fact saying they were now getting out more money than they were previously with the ATM because they could once they worked that out.
Some venues were in fact putting things in place saying no you can't take any more out than the daily limit or deliberately not telling patrons that they could take more money out than the daily limit. So putting things in place. But they did express some kind of frustration at the fact that this hadn't 
- the daily limits that had been there in place and been accepted by the community weren't put across into the Eftpos. So they did express frustration around that and yeah.

So in terms of impact on control. So did it in terms of effectiveness or - effectiveness does it also make people fell more in control? If we're talking about giving them information, giving them assistance to make better decision and over half of the moderate and high-risk gamblers reported that the information had assisted them to manage their spending. That this was helping them and interestingly about 30 per cent of that no risk and low risk gamblers also said that it helped them to manage their gambling and feel in control and there were substantive reductions in the percentage of people reporting spending more than they had intended in the venue. So whereas in time one say problem gamblers around 44 per cent of them said that they would always or almost always spend more than they had intended to at the venue. That had dropped to around 26 per cent at time two and you saw similar drops well not as to that extent but you also saw that pattern of reduction in impulsive overspends for the lower risk gamblers as well and increases in percentages of people who said that they now very rarely spent more than they had intended to.

So it did seem to be working here both as that harm reduction, harm minimisation measure for the high risk gamblers and also as a protection measure across the board for gamblers in venues and that's interesting and important to think about the fact that even people who were at this no risk or low risk - and low risk still means you're ticking off one or more items, one or two items on the screen for gambling issues - that even at that level people are quite commonly spending more than they wanted to and that this was assisting them to not do so.

Qualitative data substantiated those findings. Most people said that it had contributed to an improved sense of control and that it was easier to do that impulsive over spending with the ATMs there. That it was so easy and quick and sort of an automated process and they had to really think about it more when the Eftpos came in and consider whether they really wanted to do that. So from the qualitative data this is a low risk gambler saying, "My personal upper limit could always be stretched previously. The ATM was right there really handy." And she thinks that, "That Eftpos system is a good way to make people think about the next step." To actually consider whether they really want to do that before they do it, which is - was sort of one of the main intentions of this intervention.
Costs and consequences. So I'll just touch on these quite briefly. Basically the most obvious cost was to revenue. So if you've got people reducing their spend and particularly people who are at high risk the ones that we know are spending the most if they're reducing their spend it's going to hit the bottom line of venues and it did. So there was an aggregate downturn in revenue. The EGM revenue down by according to the venue reports was between 6 and 7.5 per cent. Didn't have a huge number of data points but it was reasonable for this and it sat outside that 7 per cent reduction in revenue that we saw with the objective across the board EGM data so we're fairly confident that that's pretty accurate.

The venues were also reporting reductions in the other gambling revenue. So if it was Keno or TAB revenue and in the non gambling revenue so bistro, alcohol that kind of thing. They were reporting that that revenue was down also. We're not as confident about those figures. Small numbers and less representative of the overarching venues and the numbers were a bit everywhere. Some people were up, some people were down and it wasn't supported by the patrons who actually said that it had very little impact on the amount that they were spending on non-EGM gambling and non-gambling things. But we did see a downturn in patronage so that would automatically reduce if they're not going there as often. So there probably is some kind of a downturn. How much it is, is less clear in that instance.

Also some interest of differential impact. So relative placement of local ATMs possibly having some impact. That if you had a local ATM just around the corner two doors down you're less likely to have any revenue impacted than if you didn't have that there and some minor loss of income from ATM fees and one off adaptations to venues. But predominantly the costs were where you would expect the costs to be. So yes they're there but that's what we expected. Yeah and some the reduction in patronage more prominent than at the hotels and clubs and more marked in the problem gamblers. So if you're seeing that reduction in patronage but it's kind of what you want if what you want is to protect the higher risk gamblers.
Very few people changed what they gambled on or where they gambled and that was important. We didn't see some switch over to suddenly to online gambling or something else like that. People knew where they gambled, why they gambled and they had reasons for going to the venues that they did and some indication that that sort of casual custom may be more impacted than the regular gamblers.

No evidence of safety incidents at the venues. So some people thought that there might be some impact through armed robberies on venues. That they may become a softer target. But that didn't appear to be the case. People generally were adapted quite well, felt that it wasn't too inconvenient and they thought that if it was working that was okay they were willing to go with it. Negative perceptions as I say largely related to feelings that this wasn't effective and that was if they saw people or knew of people who were withdrawing more money than beforehand because of the Eftpos situation. So that was largely where the frustration occurred and that happened from patrons, counsellors and venue staff.
So clear evidence that this was really working quite well as the evidence had suggested beforehand both as a harm reduction measure and as a consumer protection measure. So that reduction in time and money spent. More of an impact at the higher risk level. Increased feelings of control. Some unintended consequences that could perhaps be used to inform government policy and further decision making around where this could be tweaked. But it looks like it's a reasonable option. Something that policy makers can really consider as a harm reduction strategy.

Okay and we did do it both ways. So it moderated that feature of the environment. It's gone across the board. You can no longer access cash in this matter you have to do it in a different way. It's restricting that access to cash. Also providing that increased capacity for choice for people. So more preplanning and thinking about things and giving them some information and some time and reflection so encouraging that better decision-making. Pre commitment technology. Okay so this responds to the fact that people often make commitments in the cold light of day that can be overridden in the heat of the moment. Chocolate would be one of mine. You know I make ongoing commitments to eat less chocolate and then you know. So I do things like I don't buy chocolate. Or I only buy chocolate that's dark chocolates and I'll eat less of that chocolate and I'll hide it away in this hidden part that I know about but it's hidden in it's not there in front of me.

So we do things to try and assist ourselves to make those better decisions when we have the urges upon us. In terms of gambling you can use non-electric pre-commitments. So people would do things like leave their credit cards at home. Take a friend with them. Tell the friend that they can tell - you know they have to stop them after a certain point. Mix it up with other activities. Set their own limits on how much they're going to spend over a day or a month. Pre-commitment technology is an electronic method of trying to encourage and assist people with that decision-making. Can be set up on different forms of gambling. I'm going to focus again on the EGM gambling in terms of this. So again do we have some evidence base behind this? Yes. People often underestimate how much they spend. EGM gamblers frequently report exceeding spending limits as per the ATM study. That's some of the evidence. People experiencing problems with their gambling often have difficulties in stopping that impulsiveness to spend once they get into that environment and even going into that environment and so this provides a technological solution that can support that self management. Again that doesn't guarantee success.

This is a much more complicated area than the ATMs so I'm going to take you through it at a very high broad brush level but there's lots of different ways that you can set up this technology and there's benefit and challenges to different ways that you can set this up. People again can have ways of circumventing the systems. In some designs it's easier than others and so again there's a need to evaluate the effectiveness of the technology and it's having to be evaluating it in these different forms as it comes up which is more difficult and more complex in this area and again need to consider costs and unintended consequences that can happen from the different designs and implementations.

So it's quite a new area. There have been quite a number of trials and implementations that have happened in Australia and overseas to date so I'm going to talk about some of the findings. I'm drawing on these reviews of the evidence that we did a couple of - a year and a half ago now focusing particularly on the overarching architecture and how that can influence the type of features that are used, the use of those features and the benefits and limitations just to give you an idea again about how we can be building up the evidence and the importance of this. So the technology works basically by linking people to their play. So it might use card technology, pins, facial recognition. Some way that whenever you play these machines what you're doing is recorded and then the data is then used and fed back to you in some kind of a way. Pre-commitment primarily is about setting limits. So setting time limits. Setting money limits on the amount of money that you want to spend before you go in and start spending it. That's predominantly what it's about. In addition the tracking of play also facilitates that account summary information. So because it's recording how much you're spending and how much you're spending in different circumstances that information can be fed back to you. So as well as helping you set limits and stick to them it can also just give you information about how much you're spending and when you're spending. Are you spending more money in these kinds of venues than these venues? More money on the weekends than the week times? More money when you're out by yourself with your friends?

And it can support electronic self-exclusion in some instances. So you can actually set your spending limits to zero and that would effectively be I am excluding myself from venues and spending altogether if it's set over a wide area.
In terms of the major findings and as I say there's been lots of different things happening but there's been relatively little in terms of actually evaluation so far and because people are putting things together in different configurations it's difficult to actually untangle everything and generally what's happened is a variety of different features have been included together and then just some evaluation of the effectiveness overall. So it's difficult to untangle it all. What we do know is that the account summary information is really popular with people. People like to be able to be given - to pick up and have a look at how much they're spending over different periods of time. That's popular. The in terms of limits money limits are what people are interested in. They're not really interested in time limits and it's money limits per session. That makes sense for people. "Okay I want to go into a venue. I'm happy to spend up to $50 that's it. That's my limit." That makes sense. However we do know that longer term limits, how much you're happy to spend over a week or a month could actually be really valuable for people so that they you know are they - were happy to spend $50 in a session but up to $200 over week so that then they actually are stopped after that period time and they can't keep going back and spending $50 every day.

Time limits also can be quite a sophisticated tool to assist people to manage their gambling but not as popular. We also know that generally if people use the system it can provide some benefit for them. So the people that were using the system were showing reduced levels of expenditure. Little bit inconsistent in terms of the high-risk gamblers. In some studies that seemed to work more effectively for the higher risk gamblers. In other studies it was not any more effective for that group than the others. So that's a little bit unclear. Okay so the early trials interestingly also tended to be very technologically driven. So they were people working with software developers. "You could do this. You could do this. Include this. This can do" - you know, "Wow isn't this great." So they put everything in. And the customers were going, "What the hell is going on here? I can't work this out." And so that - they just turned them off. They did not know what to do with it. It was really complicated so you know it was a bit of suck it and see experimentation really. "Let's try this out. Let's try this out."

So the later and the number of - yeah so the newer designs have been informed by these earlier designs and one of the big lessons learnt was keep it simple. Keep it very very simple. What people want primarily is the monetary loss limits and only offer them daily limits or maybe daily limits and either weekly or monthly. Something like that so it's really easy to use. Because if you don't make it easy to use you're turning people off and it's difficult to get them back again. The system designs are also very responsive to policy consideration. So in terms of policy makers are they mostly interested in providing you with information and a tool to use to make better decisions. Here is something you can use if you want to use it. Or is there policy consideration about, "This is really quite risky and we want to assist people across the board to not spend more than a certain amount of money and that will determine also the direction that the policy makers are likely to go in terms of designing their systems.

So in terms of the system architecture. Geographic coverage can be at a venue level or at a state level or at a national level. The bigger the better really is what this is about because it makes it easier for the customer. I can set my limit and every time I use my card in whatever machine across a state or a nation it will track my play and it will tell me whether I'm within my limits or not. If it's just per venue then you could go and play at a different venue. You've got to kind of do it all over again. Registration. That can be again required or optional. So you have to register to take part and play on any EGM or it's up to you if you want to register with a pre-commitment system as you're playing an EGM. Identification again may be required or optional. So it may be in some instances it is linked to security numbers or bank account details or something along that nature. So it's actually linked to you and that's in those instances about making sure that it's one person per card linked to their play.

Limit setting can be optional or required so it may be part of the system that you have to if you want to engage and you want to play on a machine you have to set a limit. That could be mandated up to a certain level in one in Norway basically you spend anything you like up to this amount but we have told you how much your maximum is per day and per month. Other systems you can set the limit as high as you like but you have to set a limit. Other systems if you want to you can set a limit. There may be defaults in there so that if you don't choose any particular limit there's this is the limit that you'll be given as well. Consequences of the limit may be binding or exceed able. So when you hit your limit that you set it may be that then you're no longer allowed to play on that machine, in this state, in this nation. Or it may be that it just tells you that you've hit your limit and what do you want to do now and you could play on after that. Increasing your limit may be immediate or delayed. So it may be that if you want to increase your limit because you've hit your limit that you can do that instantly or there may be a time delay on for you to actually increase that limit. You might not be able to do that to the next day or the next month.

Okay so some examples just to show you how variable this can be. In Norway they actually took out all the EGMs a few years ago. Brought them back but no where near as many and much more limitation around the play on them. So they had national coverage. You have to be registered. You have to use ID. It's a card-based system to play on them. There's a mandated maximum limit per day and per month. They're quite low and you can set lower limits than that if you want to. In Nova Scotia and Canada they moved from a voluntary system, limited trials through to a required enrolment and identification and later light enrolment and then the option to set limits and there was some - so they moved sort of to a more restrictive one and then moved back again because there was a lot of kickback from people with that system and then you could use multiple cards with the light enrolment. Optional to set limits, time delay on increasing limits. In Victoria there's a system coming into place at the end of this year that has been informed by a lot of the interstate and international trials. Statewide coverage so everything's linked together. Card based used. Voluntary. So it's voluntary to take part. You can use your card or not. You can register or not. You can set limits or not and the information will be provided in terms of your statewide usage.

In Sweden they've got national coverage and they've moved from a hybrid system where you had sort of lighter or heavier enrolment depending on the machines you were using to a mandated system with registration and ID. Limit setting is required but it can be as high as you like and their limits once you set them are binding with a time delay on increasing limits. Some evaluations are being conducted at the moment in Victoria and in Sweden so that will be really interesting because that's really about that sort of the voluntary type system versus that sort of mandated - more mandated system that you have to take part. So it'll be interesting to see how well each of those work and for whom. So those sort of partial - just to give you a general sense of it. They tend to sort of flow into partial and or full systems. So voluntary or mandatory systems. But there can be differentiation in them. In the partial system the geography as I say can be limited to the venue or as wide as the state so far. User is not required to register and sign up to use it so it's up to you if you want to use the system. You generally are not required to identify yourself to use them. You can choose whether or not to set a loss limit. So you can choose to take part, set a limit or not and those loss limits could be binding or not but in reality even if they are binding if you can take your card out and keep playing or go to another venue and keep playing they're not binding because you can choose to override them.

Benefits of this is that it give the - it's very much geared towards giving a person a choice. Giving them a tool that they could use and they could choose to use it or not. That's one of the benefits of the system. Maybe the people are more willing to try it out. Certainly they say that they find that a better system that they're more happy to have that kind of system in place and so it may be important in terms of early introduction because it's really important to get the system right because if you get it wrong people kick back and they kick back hard on that. Tends to be very low uptake. We're talking 1 to 2 per cent of people who will take part when it's in a partial system in the trials and interventions to date. So people see it as something for problem gamblers so they're less likely to take part unless they're a problem gambler, which stigmatises further people who are trying to take part in it who have some gambling issues. Restraints are not binding. So for the people who are really struggling with control it's not giving them that sort of bind that they can't then in that urge situation stop them from gambling because the limits are exceed able and the self exclusion in not going to work in this situation because you can actually pull your card out and keep playing so that's not as - doesn't work as well.
The accounts summary data also has the potential to become inaccurate because if you're sometimes using the card and then you go, "Oh but tonight I'm not going to because I just feel like I want to play a little bit more and eat that chocolate a little bit more." So you know if you can do that then you're not - no longer giving that person even accurate data on how much they're spending because it's only capturing some of their spend. So that's an issue. So basically from the reviews that we've done the evidence thus far would suggest that these partial systems are not likely to be as effective in providing that protection for the really high-risk gamblers. May provide a really useful tool for people who are mostly in control who want to have a reminder when they hit a limit so that then they don't have to think about how much money they're feeding in or not. They get a message when they've finished when they reach that limit and then they can stop. Could work really well for them. Less likely to work for the people who are very highly at risk.

In a full system or also known as mandatory system all gamblers are required to register and identify themselves. So if you want to play on a machine then you need to actually take part in the system. It generally operates in a wide geographic area but as I say it can happy either way for either of them. Limits are generally binding and access to EGMs is generally denied then when the limit's set. So it is across the system. You need to take part in it. In terms of limits you may be able to set them as high as you like but once you set them then it will hold you and that's hard to - yep so and those sort of increases in limit setting generally require you to have a set period before you can increase your limit. So the benefits of that are that everyone's taking part. So in a sense that will normalise the process. This is just something you have to do with this process. It's not just something for problem gamblers and it reduces your ability to circumvent the system. If it's across the entire nation or across the entire state then you're going to have to take part if you want to play the EGMs and that again will then give you very accurate data in terms of your plays. Even if you can set your limits very high it's going to give you that information and everyone has to set his or her loss limit. If that's in place it's going to encourage thinking about and considering just the idea that you might actually want to think about how much you're spending before you go in and spend. Lots of people are not thinking about how much they're spending before they go in so this will give you that sort of impetus to think about it and reflect on it and it will provide more protection at that time of urge in that hot cognition mode in the venue.

Limitations. Some people are talking about the fact that some gamblers may set very high limits. So just in case limits. "Well I really only want to spend $50 but I'll just set it to $100 just in case I might want to just spend a little bit more." So that may happen. We haven't got any evidence that that will at the moment but that could happen. Could also potential encourage chasing loses particularly if you're given information about your spending in the session and that can happen. So you can actually get messages saying, "Hey did you know you just spent $20. You just - you know you've just lost $30. Oh you've hit your limit at this." That that sort of may encourage - if someone thinks that they're really close to it, "My God I've already spent that much, I need to win that money back." So it could possibly encourage chasing for some people. Perceptions of paternalism and privacy concerns. Very important. People - if you're in a type of community where people that they should be able to make that bad choice if they want to make that bad choice having a system that's in place and you have to take part in it can really - might really annoy people and will really annoy some people that they will not feel that it should be up to the government to tell me how much I can spend. So there is that consideration to be taken into account and so it's really important that the message is sold very well and the education system is in place to tell people that this is about encouraging them and helping them to make their own decisions and giving them the information for that.
And privacy concerns. If things are linked to your social security number people are really concerned about who has this information? Where's it being recorded? Who can look at it? People don't even like someone in the venue knowing how much they're withdrawing to spend on you know on the things with our study with the ATMs. That was very clear. So the fact that all of your play is being recorded is going to set up some stronger privacy concerns.
There's also the issue of card sharing and multiple card use and the Nova Scotia experience was that once they introduced light enrolment and you could pick up another card and another card without having identification there was - ended up with millions of cards in the system and they've actually just shut the whole system down because it just didn't work in the end and that was a major issue and that sort of again leads to inaccurate data. If you've got five cards and half your spending is on all different cards then you don't know how much you've spent. If you're also sharing a card with your wife and your son and your daughter then you won't know how much you're spending.

So there can be a lot of user frustration if the system is not well designed and there have been examples of that. So it's really important that if you're bringing in a big full mandatory system that it's designed very very well. So in terms of effectiveness it does appear that if you us it, it will be effective in some sense. Not sure how much more effective it is for the higher risk gamblers but most of the trials have been on the partial systems. The expenditure loss limits seem to be the most relevant. Account summary's very popular. Must be simple and easy to use.

In the full system you're likely to have more comprehensive protection but it could be rejected if it's not implemented carefully and that can cause it's own issues. Partial system is maybe preferred. Maybe a good soft introduction. But they will have very low sign up rates so it's only going to be effective for the very few people who are using it and less protection for those most at risk. If you got a sudden and immediate introduction it's going to cost a whole lot of the industry so a badly designed one or one that's introduced - not introduced carefully can be resisted by customers as I said and that can be an unintended consequence of a system and if it's - once it's rejected it seems to be very difficult to get people back on board. So it is important. But as I said a voluntary system may provide that inaccurate spend data. So basically again this is another where governments can put something in place that could be either something that's informing people in terms of their decision making and giving them good data. In a partial system that's really what it's all about is giving someone a tool and information that they can use to make a better decision. Just getting those account summary information if that's accurate data can give you really good information to inform future decision-making. It can also be something that can moderate a risky feature in whole across environment and the Norwegian system; the Sweden system is very much about that. Protection overarching everyone and that sort of you know if it's got mandated or self imposed limits that are binding it will provide that additional protection.

So just to wrap up very briefly because I'm being given warnings about time. Gambling is an accepted activity in Australia but potentially harmful and as such there is a need for continual improvement and harm reduction in this space. Really very much a role of government is to balance that. How much protection while allowing freedom of choice? And that can be done through both increasing the capacity for informed choice for people and or moderating risky features of the environment and both of these things are important. But it is essential that research be provided to underpin that policy development.

Not likely to be perfect. You can't wait for it to be perfect before you do anything but it is important that it's built and that anything that's put into place is continually evaluated. That's it. Done. Thank you.

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