Gambling Harm Treatment and Support in Scotland: Current provisions and future directions
Findings from a study providing a comprehensive, system level understanding of gambling harm treatment and support services in Scotland. The study combined desk based service mapping, a survey, interviews, geographic mapping and intervention effectiveness evidence update.
Chapter 4: Mapping of gambling harm treatment and support services in Scotland
4.1 Introduction
This chapter presents a system-level mapping of gambling harm treatment and support services in Scotland. It examines how services are configured, how they operate in practice, and how individuals access and move through the system.
The analysis draws on survey data, qualitative interviews and geographic analysis. It focuses not only on the presence of services, but on how they function as part of a wider ecosystem, including relationships between providers, pathways into and through support, and the conditions under which services are delivered.
4.2 Overview of the service landscape
The mapping identifies a diverse but unevenly structured ecosystem of gambling harm treatment and support services in Scotland.
Table 2 shows the types of treatment and support organisations included in the study. Provision of gambling treatment and support services in Scotland spans specialist statutory clinical services, third-sector organisations with gambling specialism, peer support groups and a range of non-specialist third-sector providers that incorporate gambling harm within broader service offers.
The majority of organisations included in the survey had an office in Scotland (11/13; 84.6%), and all have been running gambling-specific projects/programmes for more than two years (13/13; 100%). Three organisations (one NHS-based and two NGOs) were specialist treatment providers (3/13; 23.1%), offering structured interventions for gambling harm. Seven had non-gambling specialism (53.8%), among which two specialized on broader addictions (15.4%), two on homelessness (15.4%), one on women’s rights (7.7%), one on health and social care (7.7%), and one on broader advisory services (7.7%). The study sample also included three peer support organisations (3/13; 23.1%).
| Provider type | Eligible providers (number) | Non-eligible providers (number) |
|---|---|---|
| NHS health & social care service | 1 | 3 |
| Non-governmental organisation (incl. charitable and third sector) – gambling specialist | 2 | 4 |
| Non-governmental organisation (incl. charitable and third sector) – non-gambling specialist | 6 | 4 |
| Peer support group/network | 3 | 2 |
| Other | 1 | 1 |
| Total | 13 | 14 |
Organisations included in the study reported providing a wide range of intervention types, including brief interventions, psychosocial support, peer support, and in a smaller number of cases, structured psychological therapies (Table 3). Table 3 presents survey findings adjusted for information received during interviews, as some organisations overreported their service provision in the survey (see Chapter 2).
In Table 3 and further in the report, the term ‘Tier’ is used to refer to levels of intervention intensity following established UK substance misuse service frameworks[26] [27]. Provision ranges from Tier 1 (information, advice, screening and referral delivered in non-specialist settings) through to Tier 4 (specialist residential and inpatient treatment). Intermediate tiers reflect increasing levels of specialisation and structured care.
| Type of intervention | Number of providers (N=13) | Percentage |
|---|---|---|
| Brief advice (short conversation that could be delivered by non-specialists; may include referral to self-help groups (e.g., online forums)) / Tier 1 | 6 | 46 |
| Extended brief interventions (typically involves 2 or 3 sessions of motivational interviewing delivered by gambling-specialist practitioners) / Tier 2 | 4 | 31 |
| Psychosocial interventions (typically involves around 6 sessions of psychosocial treatment delivered one-to-one or in a group format by gambling treatment practitioners that vary in their techniques and structure) / Tier 3 | 4 | 31 |
| Psychologist-led CBT (typically involves 8 to 14 sessions of CBT for gambling disorder, delivered by clinical psychologists or CBT-accredited psychotherapists. It may also include psychological therapy for co-existing mental health conditions) / Tier 3 | 1 | 8 |
| Intensive residential treatment (typically involves a 12-week residential treatment programme that would include one-to-one therapy and group sessions) / Tier 4 | 0 | 0 |
| Peer support | 7 | 54 |
As Table 3 indicates, lower-intensity interventions are more widely available than higher-intensity or specialist provision. Peer support represents the most common type of support available across Scotland.
Specialist provision is both less common and, overall, tends to be offered at a lower tier. Structured psychological interventions (e.g., interventions incorporating some elements for motivational interviewing (MI) and cognitive-behavioural therapy (CBT)), particularly those delivered by trained specialists, are concentrated within a small number of providers.
Higher-intensity Tier 3 and Tier 4 interventions are largely absent from publicly funded provision in Scotland. Psychologist-led CBT has so far been provided only by an NHS service based in England to which Scottish residents can be referred. Statutory residential treatment is currently not available in Scotland. Several interviewees mentioned a free-at-the-point-of-access residential treatment service in Edinburgh, a trial for which commenced in January 2026, and which they referred some of their clients to. However, no further details about this service have been uncovered during the fieldwork. And the stage or results of this trial are unknown.
Among responding organisations, there was no evidence of publicly funded provision for Tier 4 services (intensive residential treatment) across Scotland. Private provision was available, but generally costs in the region of £18,000 to £40,000 per person.
Peer support groups, as discussed below, operate as a distinct component of the system with the largest geographical reach. However, they are largely found outside formal service structures and explicitly opt to maintain their status and funding independence, which their members view as central to their effectiveness.
This distribution has implications for the alignment between need and provision, particularly for individuals requiring sustained or intensive support and those who may find the treatment approaches and philosophy of the peer support groups unsuitable for any reason.
4.3 Service models and approaches
The study reveals that services operate according to distinct and, in some cases, non-equivalent models of support, which are oriented towards different populations, rely on different assumptions about the nature of gambling harm and recovery, and employ different modes and intensities of intervention.
For analytical purposes and in relation to anonymity considerations, we have classified all the providers that have taken part in the mapping into the following mutually exclusive groupings:
- specialist treatment providers (NHS & third sector)
- non-specialist support providers
- peer support networks
- system-level and enabling organisations
Specialist providers tend to deliver structured interventions, including CBT and MI, often within defined treatment pathways and time-limited programmes. Two specialist providers also indicated that they use a five-step method[28] for supporting affected others. These services are oriented towards individuals who self-identify as experiencing gambling-related harm and who proactively seek support.
By contrast, non-specialist support providers adopt person-centred, relational, and flexible approaches, emphasising sustained engagement, trust-building, and responsiveness to complex social needs. In these models, gambling harm is often one of multiple, intersecting issues (e.g., alcohol and drug use, homelessness, mental health), and the approach to gambling harm treatment and support is framed as ‘holistic’. These services tend to be oriented towards individuals who may be experiencing gambling harm (along with related issues), but may not identify as such. One of the non-specialist providers described themselves in the interview as ‘the last port of call’ for people experiencing gambling harms, but that people tended to present with other issues. These non-specialist organisations are focused on raising awareness both among their clients and among their staff, many of the latter also frequently lack knowledge and awareness of gambling harms.
Peer support groups operate according to a different logic again, centred on shared experience, mutual accountability, and ongoing recovery rather than time-limited intervention, often embracing the disease model of addiction.
In terms of delivery mode, there are clear differences between these three organisational groupings. Specialist gambling treatment in Scotland is currently delivered predominantly remotely, either online or over the phone.
We do have some face-to-face service users here in our offices, and we do have a member of staff that goes to different areas throughout the week, so like Stirling and Falkirk, to deliver face-to-face in those areas as well. And then, kind of end of last year, we had someone going to all of the Ayrshire to sit and meet people face to face as well. So that increases our face-to-face engagement. But the reality is most of the work that we do is remote. (specialist treatment provider)
Non-specialist support providers, on the contrary, work primarily in-person, emphasising the importance of relationship building for recovery and community-embeddedness:
We meet people one-to-one. […] The geographic area is important to us because it allows us to meet with people one to one and have a more holistic approach based on their needs and the level of support that is required for people. And we're very much relationship based. We really want to build up that relationship, especially within the sector that we're working in. A lot of the people that we're working with really struggle to build relationships with people and have trust in relationships which leads to a lot of relapses and unsustained recovery…. But we are opening ourselves up to telephone and video calling for people that need support that live maybe slightly out with our remit. (non-specialist support provider)
Similar to non-specialist support providers, in-person mode of delivery is central to the work of the two major peer support networks present in Scotland.
you know, we are very, especially in Scotland, we're kind of entrenched in our in-person meetings. We offer those other methods when someone doesn't have the ability to get to an in-person meeting, because we like that kind of human connection and that local connection. (peer support organisation)
Only an England-based peer support network indicated that they provide their peer-to-peer services online.
Finally, the fourth grouping of organisations, that we termed system-level and enabling organisations, mostly do not provide direct treatment and support except for brief advice. They have additional important functions within the treatment and support ecosystem (and that may be important to maintain as this ecosystem develops in the future). One of these organisations is an umbrella organisation essentially working towards shifting gambling harm treatment and prevention in Scotland towards a public health approach, which in the longer term would benefit the treatment and support landscape. This organisation, along with another Scotland-level research and advocacy organisation, also carried out several important research and public consultation projects focused on gambling harm, thus providing crucial evidence for policy and advocacy work.
Population-based prevention activities are provided by actors from all of the four of the above-mentioned groupings (see Table 4).These activities have variable reach and duplication across organisations. For example, several organisations reported running parallel trainings/workshops in prisons and the armed forces.
| Type of intervention | Number of providers (N=13) | Percentage |
|---|---|---|
| School-based programmes | 2 | 15 |
| Workplace programmes | 5 | 38 |
| Lived experience forums | 5 | 38 |
| Training for other organisations | 8 | 61 |
| Knowledge brokering | 5 | 38 |
| Research | 5 | 38 |
| Advocacy | 3 | 23 |
4.4 Service reach
4.4.1 Overall scale
Across providers, the overall reach of services appears low relative to the estimated population need outlined previously in Chapter One. While recent survey data indicate that a substantial proportion of the population experiences gambling-related harm, only a small minority engage with formal support services, and even less with gambling-specific support services, pointing to a significant utilisation gap.
Within the survey and the follow-up interviews, organisations were asked to report estimates on how many people they supported in October 2025. Results are shown in Table 5, showing that specialist treatment providers reported supporting between 100 and 248 people each; non-specialist support providers have had between 1 and 500 clients each; and peer support organisations indicated between 8 and 1200 regular members (i.e., those taking part in weekly meetings across all their locations). Looking at non-peer support organisations shows a very low client load.
Another illustration of the limited scope of reach came from an annual report of a specialist treatment provider. This free-to-access, treatment provider covers an area of Scotland with an estimated adult population of c.121,500 and reported a client load of just 23 people for the financial year 2024-2025.
While peer support networks account for the largest volumes of engagement, these figures should be interpreted with caution, given differences in service models, intensity of engagement and reporting practices. An estimate of 1200 regular members was provided in an interview, however the organisation also reports not formally collecting any user data and thus this is a best guess.
| Provider type (number of providers) | Reported range of number of users in October 2025 |
|---|---|
| Specialist treatment providers (N=3) | 103 – 248* |
| Non-specialist support providers (N=5) | 1 – c.500 |
| Peer support groups (N=3) | 8 – c.1200 |
| System-level and enabling organisations (N=2) | N/A |
* - Figures provided from only 2 of the 3 organisations
The issue of comparatively low client load was mentioned in multiple interviews:
We don't have massive… we don't have a huge cohort of referrals. What we do have is a... a number of cases that are open and closed. So at the moment we've got a caseload of 17 that are open, but we have recently just, we've just met on Monday and closed at least four people. So I would say on average we're sitting with about 5 clients each, just four of us in the team. (non-specialist support provider)
Across the interviews, stigma was consistently identified as a major barrier to engagement:
In Scotland, there's still very much taboo culture around gambling. (specialist treatment provider)
Stigma was also identified as a particularly strong deterrent to access for certain population groups, including women and some ethnic minority communities:
I think there's still a huge stigma around it, especially for women, and even more so for women with children who are scared about the impact that that might have on their family. (non-specialist support provider)
We need to challenge the stigma around gambling, especially with some of the ethnic minorities in communities, because it's really entrenched in their kind of beliefs that it's a shameful activity. (non-specialist support provider)
Specialist treatment providers consistently reported that concerns about visibility, judgment and financial constraints shape both help-seeking behaviour and preferences for remote delivery.
There is so much stigma associated with gambling. They don't want to risk being seen going into a building. You know, I suppose like the stigma around sexual health clinics, they don't want to bump into anyone in their neighbourhoods, seeing that they're going in’ (specialist treatment provider)
These perspectives contrast with the approach taken by the major peer support networks, which place a strong emphasis on community embeddedness and face-to-face meetings, and currently have the largest reach in Scotland. One interviewee from a specialist treatment service attributed this discrepancy to a lack of trust in statutory treatment services among the population. For similar reasons, a non-specialist support provider with extensive presence across Scotland described their role in the ecosystem as essential, noting that ‘it might feel less stigmatised going to your local bureau than going to a specialist kind of gambling provider’.
4.4.2 Targeted provision for specific populations
Most surveyed organisations (11/13; 84.6%) reported providing some form of support both to individuals experiencing harm from their own gambling and to affected others. Two major peer support organisations, however, focused exclusively either on people gambling themselves or on affected others.
Seven organisations (53.8%) indicated that they operate specialist provision for certain population groups (Table 6). These provisions, alongside focus on the intersection of gambling harms with alcohol and drug use, mental health issues and financial hardship, signal attempts to address the needs of at least some populations thought to be at higher risks of gambling harms in Scotland (see p.26 of the PHS report for the category list[29]).
| Population group served | Number of providers (N=13) | Percentage |
|---|---|---|
| Women | 6 | 46 |
| Young people aged 18-34 | 2 | 15 |
| Ethnic minorities | 3 | 23 |
| Homeless people | 4 | 31 |
| LGBTQ+ | 3 | 23 |
| Members of armed forces | 2 | 15 |
| People in the criminal justice system | 2 | 15 |
| People with disability, accessibility needs, and/or neurodiverse | 1 | 8 |
It is important to recognise the relatively modest scale and the often underdeveloped nature of these provisions, as evidenced in the interview data. While women-focused services were reported by nearly half of providers, one interviewee characterised current provision for women as follows:
the gender side of things doesn't exist and it needs to exist. You know, we've had women come forward who have been to multiple different, well, some different support, and they're not finding their pathway to recovery because it's not tailored to their needs, and It's not gendered and responsive to, you know, what they really need in terms of their journey or pathway to recovery as well. (non-specialist support provider)
Crucially, peer support organisations, despite having the largest reach across Scotland, do not report specialist provision for particular groups, including women. When asked if women-specific groups were available, they indicated that these groups have never properly taken off, while acknowledging that they exist in other country contexts.
Those aged 16 or under appear to be significantly underserved within the Scottish treatment and support system, with only peer support provision offering support for them as an affected other. As a result, minors experiencing harm due to their own gambling are not supported within the current system. A specific youth-focused organisation in Scotland stated: ‘We deliver early education and prevention sessions to children and young people in schools and youth groups. We also deliver to parents and practitioners. So no early intervention, just awareness raising and signposting to treatment & support options.’
4.4 Geographic distribution and accessibility
Spatial analysis (see Appendix 3 for full report) indicates that service provision is partially aligned with areas of higher socioeconomic deprivation, with greater concentration of services in urban and more deprived areas.
However, this overall pattern masks important gaps. While around 81% of the population lives within a drive distance of 10 miles to a service, over one million people (19%) face greater distances, with around 8% needing to travel more than 20 miles to their nearest services. Approximately 46,451 people across Scotland living in the most income and employment-deprived areas have limited (>10 miles for 32,665 people) or poor (>20 miles for 13,786 people) access to support. The most acute access barriers are observed in remote rural areas.
These patterns suggest that geographic proximity remains an important determinant of access, particularly for interventions requiring sustained engagement.
4.5 Organisation of the gambling harm support ecosystem
4.5.1 Access and pathways
Access to support is characterised by multiple entry points, but pathways through the system remain weakly defined and often informal, with personal relationships and knowledge carried by individual staff members playing an important role in determining the user’s pathway through the system.
The survey proved of limited value in identifying typical referral pathways. Most organisations selected multiple referral options. When explored in interviews, this appeared to reflect overreporting rather than actual practice.
The National Gambling Helpline operates as a central access point across Great Britain, with specialist treatment providers highlighting its role in triage and referral. However, its future commissioning remains uncertain, raising questions about the stability of this access route.
Self-referral, particularly via online channels, has become increasingly important. Several providers reported a shift towards direct access through websites and digital platforms. Individuals presenting via self-referral were described as typically experiencing less severe forms of harm than those referred through partner organisations.
We're seeing that the people who are coming through our website, whilst everyone is damaged by gambling harm, we're seeing that they're not at the stage that we're seeing [in the clients who] come through our community services. They're not quite at the state of chaos that we're getting referred from our third sector organisation. (specialist treatment provider)
Non-specialist support providers also play a key role in identifying and engaging individuals who may not seek help through formal channels. This is often achieved through outreach and informal contact points embedded within their own or partner organisations.
In contrast, pathways through primary care remain limited. Interviewees consistently reported low levels of identification and referral within GP settings, alongside uncertainty among practitioners about how to recognise and respond to gambling harm.
when people are accessing GPs, they're not knowledgeable. They don't know where to send people and people are being sent to GA, which is great for some people, they'll find their support and recovery through that, but it doesn't work for everyone. And people aren't being given the choice of where they can go for support. And so I think that's a big one for me in terms of the gap between your people, your trusted person that people will go to. (non-specialist support provider)
Once individuals enter the system, onward pathways between services are often unclear or inconsistently applied. Although organisations report making referrals, the absence of clearly defined pathways means that movement through the system is not systematically structured. While some interviewees described the use of ‘warm referrals’, whereby staff actively facilitate engagement with another service, the possibility of such referrals appears to depend on the knowledge and relationships of individual staff members. This was corroborated by an interviewee from an umbrella organisation, who described plans to develop a resource booklet for gambling harm support providers in Scotland to make this institutional knowledge more systematised and accessible.
4.5.2 Waiting times
In the context of the relatively low client volumes discussed in Section 4.4, waiting times do not currently appear to be a significant constraint within the Scottish system. Only the organisations offering Tier 3 psychosocial interventions indicated wait times of more than a week. Of the four organisations, one reported wait times of up to two weeks and one of more than four weeks. The provider reporting waiting times longer than four weeks did not participate in interviews, and therefore the reasons for this could not be explored. It should also be noted that this provider reported only a single service user in the relevant period, suggesting this may represent an outlier rather than a systemic issue.
4.5.3 Aftercare
Following the completion of treatment, all specialist gambling treatment providers reported structured aftercare, typically involving follow-up at 3, 6, and 9 or 12 months, usually by phone. Three of the non-specialist support providers reported short-term aftercare provisions, framed as being driven by client needs.
Across both specialist treatment providers and non-specialist support organisations, referral to peer support groups was the most common aftercare type. This included a range of peer-support types, including those providing face-to-face support, as well as England-based organisations that specialise in remote provision. One specialist treatment provider indicated they have in-house aftercare groups. None of the England-based aftercare groups named by interviewees were eligible to be included in this study, because they serve too few Scottish residents, indicating their limited role in the Scottish ecosystem.
Overall, the lack of long-term aftercare options was perceived by the interviewees as a significant gap in the current ecosystem:
A phone call doesn't cut it. It has to be something solid for people… that people can navigate their own recovery with options. And I think that at the moment, there's not a lot of options. It's sort of one route down there and then that's it. (non-specialist support provider)
4.5.4 Ecosystem organisation and inter-organisational relationships
The above-described patterns of access and movement through the system reflect broader features of how the Scottish gambling harm support ecosystem is currently organised. Across the interviews, a number of consistent features emerged.
First, GambleAware-funded infrastructure functions as a foundational core. At the point of interview, GambleAware was the primary funding source for all surveyed specialist treatment providers and for the majority of non-specialist support organisations. This funding architecture underpins much of the existing service landscape and is discussed in more detail in Section 4.9.
Second, the system is characterised by strong interpersonal and organisational relationships. Scotland-based providers frequently emphasised a collaborative ethos, noting that organisations and staff are often well known to one another, with some individuals having worked across multiple organisations in the sector. This relational infrastructure is reflected in joint events, shared initiatives, and practical collaboration. For example, one non-specialist provider described specialist staff previously delivering regular on-site consultations within their service.
Third, despite the presence of strong interpersonal ties and a stated ethos of collaboration, this does not appear to translate into consistent sharing of clients across organisations. The example noted above, where specialist staff delivered on-site consultations within a non-specialist service, was ultimately discontinued due to low demand, suggesting that such forms of integrated working may be difficult to sustain in practice. More broadly, interview data point to limited movement of service users between providers. This dynamic may reflect patterns observed in the wider UK gambling treatment system, which one interviewee from a specialist treatment provider characterised: ‘people seem to be competing for patients and patients are like parcels’. Concerns about low client volumes, combined with funding uncertainty and competitive commissioning arrangements, may further discourage referrals and collaboration, reinforcing a tendency for organisations to retain rather than share service users.
Fourth, there is a notable degree of scepticism towards NHS-led provision, particularly the model of secondary care specialist gambling clinics developed in England. This scepticism was expressed by both specialist third-sector providers and non-specialist organisations, although the underlying rationale was not always clearly articulated. A perceived lack of visibility and accountability of NHS provision was one factor identified:
we've never had an NHS presence and that would change, that would be a big change, I think, within the landscape. We've got Government and Public Health Scotland. We know there are people there and who is funding it, whereas having the NHS presence… apparently it's not as visible or you don't really know what's happening. The communication hasn't been great. (specialist treatment provider)
Some scepticism of the NHS clinic approach was also expressed by other providers working across the UK:
in the last six years, we've only referred 3 patients to the NHS clinics […] What we've shown is that gambling can actually be treated in the community. You don't need expensive secondary care treatment. (specialist treatment provider)
Whilst not directly articulated by interviewees, concerns about the NHS secondary care gambling clinics expansion into Scotland may be partly shaped by perceived or anticipated competition.
Finally, peer support networks occupy a distinct position within the ecosystem. The two largest networks interviewed reported not making formal referrals to other services, while receiving individuals from across the system. This was a pattern corroborated by multiple interviewees. One clinically trained participant from a non-specialist organisation went further, suggesting that peer support may, in some cases, be more effective than formal treatment approaches. Notably, a major online resource for gambling harm support in Scotland positions peer support networks as a primary entry point into support, reinforcing their role as both an entry and endpoint within the system, playing a central role in the ongoing aftercare and recovery.
4.6 Staff
4.6.1 Staff numbers
Overall, the organisations providing treatment and support for gambling harm in Scotland have limited human resources dedicated to this specific area of work (Table 7). Two UK-wide specialist treatment providers reported comparatively high capacity due to their country-wide focus, but were unable to specify the exact number of human resources dedicated to the delivery of treatment and support in Scotland (we therefore did not include them in Table 7). Scotland-based providers, in contrast, reported very few staff members in programmes and projects focused on gambling harm treatment and support. Large numbers of volunteers, however, were apparent in some of the peer support groups linked to those networks being fully run by volunteers across multiple locations in Scotland. However, this finding should be interpreted with caution. While formal staffing levels in Scotland-based services are low, substantial human resources are concentrated within peer support networks, which are largely volunteer-run.
| Provider type (Number of providers) | Full-time staff members | Part-time staff members | Volunteers |
|---|---|---|---|
| Scotland-based specialist treatment provider only (N=1)* | 4 | 3 | 0 |
| Non-specialist support providers (N=5) | 0 - 5 | 0 - 6 | 0 – 5 |
| Peer support groups (N=3) | 0 - 1 | 0 - 2 | 8 – c.200 |
| System-level and enabling organisations (N=2) | 2 | 1 | 0 |
* Note: Two UK-wide specialist treatment providers included in the study did not provide Scotland-specific staff capacity figures and have not been included into this table.
In the context of the relatively low client load and minimal waiting times discussed above, it remains unclear whether limited staffing in formal services reflects low expressed demand or whether there is a risk of some needs not being met. This pattern also triangulates with findings from the Gambling Survey for Great Britain presented in Table 1, which indicate relatively high levels of need alongside limited engagement with specialist support, suggesting that some individuals may not seek help, may be unsure how to access services, or may rely instead on non-specialist provision or peer-led support.
4.6.2 Staff training
The workforce delivering gambling harm services is heterogeneous, reflecting the diversity of service models. An overview of the training and qualifications of staff members by service model is shown in Table 8 on page 39.
Specialist providers employ the workforce with the widest range of qualifications, including a comparatively higher presence of clinically trained staff members when compared with non-specialist support providers and peer support groups. None of the specialist treatment services had HCPC-registered psychologists among the staff, and only two out of three organisations in the grouping reported having certified counsellors and psychotherapists. This indicates that, despite the primacy of CBT-therapy in the treatment offer for gambling harms, not all organisations in this grouping have appropriately qualified staff to deliver such treatments (as per NICE Guidelines Recommendations 1.3.7 and 1.5.9)[30].
Interviews reflected a contrast between NHS-based services and all the other specialist and non-specialist support providers in terms of their staffing models. While NHS-based service placed primary focus on clinical competencies, in the other surveyed organisations, especially among the non-specialist support providers, the principle of ‘skills over qualifications’ appeared to predominate.
When it comes to non-clinical training on gambling harms, there is no shared competency framework across the system, and training provision is fragmented, with multiple organisations delivering thematically overlapping short-term programmes for staff. Some organisations indicate that they commission training for staff members externally, while others have developed their own in-house training modules.
All interviewees without clinical training indicated having undertaken short-term training on gambling harms as part of their current or previous roles. For those without lived experience of gambling harm (constituting the majority of interviewees), this training served as their main source of gambling-related knowledge.
4.6.3 Recruitment
Recruitment challenges were not discussed in depth. Despite this, non-specialist support organisations reported struggling to find appropriately qualified staff, as reflected in the following quote:
when we were hiring as well, we understand this is still relatively niche. So we weren't going to get a lot of people coming through the door that had ticked all the right boxes in terms of having the gambling harm experience or having the understanding and whatnot’. (non-specialist support provider)
Specialist treatment services, by contrast, did not report any recruitment challenges.
| Provider type (Number of providers) | HCPC-registered practitioner psychologists | Psychiatrists | BACP/UKCP/COSCA accredited psychotherapists or counsellors | Health and social care practitioners | Peer support workers | Non-peer support workers | Other |
|---|---|---|---|---|---|---|---|
| Specialist treatment providers (N=3) | 0 | 1 | 2 | 3 | 1 | 2 | Clinical care coordinators |
| Non-specialist support providers (N=5) | 0 | 0 | 2 | 2 | 2 | 2 | Specialist advisors |
| Peer support groups (N=3)* | 0 | 0 | 0 | 1 | 1 | 1 | Self-employed office coordinator |
| System-level and enabling organisations (N=2) | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
*Note: Figures are for paid staff members only. In this grouping, low numbers are related to the fact that some peer support groups rely almost entirely on volunteers without formal qualifications.
4.7 Data, evaluation and evidence generation
All organisations were asked about the kinds of data they routinely collect across their organisations and about any evaluation of services they undertake.
Data collection and evaluation practices vary significantly across organisations. Some providers report relatively developed systems for collecting data on their service users, while others collect limited or no systematic data at all. The former are comprised primarily of providers that used to be part of GambleAware-funded treatment and support infrastructure and reported to their Data Reporting Framework (DRF) (Table 9). Thus, the most developed user monitoring systems were within specialist treatment providers operating within the GambleAware system.
Among the non-specialist support providers, practices varied widely with some pockets of good practice, such as collection of PGSI scores and data on gambling behaviours and wider harms. However, a non-specialist support provider noted that they have only recently introduced this practice, despite being part of the GambleAware network.
Peer support groups have the least developed or completely absent user monitoring systems, largely due to the organisations’ ethos especially around anonymity.
| Provider type (Number of providers) | Yes | No | Don’t know |
|---|---|---|---|
| Specialist treatment providers (N=3) | 3 | 0 | 0 |
| Non-specialist support providers (N=5) | 3 | 1 | 1 |
| Peer support groups (N=3) | 0 | 3 | 0 |
| System-level and enabling organisations (N=2) | 0 | 1 | 1 |
Overall, the collection of data relevant to service effectiveness evaluation was limited. Exploration of evaluation practices during the interviews indicates that organisation evaluation metrics have mainly focused on specific processes and activities (number of workshops, number of consultations, evaluation forms filled by the clients etc.), and not data collection which would allow assessment of longer-term outcomes or impacts. However, there was evidence of some innovative practices in this domain, illustrated by a quote from one of the non-specialist support providers:
We also have our outcome star. So we do those two or three times throughout the – depending on how long a person is with us – two or three times throughout that period. So that looks at finances, understanding of the gambling harms behaviour, community social life, education, employment and volunteering, knowledge of the gambling harm support available, the time and money… So that could be like time and money that's spent on gambling. Or budgeting and things like that. Physical health, mental health, housing and relationships. And yeah, I think I said finances. So we use these webs. We also, we input that data onto our database system, and that produces a web for us. And then we can use over time, you can see the pattern, so you can see the web outcome. And I tend to take them and use them with our service accessors to show them the progress that they've made to see which is the next topic that they want to work on, things like that. So we're able to, I guess we're able to monitor their progression through that as well. (non-specialist support provider)
There was a broad consensus among non-specialist providers that this area requires substantial further strengthening, and providers extensively shared their plans for improving their monitoring and evaluation systems. Interviewees from organisations that took part in recent Evaluation Support Scotland workshops mentioned these workshops without being prompted, framing them as an opportunity to improve their evaluation systems and practices in the future. One non-specialist support organisation noted that they are proactively looking to establish a research partnership with a Scottish university to evaluate their programme.
Currently, across the ecosystem, there is no common outcome framework, and limited capacity to generate population-level insights into service effectiveness. This limits the ability to assess system performance and to align provision with evidence-based approaches.
4.8 Lived experience involvement
Lived experience is widely recognised across the Scottish gambling harm support ecosystem as an important component of service design, delivery, and engagement. Survey findings indicate that most organisations report some form of lived experience involvement (Table 10). However, both survey and interview data point to a clear distinction between peer support networks, where lived experience is foundational, and other types of organisations, where lived experience is more typically incorporated in supporting or consultative roles.
| Provider type (number of providers) | Have peer workers or peer mentors with LE | LE support recruitment | LE consulted on service develop-ment | LE involved in governance | No LE involvement declared |
|---|---|---|---|---|---|
| Specialist treatment providers (N=3) | 1 | 2 | 3 | 2 | 0 |
| Non-specialist support providers (N=5) | 2 | 2 | 2 | 1 | 1 |
| Peer support groups (N=3) | 2 | 1 | 2 | 3 | 0 |
| System-level and enabling organisations (N=2) | 1 | 1 | 1 | 1 | 1 |
Across specialist treatment providers, non-specialist support providers and system-level organisations, lived experience is incorporated mainly through consultation and feedback mechanisms. The presence of staff or volunteers with personal experience of gambling harm or recovery was declared by less than half of these organisations. More formalised approaches were more variable, such as co-production, lived experience people occupying governance roles or independently led lived experience initiatives.
Interview data suggest that, in these settings, lived experience is primarily framed in instrumental terms as a means of improving service design, enhancing credibility and supporting engagement. Within specialist treatment providers in particular, lived experience is generally integrated into existing professional and clinical structures in a hierarchical way. Decision-making authority remains with clinically trained staff. In some cases lived experience involvement appears limited and difficult to evidence in practice. One interviewee from a specialist treatment provider could not, when asked, provide a specific example of how consultation with people with lived experience changed practice or processes.
In three cases (two non-specialist organisations and one system-level one), lived experience was described as central to the direction of organisational work: ‘everything we do is lived experience-led’. These organisations had staff members with lived experience and they have also developed more structured mechanisms for engagement, such as lived experience forums with regular meetings, shared agenda-setting and an intra-organisational lived experience-led magazine.
In contrast, peer support networks represent a qualitatively different model. The organisations included in the study are fully lived experience-led and governed with lived experience constituting the basis of service delivery, organisational identity and decision-making.
Taken together, these findings suggest that while lived experience is widely reported to be present across the system, its role differs significantly by organisational type. In most cases it is incorporated as a ‘supporting input’ into professionally led services. In peer support networks, and in a small number of other cases, it functions as a ‘primary organising principle’ shaping both the content and direction of support. More structurally embedded roles for lived experience in governance and system-level decision-making remain limited and uneven.
4.9 Funding and system dynamics
The organisation of services within the Scottish gambling harm support ecosystem is strongly shaped by funding arrangements which are summarised in Table 11.
Survey data collected in January 2026 indicated a high degree of reliance on GambleAware funding among both specialist treatment providers and non-specialist support providers. From April 2026, funding for treatment is now provided directly by the Scottish Government and it is likely that reliance will switch to this funding source instead.
By contrast, peer support networks are predominantly self-funded, while system-level and enabling organisations rely primarily on government funding. This distribution highlights the coexistence of distinct funding models across the ecosystem corresponding to different organisational roles.
| Provider type (number of providers) | Gamble Aware | Central or local government | Direct funding from gambling industry | Direct donations from other sources | Self-funded |
|---|---|---|---|---|---|
| Specialist treatment providers (N=3) | 3 | 1 | 1 | 1 | 0 |
| Non-specialist support providers (N=5) | 4 | 3 | 0 | 0 | 1 |
| Peer support groups (N=3) | 1 | 0 | 0 | 0 | 2 |
| System-level and enabling organisations (N=2) | 0 | 2 | 0 | 0 | 0 |
Interviewees consistently described operating for the last year under conditions of funding uncertainty, with ongoing changes in commissioning structures having a profound impact on the entire ecosystem:
The issue that's been with our project and all projects is the landscape of the funding is kind of like halted collaborative working and innovation just for this amount of time. There's a lot of things like obviously we're just the new members of staff and we've came in all guns blazing wanting to get the wheels in motion. But it's hard to start planning at the moment for something that we don't even know if we're going to get funded in and other organisations don't want to kind of set up those collaborative spaces because they're also in that same situation of, well, are we actually going to get funded? So that I would say that has been the biggest issue. (system-level and enabling organisation)
Several interviewees indicated that existing funding models may create disincentives for collaboration, including competition between organisations and pressures to retain service users. In this context, referral practices and inter-organisational relationships are not only shaped by service design, but also by the conditions under which organisations are funded.
These dynamics affect not only service delivery but also the overall coherence of the system, reinforcing patterns of fragmentation and limiting the development of more integrated pathways across providers.
4.10 Summary
The study shows that Scotland’s gambling harm support system is characterised by diversity of provision but limited system integration.
Services exist across multiple tiers of support and treatment provision. However, they operate according to different models and are not consistently connected through clear pathways or shared frameworks. Access is multi-channel but uneven, with geographic, social and structural barriers affecting engagement.
These findings provide the basis for the analysis in the following chapter, which examines gaps and challenges in relation to priorities for future service development.
Contact
Email: gambling@gov.scot