Transcript Document 7499185

Secrets, Lies and Fraud
Auckland Clinical Team
The Problem Gambling
Foundation of New
Zealand
2009
Social theory
Mills. C. W. (1959) The Sociological Imagination.
Aim and Methodology
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
Fraud & Gambling
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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-offending
Minchin 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
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Couple relationships
Family
Community
Society
• Identify factors amenable to change
Develop optimally effective interventions
Basic Risk and Protective Factors
Model - Evidence based
Protective, Moderating
and Risk Factors
Propensity to Gamble
Gambling Services
and Products
Protective, Moderating
and Risk Factors
Gambling Uptake
Gambling Outcomes
and Consequences
Protective, Moderating
and Risk Factors
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
PG
K10 Severe mental disorder
No
PG
35.7% 1.9%
Relative
risk
18.8
WHO AUDIT hazardous
alcohol use
50%
Positive depression screen
71.4% 29.5% 2.4
Smoke daily
57.1% 15%
11.5% 4.3
3.8
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.
Case study
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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: Layers of concealment
• 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.
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
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
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
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.
Continuum Approach –
12 -24 months service contact
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
Risk Management - Goals &
Outcomes
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
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
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
[email protected]
[email protected]
[email protected]
[email protected]
Problem Gambling Foundation
09 368 1520
128 Khyber Pass Grafton Auckland.