August 29, 2013

The Honourable Deborah Matthews, M.P.P. Deputy Premier Minister of Health and Long-Term Care Hepburn Block 80 Grosvenor Street, 10th floor , M7A 2C4

Re: Health and Social Impacts Related to Problems with Gambling

Dear Minister,

On August 19, 2013, the Board of Health for the City of Health Unit approved recommendations in the report Health and Social Impacts Related to Problems with Gambling to address gambling- related harm in Ottawa and across the province of Ontario, a copy of which is attached. Among the recommendations, the Board of Health approved the following:

2. Approve that the Chair of the Board of Health for the City of Ottawa Health Unit write the following letters, and that the Mayor of Ottawa be provided the opportunity to co-sign these letters: b. To the Ontario Minister of Health and Long-Term Care requesting that the Ministry of Health and Long-Term Care augment the Open Minds, Healthy Minds, Ontario’s Comprehensive Mental Health and Addictions Strategy by including a comprehensive approach to prevent gambling-related harm in Ontario, provide early identification and timely treatment, and protect vulnerable populations, through integrated planning and services across the Ministries assigned to the Standing Committee on Social Policy, the Ministry of Consumer Services, the OLG and local Boards of Health.

We request that you implement these recommendations and would be pleased to work with you. Should you or a member of your staff wish to discuss this further, please contact Dr. Isra Levy, Medical Officer of Health for the City of Ottawa Health Unit, by telephone at 613-580-2424 ext 23681 or via email at [email protected].

Sincerely,

“Original Signed By” “Original Signed By”

Jim Watson Diane Holmes Mayor, City of Ottawa Chair, Board of Health for the City of Ottawa Health Unit City Councillor c.c. Mr. Lorenzo Berardinetti, M.P.P., Scarborough Southwest Mr. Alexander Bezzina, Deputy Minister of Children and Youth Services The Honourable , M.P.P., Minister of Citizenship and Immigration Ms. Cheri DiNovo, M.P.P., Parkdale-High Park The Honourable , M.P.P., Minister of Training, Colleges and Universities Mr. Giles Gherson, M.P.P., Deputy Minister of Consumer Services Ms. , M.P.P., Oak Ridges-Markham The Honourable Tracy MacCharles, M.P.P., Minister of Consumer Services Ms. Amrit Mangat, M.P.P., Mississauga-Brampton South Mr. Michael Mantha, M.P.P., Algoma-Manitoulin Ms. Jane McKenna, M.P.P., Burlington The Honourable Ted McMeekin, M.P.P., Minister of Community and Social Services Ms. Deborah Newman, Deputy Minister of Training, Colleges and Universities The Honourable Teresa Piruzza, M.P.P., Minister of Children and Youth Services Mr. Chisanga Puta-Chekwe , Deputy Minister of Citizenship and Immigration Ms. Marg Rappolt, Deputy Minister of Community and Social Services Mr. Saäd Rafi, Deputy Minister of Health and Long-Term Care The Honourable , M.P.P., Minister of Education The Honourable Mario Sergio, M.P.P., Minister Responsible for Seniors Affairs Mr. George Zegarac, Deputy Minister of Education Mr. Ted Chudleigh, Vice-Chair of Standing Committee on Social Policy Mr. Ernie Hardeman, Chair of Standing Committee on Social Policy Dr. Arlene King, Chief Medical Officer of Health Ms. Kate Manson-Smith, Assistant Deputy Minister – Health Promotion Division, Ministry of Health and Long-Term Care Ms. Roselle Martino, Executive Director, Public Health Division, Ministry of Health and Long- Term Care Dr. George Pasut, Vice-President, Science and Public Health, Public Health Ontario Mr. Rod Phillips, President and Chief Executive Officer, Ontario Lottery and Gaming Mr. William Short, Clerk of Standing Committee on Social Policy Ms. Linda Stewart, Executive Director, Association of Local Public Health Agencies Dr. Isra Levy, Medical Officer of Health, City of Ottawa Mr. Rick O’Connor, City Solicitor and Clerk, City of Ottawa

Attch: Health and Social Impacts Related to Problems with Gambling report Ottawa Board of Health Extract of Draft Minutes for the meeting of August 19

Report to/Rapport au :

Ottawa Board of Health Conseil de santé d’Ottawa

August 19, 2013 / Le 19 août 2013

Submitted by/Soumis par : Dr./Dr Isra Levy, Medical Officer of Health/Médecin chef en santé publique

Contact Person / Personne ressource: Sherry Nigro, Manager/Gestionnaire Health Promotion and Disease Prevention/ Promotion de la santé et prévention des maladies Ottawa Public Health/Santé publique Ottawa 613-580-2424, ext./poste 28971, [email protected]

CITY WIDE / À L‟ÉCHELLE DE LA VILLE Ref N°: ACS2013-OPH-HPDP-0006

SUBJECT: HEALTH AND SOCIAL IMPACTS RELATED TO PROBLEMS WITH GAMBLING IN OTTAWA

OBJET : RÉPERCUSSIONS LIÉES AUX PROBLÈMES DU JEU SUR LA SANTÉ ET SUR LE PLAN SOCIAL À OTTAWA

REPORT RECOMMENDATIONS

That the Board of Health for the City of Ottawa Health Unit: 1. Receive for information the Ottawa Public Health gap analysis of gambling prevention, outreach and treatment services, as outlined in this report; 2. Approve that the Chair of the Board of Health for the City of Ottawa Health Unit write the following letters, and that the Mayor of Ottawa be provided the opportunity to co-sign these letters: a. To the Ontario Lottery and Gaming Corporation (OLG) and the Ontario Minister of Finance with a copy to the Ontario Minister of Health and Long-Term Care and Ottawa-area Members of Provincial Parliament, requesting that the OLG: i. Fully implement healthy public policies, as outlined in this report, for current and future gambling sites in Ottawa; ii. Allocate $2.0 million on an annual, on-going basis to the Champlain Local Health Integration Network, an increase from current funding of $741,000, to address the funding gap for community-based gambling treatment services in Ottawa, as outlined in this report; b. To the Ontario Minister of Health and Long-Term Care requesting that the Ministry of Health and Long-Term Care augment the Open Minds,

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Healthy Minds, Ontario’s Comprehensive Mental Health and Addictions Strategy by including a comprehensive approach to prevent gambling- related harm in Ontario, provide early identification and timely treatment, and protect vulnerable populations, through integrated planning and services across the Ministries assigned to the Standing Committee on Social Policy, the Ministry of Consumer Services, the OLG and local Boards of Health; c. To the Ontario Minister of Health and Long-Term Care and the President and Chief Executive Officer of Public Health Ontario requesting that studies be commissioned to evaluate the effectiveness of public policies that mitigate problems with gambling and to strengthen provincial surveillance of populations at risk of gambling-related harm; 3. Approve Ottawa Public Health’s position against increasing access and availability of gambling in Ottawa; 4. Recommend that City Council: a. Receive this report for information; and b. Approve as part of the 2014 City of Ottawa Draft Operating Budget an allocation of 6.5% of the City of Ottawa's municipal commission from the OLG on an annual, on-going basis (estimated to be approximately $350,000) to Ottawa Public Health, an increase from current funding of zero per cent, to fund gambling prevention and outreach with community partners, as outlined in this report.

RECOMMANDATIONS DU RAPPORT

Que le Conseil de santé de la circonscription sanitaire de la ville d’Ottawa : 1. Reçoive l’information issue de l’analyse des lacunes faite par Santé publique Ottawa concernant la prévention du jeu, les services de sensibilisation et de traitement, comme il est présenté dans ce rapport; 2. Approuve que la présidente du Conseil de santé de la circonscription sanitaire de la ville d’Ottawa rédige les lettres suivantes, que le maire d’Ottawa aura la possibilité de cosigner : a. à l’intention de la Société des loteries et des jeux de l'Ontario (SLJO) et du ministre des Finances de l’Ontario, avec copie à la ministre de la Santé et des Soins de longue durée de l’Ontario et aux députés provinciaux de la région d’Ottawa, demandant à la SLJO : i. de mettre en œuvre les politiques de santé publique décrites dans le présent rapport, concernant les sites de jeux de hasard à Ottawa; ii. d’affecter tous les ans la somme de 2 millions de dollars au Réseau local d’intégration des services de santé de Champlain, une hausse comparativement au financement actuel de 741 000 dollars, afin de combler l’écart sur le plan du financement des services communautaires de traitement des problèmes de jeu, comme il est décrit dans le présent rapport; b. À l’intention de la ministre de la Santé et des Soins de longue durée de l’Ontario afin que la ministre élargisse la Stratégie ontarienne globale de santé mentale et de lutte contre les dépendances appelée Esprit ouvert,

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esprit sain en intégrant une démarche complète visant à réduire les dangers que présentent les jeux de hasard en Ontario, à assurer le dépistage hâtif et à fournir le traitement en temps opportun et à protéger les populations vulnérables. Pour ce faire, il faudrait intégrer la planification et des services au sein des ministères concernés par le Comité de la politique sociale, du ministère des Services aux consommateurs, de la SLJO et des conseils de santé régionaux; c. À l’intention de la ministre de la Santé et des Soins de longue durée de l’Ontario et du président-directeur général de Santé publique Ontario pour demander la mise en œuvre d’études afin d’évaluer l’efficacité des politiques publiques visant à diminuer les problèmes liés au jeu de hasard et pour renforcer la surveillance provinciale des populations à risque; 3. Soutienne la position de Santé publique Ottawa qui s’oppose à ce qu’on accroisse l’accès aux jeux de hasard, et leur nombre, à Ottawa; 4. Recommande que le Conseil municipal : a. Prenne connaissance du présent rapport; b. Approuve, dans le cadre du budget de fonctionnement provisoire de 2014 de la Ville d’Ottawa, l’affectation annuelle et récurrente de 6,5 % de la commission municipale que reçoit la Ville d’Ottawa de la SLJO (montant estimatif de 350 000 $) à Santé publique Ottawa, soit une augmentation du financement actuel qui est inexistant (0 %), pour financer la prévention du jeu de hasard et des campagnes de sensibilisation avec les partenaires communautaires, comme il est décrit dans le présent rapport.

EXECUTIVE SUMMARY

Gambling has emerged in the literature as a public health concern, which has the potential to cause mental health, social, physical and major financial impacts to individuals, families and communities. In Ottawa, a majority of the population engages in at least one gambling activity, and does so without negatively affecting their health or the well-being of others. However for some, gambling behaviours can vary within a lifetime, moving back and forth between non-problematic to severely problematic. About two per cent of the population over the age of 18 – approximately 13,000 people living in Ottawa – are estimated to be experiencing problems with gambling.

Given the current City Council debate regarding gaming expansion at the Rideau Carleton Raceway and/or another location, Ottawa Public Health (OPH) has collected information from community partners as well as population health and social data, to help inform this discussion. This report outlines the health and social impacts related to problems with gambling, healthy public policies to mitigate these effects, and current gaps in preventing and treating problems with gambling in Ottawa. Based on this information, OPH developed recommendations to address current and future needs.

Findings from OPH‟s key informant interviews, consultations with more than 40 agencies and review of best practices include:

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A coordinated, locally-focused approach to prevent gambling-related harms is needed in Ottawa. Also, a better model to identify individuals experiencing problems with gambling and link them with available, local treatment services is needed. Only about 280 individuals seek treatment in Ottawa each year for problems with gambling.

In 2011-2012, the Ontario Lottery and Gaming Corporation (OLG) allocated approximately $54 million to address problems with gambling within the province of Ontario. This includes approximately $41 million for problem gambling prevention, treatment and research, and approximately $13 million for socially responsible gambling initiatives. These initiatives include funding the Responsible Gaming Council that operates the Know your Limits campaign, supporting research at the Ontario Problem Gambling Research Centre, providing on-line resources and some on-site support at casinos. Although these programs are available, they lack local context and typically require individuals to actively seek out the information.

In 2010-2011, the OLG revenue was $6.69 billon. Of this amount, 0.8% ($52.1 million) was distributed to initiatives across Ontario to address problems with gambling. In contrast, OLG spends approximately $300 million yearly on marketing and promotion of gambling. During roughly the last decade, funding for problem gambling treatment services has not appreciably increased, while the cost of treatment has risen. Funds flowing from OLG revenues to Ottawa treatment providers have remained essentially unchanged since 2007 at approximately $741,000.

In recent years, plans to increase availability of and access to gambling across Ontario as a means to generate revenue have been proposed without concerted, increased efforts to mitigate gambling-related harm among Ontario residents. There is an identified need to improve awareness-raising, early identification of people experiencing problems with gambling and to provide these individuals with timely and adequate treatment. All relevant Provincial Ministries should contribute to protecting vulnerable, at-risk populations through integrated planning and services. Local public health units can contribute by strengthening partnerships between primary care providers, prevention and treatment providers and OLG staff to implement effective policy initiatives and increase referrals of at-risk gamblers to treatment providers.

On-going research and program evaluation is needed to assess the effectiveness of policies and programs that are designed to mitigate gambling-related harm, as is surveillance of at-risk populations.

In order to address current gaps in the prevention, outreach and treatment of gambling- related harm, OPH recommends that:

City Council allocate 6.5% of the City of Ottawa's municipal commission from the OLG on an annual, on-going basis to OPH, an increase from current funding of zero per cent, to fund gambling prevention and outreach with community partners. (It is anticipated that the City will receive a $5.3 million municipal commission in 2013;

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this is an increase of approximately $1 million from previous years, and it is assumed that this level will be sustained.)

The OLG: o Fully implement healthy public policies for current and future gambling sites in Ottawa that mitigate gambling-related harm by limiting gambling availability, gambling modality and hours of operation o Allocate $2.0 million on an annual, on-going basis to the Champlain Local Health Integration Network, an increase from current funding of $741,000, to address the funding gap for community-based gambling treatment services in Ottawa.

The Ministry of Health and Long-Term Care augment the ten-year Open Minds, Healthy Minds, Ontario‟s Comprehensive Mental Health and Addictions Strategy, that aims to transform the mental health system, by including a comprehensive approach to prevent gambling-related harm in Ontario

The Ministry of Health and Long-Term Care and Public Health Ontario commission studies to evaluate the effectiveness of public policies that mitigate problems with gambling and to strengthen provincial surveillance of populations at-risk of gambling- related harm

Furthermore, OPH recommends against increasing access and availability of gambling in Ottawa, including new casinos or slot machines, as increasing such access and availability has been shown to increase the prevalence of problems with gambling. Gambling opportunities already exist in many forms in Ottawa, including online and in casinos. But electronic gaming machines, such as slot machines, and casino table games are more likely to be associated with gambling problems.

OPH‟s consultations with local agencies as well as a review of the literature and best practices exposed several significant gaps in the prevention, outreach and treatment of gambling-related harms. These gaps should be addressed to help mitigate current and future gambling-related harm.

RÉSUMÉ

Dans la documentation actuellement disponible, le jeu est présenté comme une question très préoccupante pour la santé publique, qui peut entraîner des problèmes de santé mentale, et avoir des répercussions sociales, physiques et financières importantes sur les personnes, leur famille et la collectivité. À Ottawa, la majorité des résidents participent à certaines formes de jeu et le font sans nuire de quelque façon que ce soit à leur santé ou au bien-être d‟autres personnes. Cependant pour d‟autres, les comportements liés au jeu peuvent varier tout au long de la vie, alternant entre les périodes où le jeu n‟est pas un problème et les périodes où ce problème devient très grave. À Ottawa, environ deux pour cent de la population de plus de 18 ans, soit près de 13 000 personnes, éprouveraient des problèmes de jeu.

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Compte tenu du débat qui a cours actuellement au Conseil municipal concernant l‟agrandissement des installations à l‟hippodrome de Rideau Carleton et/ou dans d‟autres emplacements, Santé publique Ottawa (SPO) a compilé de l‟information auprès de se partenaires communautaires ainsi que des données sociales et sur la santé de la population, pour éclairer la discussion. Le présent rapport décrit les conséquences des problèmes de jeu sur la santé et la société, les politiques en santé publique pour atténuer ces effets et les lacunes actuelles dans la prévention et le traitement de ces problèmes à Ottawa. En fonction de cette information, SPO a formulé des recommandations afin de combler les besoins actuels et futurs. Voici certaines conclusions tirées des entretiens qu‟a eus avec des informateurs clés, des consultations avec plus de 40 organismes et de l‟examen des meilleures pratiques :

Il faudrait mettre en œuvre à Ottawa une démarche coordonnée et ciblée localement pour prévenir les dommages liés au jeu. Il faudrait également élaborer un modèle amélioré pour repérer les personnes éprouvant des problèmes de dépendance au jeu et les mettre en contact avec les services de traitement locaux. Seulement 280 personnes environ demandent de l‟aide chaque année pour des problèmes de jeu à Ottawa.

En 2011-2012, la Société des loteries et des jeux de l'Ontario (SLJO) a affecté environ 54 millions de dollars pour résoudre les problèmes de jeu dans la province de l‟Ontario. Ce montant comprend environ 41 millions de dollars pour des initiatives de prévention et de traitement des problèmes de jeu et la recherche sur le jeu et environ 13 millions de dollars pour des initiatives sociales portant sur le jeu responsable. Ces initiatives comprennent notamment l‟allocation de financement au Conseil du jeu responsable qui administre la campagne « Dépasser ses limites, ce n‟est plus du jeu », le soutien à la recherche effectuée au Ontario Problem Gambling Research Centre, la fourniture de ressources en ligne et de soutien sur place dans les casinos. Bien que ces programmes soient disponibles, ils ne sont pas vraiment adaptés au contexte local et exigent que les personnes concernées cherchent activement ces informations.

En 2010-2011, les recettes de la SLJO se sont chiffrées à 6,69 milliards de dollars. De ce montant, 0,8 % (52,1 millions de dollars) a été distribué à des initiatives dans l‟ensemble de l‟Ontario pour résoudre les problèmes liés à la dépendance au jeu. Par opposition, la SLJO dépense environ 300 millions de dollars par an pour le marketing et la promotion des jeux de hasard. Pendant à peu près toute la dernière décennie, le financement pour les services de traitement des problèmes de dépendance au jeu n‟a pas augmenté, contrairement au coût du traitement. Les fonds alloués à même les revenus de la SLJO qui sont versés aux fournisseurs de services de traitement d‟Ottawa sont restés essentiellement les mêmes depuis 2007, soit environ 741 000 dollars.

Au cours des dernières années, des plans ont été élaborés afin d‟accroître la disponibilité du jeu en Ontario et de favoriser l‟accès, comme moyen de générer des revenus, sans pour autant augmenter les efforts concertés pour atténuer les dommages liés au problème du jeu chez les Ontariens. Il est devenu évident qu‟il

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faudrait améliorer les campagnes de sensibilisation, les méthodes de détection hâtive des personnes qui ont un problème de dépendance au jeu et offrir à ces personnes un traitement adéquat en temps opportun. Tous les ministères provinciaux concernés devraient participer à la protection des populations vulnérables à risque, au moyen d‟une démarche intégrée de planification et de prestation de services. Les unités de santé publique peuvent contribuer localement en s‟efforçant de renforcer les partenariats entre les prestataires de soins primaires, les fournisseurs de services de prévention et de traitement et le personnel de la SLJO afin de mettre en œuvre des initiatives politiques efficaces et d‟accroître le nombre de cas de joueurs à risque qui sont aiguillés vers les fournisseurs de services de traitement.

Il faudrait également examiner constamment les programmes et les études visant à évaluer l‟efficacité des politiques et des programmes qui sont conçus pour atténuer les dommages liés au jeu, ce à quoi servent déjà les mécanismes de surveillance des populations à risque.

Afin de combler les lacunes actuelles dans la sensibilisation aux dommages liés au jeu, la prévention et le traitement, SPO recommande :

Que le Conseil municipal affecte à Santé publique Ottawa, sur une base annuelle et récurrente, 6,5 % de la commission municipale que reçoit la Ville d‟Ottawa de la SLJO, représentant une augmentation du financement actuel qui est inexistant (0 %), pour financer la prévention du jeu de hasard ainsi que des campagnes de sensibilisation avec les partenaires communautaires. (On prévoit que la Ville recevra une commission municipale de 5,3 millions de dollars en 2013; il s‟agit d‟une augmentation d‟environ 1 million de dollars par rapport aux années précédentes et on prévoit que la commission se maintiendra à ce niveau).

Que la SLJO : o Mette en œuvre des politiques de santé publique concernant les sites de jeux de hasard actuels et futurs à Ottawa; afin de réduire les dommages liés au jeu en limitant l‟offre de jeu ainsi que les modalités des jeux et les heures d‟ouverture. o Affecte sur une base annuelle et récurrente la somme de 2 millions de dollars au Réseau local d‟intégration des services de santé de Champlain, une hausse comparativement au financement actuel de 741 000 dollars, afin de combler l‟écart sur le plan du financement accordé aux services communautaires de traitement des problèmes de jeu à Ottawa.

Que le ministère de la Santé et des Soins de longue durée de l‟Ontario renforce la Stratégie ontarienne globale de santé mentale et de lutte contre les dépendances étalée sur dix ans et appelée Esprit ouvert, esprit sain, en intégrant une démarche complète visant à réduire les dommages liés aux jeux de hasard en Ontario;

Que le ministère de la Santé et des Soins de longue durée de l‟Ontario réalise des études afin d‟évaluer l‟efficacité des politiques publiques visant à diminuer les

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problèmes liés au jeu de hasard et de renforcer la surveillance provinciale des populations à risque;

En outre, SPO s‟oppose à ce que l‟accès au jeu de hasard et la disponibilité des jeux soient augmentés à Ottawa, y compris l‟ajout de nouveaux casinos ou de machines à sous, puisqu‟il a été prouvé que l‟accès au jeu et sa disponibilité augmentent la prévalence des problèmes de dépendance au jeu. La région d‟Ottawa offre déjà de nombreuses occasions de jouer sous différentes formes, en ligne et dans des casinos. Or, les appareils de jeux de hasard électroniques, comme les machines à sous et les jeux de table de casino, sont plus souvent associés à des problèmes de dépendance au jeu.

Les consultations effectuées par SPO auprès d‟organismes locaux ainsi que l‟examen de la documentation et des meilleures pratiques ont révélé qu‟il existe d‟importantes lacunes dans la sensibilisation aux problèmes de jeu, la prévention et le traitement des personnes souffrant de dépendance au jeu. Il faut combler ces lacunes pour aider à atténuer les dommages actuels et futurs découlant de la dépendance au jeu.

BACKGROUND

Current context for gambling in Ottawa

City Council is currently debating gaming expansion in Ottawa at the Rideau Carleton Raceway (RCR) and/or another location (Document 1). Following the initial Council discussions about expanded gaming in Ottawa, as well as the City Council recommendation that City staff “consult with Ottawa Public Health staff on the potential public health impacts of an expanded gaming facility in Ottawa”, Ottawa Public Health (OPH) staff began collecting information from partners as well as population health and social data, to help inform this discussion.

This report outlines the health and social impacts related to problems with gambling, healthy public policies to mitigate these effects, and current gaps in preventing and treating problems with gambling in Ottawa. Based on this information, OPH developed recommendations to address current and future needs.

Currently, Ottawa residents have access to two gambling facilities: RCR; and Casino du Lac-Leamy in Gatineau, which is approximately seven kilometres from downtown Ottawa. RCR has more than 1,250 slot machines and has an average daily patron volume of 5,000 (1.8 million patrons per year). Casino du Lac-Leamy has over 1,800 slot machines, 65 tables and approximately 8,000 daily patrons (3 million patrons per year). Both of these facilities are open 24 hours a day, seven days a week. 1, 2 In 2007- 2008, approximately 10 per cent of Ottawa residents had used a casino in the past 12 months.3

At present, the City of Ottawa receives revenue – a municipal commission – from the slot machines at the RCR. Prior to this year, the City received 3.08% of the RCR slot machine revenue, which totalled approximately $4.25 million in 2012. This year the funding formula has changed; the City receives 5.25% on the first $65 million of slot

9 machine revenue, after that the City receives 3% on the next $135 million and further amounts on a sliding scale based on total slot machine revenue. It is anticipated that the City will receive a $5.3 million municipal commission in 2013; this is an increase of approximately $1 million from previous years that is anticipated to be sustained.

Problems with Gambling in Ottawa

Population data

Gambling is a common activity and most individuals who engage in this behaviour do so without causing harm to themselves or others. In Ottawa, a majority of the population engages in at least one gambling activity in any given year. However for some, gambling behaviours can vary within a lifetime, moving back and forth between non- problematic to severely problematic. Gambling can be looked at in terms of a continuum of use, similar to alcohol and substance misuse, ranging from not gambling, gambling responsibly, some problems with gambling that carry a moderate risk of consequences, gambling that causes some serious social harm (problem gambling) to the most problematic form – pathological gambling. At this stage, individuals engage in “persistent and recurrent maladaptive patterns of gambling behaviour that disrupt personal, family or vocational pursuits.” As gambling behaviour becomes more problematic, so does the severity of the mental and physical health impacts as well as social and financial consequences.4

About two per cent of the population over the age of 18 – approximately 13,000 people living in Ottawa – are estimated to be experiencing problems with gambling. This is not significantly different than the Ontario-wide estimate of 1.3% of people over the age of 18 experiencing problems with gambling.a Additionally, if the Ontario percentage of people experiencing the most severe problems with gambling (0.3%) is applied to the Ottawa population over the age of 18, then approximately 2,035 people in Ottawa suffer from the most severe problems with gambling.b These individuals have experienced negative consequences of gambling and may have lost control over their behaviour.

Despite approximately 2,035 of Ottawa residents with severe problems with gambling, only about 280 individuals seek treatment in Ottawa each year for problems with gambling. Treatment seeking is hindered by many barriers, including the stigma associated with the problem, the desire to solve the problem oneself, the inability of individuals to recognize that they have a gambling problem, and a lack of awareness about available treatment options. 5, 6, 7 a“Problems with gambling” combines the categories of moderate risk gambling and problem gambling from the Canadian Community Health Survey. Moderate risk gamblers are those with a level of gambling problems that may mean they have experienced negative gambling consequences. Problem gambling means the group has experienced negative consequences of gambling and may have lost control over their behaviour. The variable is from the Canadian Community Health Survey (2007-2008) and is a composite score that is based on the Canadian Problem Gambling Index with some modifications. This score is only calculated for those who have gambled more than 5 times in the past year. The score is based on answers to a number of questions about problems associated with problem gambling (e.g. whether gamblers spent more than they wanted to, had they ever borrowed money or sold something to get money for gambling). b The population estimate for Ottawa in 2008 for those over the age of 18 is 678, 341.

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According to provincial data for 2011-2012, nearly half of all individuals seeking treatment in Ontario (42%) are vulnerable economically. These individuals cite their primary source of income as: retirement funds (8.8%); no income (8.1%); family support (7.3%); Ontario Disability Support Program (4.8%); Ontario Works (4.1%); disability insurance (3.7%); unemployment insurance (3.1%). 8

Provincial data also indicates that many individuals seeking treatment for gambling- related harm have concurrent mental health and substance misuse problems 9: 40.5 % have been treated for a mental health, emotional, behavioural or psychiatric problem 21.5 % problems with alcohol 8.9% problems with cannabis 7.8% problems with tobacco 3.5 % problems with opiods 3.1% problems with cocaine

Gambling modalities and problematic behaviour

Games that involve some skill, or give the player the impression that they need skill as well as the experience of almost winning are more likely to be associated with gambling problems, as are games that allow the use of credit to play. These types of games include electronic gaming machines, such as slot machines, and casino table games. 10, 11, 12, 13

In Ottawa, the four most common modalities of gambling for those over 18 years of age and who have gambled more than five times in the past year were: lottery tickets (45.4%), instant win (18.0%), cards/board games with family/friends (7.2%) and video- lottery terminals, such as slot machines (4.7%).14

Problem gamblers in treatment as well as callers to the Ontario Problem Gambling Helpline report that their primary troubles are with slot machines and card gambling at casinos. In addition, although difficult to study, there are examples in the literature suggesting that a significant amount of slot machine revenue is derived from people with gambling problems.15

Health and Social Impacts Related to Problems with Gambling

Gambling has emerged in the literature as a public health concern, which has the potential to cause mental health, social, physical and major financial impacts to individuals, families and communities (Document 2):

A significantly higher proportion of problem gamblers report having thoughts of committing suicide in their lifetime compared to non-problem gamblers. The risk of suicide is also higher among older adults with gambling problems. Additionally, spouses of problem gamblers and their children are more likely to attempt suicide than the general population.

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Children who grow up in an environment where there are parental problems with gambling are exposed to the consequences of these problems, including family conflict, financial problems and inconsistent parenting behaviours. These children may witness domestic violence, and be subject to child abuse or neglect resulting in symptoms of anxiety and depression. They may also indulge more frequently and more heavily in potentially addictive substances and activities, and appear to be at greater risk for developing addictive patterns of behaviour.

Gambling is the third most likely and fastest growing cause of bankruptcy in the western world, and one in five persons who experiences problems related to gambling will eventually file for bankruptcy. Bankruptcy affects not only the gambler, but the family as well. Lack of finances directly impacts the ability to provide safe, affordable housing as well as food.

It is estimated that one in six Ontario adults (16.2%) experience a problem resulting from their own or another person‟s gambling.16

People who may have a predisposition to developing problems with gambling are individuals who have other mental health and addiction disorders, individuals who do not understand the random nature of gambling and those who perceive gambling as a way to address a personal need (solving a financial problem or being part of a social gathering). 17

Health and Social Impacts Related to Increasing Access and Availability of Gambling

Overall, the literature indicates that increased opportunities to gamble within a community, such as the addition of a new casino, are associated with an increase in problems with gambling. 18, 19, 20, 21, 22, 23 Increased opportunities to gamble arise not only from an increase in gambling locations, but also improved proximity to a gambling venue and ease of access. There is international evidence to support that the number of people presenting for problem gambling treatment and the number of bankruptcies both rise following the opening of a casino. 24

One study found that residents who lived within 10 miles of a casino had more than twice the rate of problem gambling compared to participating residents who lived more than 10 miles away.25 Similarly, another study revealed that those living less than 80 miles from a casino experienced a higher rate of problem gambling26, and a similar proximity effect was noted in a number of other studies. 27 28 Toronto Public Health also concluded that proximity to a gambling venue is a determinant of problem gambling. 29, 30

Several communities in Ontario have reported increases in persons seeking treatment for problems with gambling following the opening of casinos, including Niagara, Sarnia, Sault Ste Marie, Brantford and Thunder Bay. 31, 32 Similar increases have also been documented in British Columbia. 33

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Current Prevention, Outreach and Treatment Services in Ottawa (Document 3)

Prevention and Outreach

At present, the Ontario Lottery and Gaming Corporation (OLG) Responsible Gaming Council operates the Know your Limits campaign and provides some on-site support at casinos. Programming is targeted to people who gamble and depends on self- awareness and self-regulation. The OLG also provides problem gambling training for employees.

Ottawa residents also have access to the following province-wide services: The Ontario Problem Gambling Helpline which provides confidential and free counselling through telephone, live chat, or email, and also hosts an information website A website for both the public and health professionals offered by the Centre for Addiction and Mental Health

OPH aims to prevent gambling-related harms through existing programs and services targeted to families for healthy child development and building resiliency in youth: Healthy Babies, Healthy Children, and Healthy Transitions programs. Currently, there are no specific programs devoted to addressing, mitigating or preventing problems with gambling within OPH.

Treatment Services

There are four Ottawa-area providers of treatment services for people experiencing problems with gambling that are funded by revenues flowing from the OLG. Another three local service providers also offer treatment for Ottawa-area residents. These programs are tailored to specific age-groups and genders, and mostly consist of group counselling with very limited individual counselling opportunities.

Current Funding for Prevention, Outreach and Treatment Services

In 2010-2011, the OLG revenue was $6.69 billion. Of this amount, 0.8% ($52.1 million) was distributed to initiatives across Ontario to address problems with gambling. This amount remained similar for 2011-2012; $53.9 million was allotted. In contrast, OLG spends approximately $300 million yearly on marketing and promotion of gambling.34

OLG funds to address problems with gambling are derived from two distinct amounts: 1) Two per cent of gross revenues are allocated from slot revenue earned at casinos and slot facilities, excluding the resort casinos ($40.8 million), for gambling problem awareness, treatment and research 2) A lump sum payment ($13.1 million) is provided by OLG for social responsibility initiatives, such as on-site brochures, self-exclusion programs and training for Responsible Gambling Centre staff

For prevention and treatment services, funds flow from the OLG to the Ontario Ministry of Finance. This money is then allocated by the Ministry of Health and Long-term Care

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(MOHLTC) to the appropriate Local Health Integration Network (LHIN) for distribution to local treatment providers. In 2012-2013, $741,000 was earmarked from Ministry funds to four Ottawa-area providers of prevention and treatment services through this mechanism.

Gaps in Current Prevention, Outreach and Treatment Services

During the last 18 months, OPH conducted key informant interviews and consulted with more than 40 agencies to gauge the impact of problems with gambling in Ottawa and to identify gaps in current services. A summary list of agencies consulted is included in the consultation section of this report. A review of best practices to prevent gambling- related harm was also undertaken.

Gaps in Prevention and Outreach in Ottawa

Although programs through the OLG are available, they lack local context. Further, the resources for responsible gambling typically require individuals to actively seek out the information. In the past year, there have been 2,500 visits to the interactive information kiosk at the RCR, but little is known whether visits to the kiosks resulted in patrons adopting responsible gambling behaviours. The OLG has also reported that its self- exclusion program could be improved by working more closely with local treatment providers.

Consultations with Ottawa-area agencies revealed there is a need to have tailored education to Ottawa residents to address common myths and raise awareness of the signs and symptoms of problematic behaviour.

OLG has also identified prevention and outreach activities that could be improved and/or enhanced: Correct misconceptions about slot machines, lotteries and increase awareness about gambling myths Enhance relevant player and public awareness research including effectiveness of its responsible gaming tools and technology Improved targeted player communication to assist patrons to the awareness and knowledge they need to game responsibly

OPH consultations also revealed that although services are available, many people are not making that last step to connect with the services they need. Increased promotion of local services, personal connections with counsellors, coordination of services with a broader range of agencies, such as credit counselling or legal services, and improved access to these services would reduce this gap.

Gaps in Treatment Services in Ottawa

Local service providers have indicated that during the last decade, funding for problem gambling treatment services has not appreciably increased, while the cost of treatment has risen. Funds flowing from OLG revenues have remain unchanged since 2007; the Champlain LHIN did provide a 1.5% stabilization increase in 2012-2013, but none prior

14 to this and none since. Consequently, the quality and variety of treatment services has eroded over time. A number of strategies are being used by some to address this shortfall, including: Shortening the length of the treatment programs Providing more group treatment and less individual sessions to maximize the number of clients that a counsellor can service Combining groups that best practices suggest should be segregated, such as grouping by age or sex

Gaps in Current Prevention, Outreach and Treatment Services across Ontario

In recent years, plans to increase availability of and access to gambling across Ontario as a means to generate revenue have been proposed without concerted or coordinated efforts to mitigate gambling-related harm among Ontario residents. There is an identified need to provide early identification of people experiencing problems with gambling and to provide these individuals with timely and adequate treatment. Furthermore, there needs to be a plan that involves all relevant Provincial Ministries to protect vulnerable, at-risk populations through integrated planning and services. There is also a lack of research regarding the effectiveness of policies that are designed to mitigate gambling-related harm as well as surveillance of at-risk populations.

The Centre for Addiction and Mental Health developed principles that support “the belief that gambling should be regulated and operated with public health as its prime imperative” in order to mitigate and prevent gambling-related harm: Ontarians are not exposed to high-risk gambling environments and modalities. Ontarians have the right to abstain from gambling, and to establish limits on the extent of their participation. Those who choose to gamble are informed of the odds of winning, and of the potential consequences and risks. Ontarians whose lives are most affected by problem gambling have access to high- quality, culturally appropriate care. Gambling legislation and regulation must establish a minimum duty of care. Government regulation and operation of gambling should have as its primary focus the protection of populations at greatest risk of developing gambling problems. Government decisions on gambling are based on best evidence, and research on gambling is supported.

Many of these principles are not evident in current provincial strategic direction and priorities. There is then, as heard in consultations, a need and an opportunity to strengthen prevention, outreach and treatment with the integration of these principles into current and future provincial mental health strategies.

Roles and Responsibilities: Prevention, Outreach and Treatment of Problems with Gambling

Ottawa Public Health

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Ontario public health units administer health promotion and disease prevention programs to inform the public about healthy life-styles, including education in healthy growth and development including parenting education, health education for all age groups and selected screening services.

Specifically, the OPH role in regards to gambling includes: Monitor and report on health impacts Provide positive parenting and mental health promotion services to families and youth Reduce stigma and improve access to appropriate resources Raise awareness and educate residents on gambling misconceptions, warning signs and safe gambling guidelines With partners, target outreach to priority populations most affected by gambling, and support screening and early intervention for those experiencing problems Support healthy public policy across all sectors

Ministry of Health and Long-Term Care

The role of the MOHLTC is based on helping people stay healthy, delivering good care when people need it, and protecting the health system for future generations.

Specifically, the MOHLTC role in regards to gambling includes: Establish overall strategic direction and provincial priorities for the health system regarding gambling through the Open Minds, Healthy Minds Comprehensive Mental Health and Addictions strategy Develop legislation, regulations, standards, policies and directives to support those strategic directions Monitor and report on the health of Ontarians regarding gambling, especially the populations at risk of gambling-related harm Plan for and establish funding models and levels of funding for the health care system specifically for the treatment of problem gambling Ensure that Ministry and system strategic directions and expectations are fulfilled

Ontario Lottery and Gaming Corporation

The role of the OLG is to: Continue to fund programs for the awareness, prevention, treatment and research of problem gambling Collaborate and learn from organizations (such as the Centre for Addiction and Mental Health, Ontario Problem Gambling Helpline, Ontario Problem Gambling Research Centre, Responsible Gambling Council and others), benefiting from their research and experience in prevention and counselling Incorporate the knowledge gained from the collaborative organizations to prevent patrons from developing problems with gambling Incorporate technology industry best practices in the area of responsible gambling features and assess the potential use of this technology when placing and replacing equipment at gaming sites

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Enhance self-exclusion programs with a greater emphasis on supporting and encouraging patrons to identify they have a problem at an early stage and seek counseling from problem gambling professionals Implement actions to correct their identified gaps in their responsible gaming program elements

DISCUSSION

Proposal to address gaps in prevention, outreach and treatment of gambling- related harm in Ottawa

Based on the information collected from consultations with local agencies, review of best practices and financial records, it is evident that there is a need to address current, local gaps in prevention, outreach and treatment of gambling-related harm.

Recommendation 2.a.i: That the OLG fully implement healthy public policies at current and future gambling sites in Ottawa

Best practices in the prevention, outreach and treatment of gambling-related harm, as described in the background section of this report, support a multi-level approach: policy development; education and awareness-raising; and environmental practices that support responsible gambling and protection of populations at greatest risk of developing gambling problems.

In order to align with best practices and similar to other local public health agencies in Ontario, OPH supports that casinos and other gambling sites demonstrate due diligence to protect their clientele by incorporating healthy public policies in their planning and day-to-day operations. A report prepared for the Ontario Problem Gambling Research Centre and the MOHLTC, entitled Prevention of Problem Gambling: A Comprehensive Review of the Evidence, and Identified Best Practices outlined some of the most effective strategies for the prevention of problem gambling. While OLG has been progressive with some policies, such as self-exclusion programs and mandatory staff training the following policies are recommended to be adopted and implemented: 1. Limiting hours of casino operation: no 24-hour access to venues, closed at least 6 hours per day; 2. Restricting the number of electronic gaming machines (EGMs) and slowing down machine speed of play and features that promote false beliefs of the odds of winning 3. Eliminating casino loyalty programs 4. Prohibiting ATMs on the gambling floor 5. Prohibiting casino credit and holding accounts 6. Reducing maximum bet size 7. Mandating a daily loss maximum 8. Implementing strong casino self-exclusion programs, including a mandatory player card system 9. Issuing monthly individual patron statements which include full membership medians and averages to compare against personal record of loss, frequency and duration of play.

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10. Designating areas for alcohol purchase and not providing alcohol service on casino floors to reduce impaired judgement.35

Recommendation 2.a.ii: That the OLG allocate $2.0 million on an annual, on-going basis to the Champlain Local Health Integration Network, an increase from current funding of $741,000, to address the funding gap for community-based gambling treatment services in Ottawa

Funding that flows from the OLG for treatment of problems with gambling has not appreciably increased during the last decade, as it has remained at approximately $741,000, and needs to be augmented to meet the immediate needs of those already seeking treatment.

Local and national service providers have estimated that treatment costs for one individual with gambling problems are $7,000, while current funding is at approximately $2,500 per person. This leaves a funding shortfall of $4,500 per person.

In order to address this shortfall in funding for treatment services, OPH is recommending that OLG allocate $2.0 million on an annual, on-going basis to the Champlain LHIN to adequately address current treatment needs of Ottawa residents experiencing problems with gambling. This funding would enable treatment providers to: Screen, assess and enrol clients in a more coordinated manner Give support to family members of clients Develop plans of care for clients that are tailored to each individuals‟ unique needs, which may include mental health support, individual, couples and group counselling, and referrals to other social and health care services

Recommendation 4.b: That City Council approve as part of the 2014 City of Ottawa Draft Operating Budget an allocation of 6.5% of the City of Ottawa's municipal commission from the OLG on an annual, on-going basis (estimated to be approximately $350,000) to Ottawa Public Health, an increase from current funding of zero per cent, to fund gambling prevention and outreach with community partners

There is a large gap between those who are experiencing problems with gambling (approximately 13,000 Ottawa residents) and those who seek treatment (approximately 280 individuals). The literature exposes a number of significant barriers that individuals face when dealing with gambling problems: a desire to deal with the problem alone, stigma, lack of awareness that their gambling is a problem and lack of knowledge of the help that is available to them. Many do not realize they have a problem until they reach a point of significant loss.

Feedback from consultations with local agencies supports the implementation of a locally-focused initiative. Additionally, information from the OLG supports strengthening prevention and outreach as well as improving self-exclusion programs through better working relationships with local treatment providers.

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To bridge the gap in current prevention and outreach services, OPH is recommending that 6.5% of the City of Ottawa‟s municipal commission from the OLG (approximately $350,000 in 2013) be provided to OPH and partners on an annual, on-going basis to: Build awareness in the youth and adult population to decrease problem gambling behaviours, provide early detection and increase treatment-seeking in this group Strengthen partnership efforts between primary care providers, prevention and treatment providers and OLG Responsible Gaming staff to implement effective policy initiatives and increase referrals of at-risk gamblers to treatment providers o Ensure multi-cultural, multi-lingual outreach and treatment services are made available o Support primary care clinicians to provide screening, brief intervention services through provision of clinical tools and appropriate referrals to local resources, including mental health and addiction counselling providers o Establish stronger screening and referral mechanisms between casino and addictions services for individuals exhibiting potential problem behavior o Carry out activities to monitor the extent of the health impacts of problem gambling o Collaborate with academics and treatment providers working in problem gambling for timely knowledge exchange Increase access to self exclusion in a non-casino setting and provide initial contact with a counsellor

This program would be carried out in partnership with community stakeholders, including: Local mental health and addictions service providers Agencies that work with people with gambling problems, such as credit counselors Other experts, such as local academics, the Responsible Gambling Council and the Centre for Addiction and Mental Health.

Proposal to address gaps in prevention, outreach and treatment of gambling- related harm in Ontario

Recommendation 2.b: That the Ministry of Health and Long-Term Care augment the Open Minds, Healthy Minds, Ontario’s Comprehensive Mental Health and Addictions Strategy, by including a comprehensive approach to prevent gambling-related harm in Ontario, provide early identification and timely treatment, and protect vulnerable populations, through integrated planning and services across the Ministries assigned to the Standing Committee on Social Policy, the Ministry of Consumer Service, the OLG and local Boards of Health

In June 2011, the MOHLTC released Open Minds, Healthy Minds, Ontario’s Comprehensive Mental Health and Addictions Strategy. The delivery and implementation of this ten year strategy is assigned to the Standing Committee on Social Policy, which includes membership from the Ministries of Children and Youth Services, Citizenship and Immigration, Community and Social Services, Education, Health and Long-Term Care, Training, Colleges and Universities, as well as the Ontario Seniors' Secretariat. Open Minds, Healthy Minds aims to transform the mental health system through four goals with the first three years focusing on children and youth:

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1. Improve mental health and wellbeing for all Ontarians 2. Create healthy, resilient inclusive communities 3. Identify mental health and addictions problems early and intervene 4. Provide timely, high quality, integrated, person-directed health and other human services

An explicit expected outcome of this strategy is that more Ontarians with mental health and addictions problems will be identified early and receive appropriate services and supports. Consequently, OPH recommends that this strategy prioritize dedicated resources to prevent gambling-related harm in Ontario, provide early identification and timely treatment for problem gambling, and protect vulnerable populations including youth, through integrated planning and services across the Ministries assigned to the Standing Committee on Social Policy the Ministry of Consumer and Services – the Ministry that ensures fair-play and oversees the regulation of the gaming machines – the OLG and local Boards of Health. With potential expansion of gaming facilities in Ontario, the risk of gambling-related harms is increased across the province.

Recommendation 2.c: That the Ministry of Health of Long-Term Care and Public Health Ontario commission studies to evaluate the effectiveness of public policies that mitigate problems with gambling and to strengthen provincial surveillance of populations at risk of gambling-related harm

Ontario has been a leader in research into problem gambling through funding by OLG to the Canadian Centre for Addiction and Mental Health. The resulting Ontario Problem Gambling Resource Centre has identified a number of promising practices to prevent and mitigate harms related to problem gambling: a range of educational and policy interventions with special emphasis on the need to keep prevention initiatives in place for a sustained period.

These policies have been demonstrated to have moderate success in reducing problems with gambling. Unfortunately, there is no current evidence demonstrating policies that have a high success in reducing problem gambling behaviour. More research in this area is needed.

Furthermore, strengthened surveillance of populations at risk of gambling-related harm is needed to help inform local decision makers on how to best protect vulnerable populations.

Recommendation 3: That the Board of Health approve Ottawa Public Health’s position against increasing access and availability of gambling in Ottawa

OPH recommends against increasing access and availability of gambling in Ottawa. Most Ottawa residents engage in some form of gambling, and do so without significantly affecting their health or the well being others. But for some individuals, gambling is a devastating problem that affects not only the gamblers themselves, but also their families and communities.

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Increasing the availability and accessibility of gambling in Ottawa, including new casinos, slot machines and table games, will likely result in an increase in the prevalence of problems with gambling among Ottawa residents. Gambling opportunities already exist in many forms in Ottawa, both online and in casinos. But electronic gaming machines, such as slot machines, and casino table games are more likely to be associated with gambling problems.

In addition, OPH‟s consultations with local agencies as well as a review of the literature and best practices exposed several significant gaps in the prevention, outreach and treatment of gambling-related harms. These gaps should be addressed prior to increasing gambling availability and access in Ottawa.

Next Steps

Should City Council decide to expand gambling opportunities at one or more casinos in Ottawa, it is likely that the population of people experiencing problems with gambling will increase as a result of greater or more convenient accessibility. This potential increase in at-risk gamblers would create: 1. Higher costs for treatment programs due to increased need for services 2. Increased need for programs to address the social problems of gamblers (need for social service supports, greater access to food banks, greater need for family and individual counselling) 3. Increased need for prevention and outreach programs

Experience from other jurisdictions indicates that gambling expansion could result in a doubling of treatment-seeking clients among those who experience problems with gambling. 36, 37, 38 Should expanded gambling opportunities be approved in Ottawa, OPH will endeavour to provide recommendations to mitigate gambling-related harms.

CONSULTATION In preparation of this report, OPH consulted with more than 40 agencies to gauge the impact of problems with gambling in Ottawa and to identify gaps in current services. Feedback was provided by a wide-range of agencies and partners that deal with the impacts of gambling, work with clients in the treatment of problems with gambling and that are involved in local gambling: Ontario, Gatineau, and Ottawa Police Services, Ottawa and Gatineau Paramedic Services, the City Of Ottawa Community and Social Services, the Alcohol and Gaming Commission of Ontario, Toronto Public Health, credit counselors, the OLG, LotoQuebec, the Vanier Institute of the Family, and a number of culturally specific groups, such as the Ottawa Chinese Community Service Centre. OPH staff also consulted with the Centre for Addiction and Mental Health and the State of Nevada regarding funding formulas for gambling treatment, prevention, or research, but there was no awareness of best practices in terms of the allocation of funds.

The recommendations for enhanced prevention, outreach and treatment services are supported in principle by local treatment providers, including those funded through the Champlain LHIN specifically to address problems with gambling: Amethyst Women's Addiction Centre, Centertown Community Health Centre, Rideauwood Addiction and Family Services and Sandy Hill Community Health Centre.

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LEGAL IMPLICATIONS There are no legal impediments to receiving the information described in recommendation 1 of this report. There are no legal impediments to implementing recommendations 2, 3, 4 and 5 of this report.

FINANCIAL IMPLICATIONS With the approval of the report recommendations an allocation of 6.5% of the City‟s OLG revenue would be included for Council‟s consideration within the 2014 Draft Operating Budget to fund gambling prevention and outreach activities. This allocation is estimated to be approximately $350K in 2014 and would be adjusted annually.

Currently, the City‟s 2013 budget reflects the $5.3 million in revenues that are projected to be received from OLG based on the most recent funding agreement for the period commencing April 1, 2013. It is anticipated that the most recent funding agreement formula will result in an additional $300k in 2014 as a result of the full year impact of the new funding agreement.

TECHNOLOGY IMPLICATIONS There are no technology implications related to this report.

BOARD OF HEALTH STRATEGIC PRIORITIES The recommendations in this report support the Board of Health Strategic Priorities 2011-2014: Apply a health lens to all municipal policies (A1); Address emerging community health needs (B).

SUPPORTING DOCUMENTATION Document 1: Decisions regarding gambling expansion in Ottawa and across Ontario Document 2: Health and Social Impacts Related to Problems with Gambling Document 3: Prevention, Outreach and Treatment Services in Ottawa: Current Programming, Best Practices and Proposed Plan

DISPOSITION Staff will prepare required letters and ensure City Council receives this Report and Recommendations.

1 Lac Leamy Casino Website: http://www.casinosduquebec.com/lacleamy/en/information-for-customers

2 Rideau Carleton Raceway website; http://www.rcr.net/slots.html

3 Canadian Community Health Survey 2007-2008

4 Gambling policy framework CAMH august 2001. Diagnotic Services Manual IV and Korn,D Gibbins,R and Azmier,J 2003. Journal of Gambling Studies 19.2

5 Suurvali, H., Hodgins, D.C., et al(2012). Motivators for Seeking Gambling Related Treatment Among Ontario Problem Gamblers. Journal of Gambling Studies 28:273-296

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6 McCormick, A.V. & Cohen, I.M. (2006). Barriers to Accessing Treatment for Problem Gambling. For the BC Centre for Social Responsibility. http://blogs.ufv.ca/cssc/files/2013/02/Cover-Barriers-to-Accessing-Treatment-for- Problem-Gamblnig.pdf

7 Cunningham, J.A., Hogins, D., et al. (2009). Barriers to Treatment for Problem Gamblers in Ontario. Prepared for the Ontario Problem Gambling Research Centre. http://www.gamblingresearch.org/content/level34.php?cid=2976&appid=2330

8 Drug and Alcohol Treatment Information System (DATIS) Central Database Problem Gambling Statistical Tables 2006-2011. July 2011

9 Drug and Alcohol Treatment Information System (DATIS) Central Database. Problem Gambling Statistical Tables 2006-2011. July 2011

10 Centre for Addiction and Mental Health (2011). Gambling policy framework. Available at: http://www.camh.net/Public_policy/Public_policy_papers/CAMH_gambling_policy_framework.pdf

11 Collier, R. (2008). Do slot machines play mind games with gamblers? Canadian Medical Association Journal 179(1), 23-24. http://www.cmaj.ca/content/179/1/23.full.pdf+html

12 Blaszczynski, A., P. Collins, D. Fong, R. Ladouceur, L. Nower, H.J. Shaffer, H. Tavares, and J.-L. Venisse (2011). Responsible gambling: General principles and minimal requirements. Journal of Gambling Issues, http://www.researchgate.net/publication/50228630_Responsible_gambling_general_principles_and_minimal_require ments

13 Williams, R.J., West, B.L., & Simpson, R.I. (2012). Prevention of Problem Gambling: A Comprehensive Review of the Evidence, and Identified Best Practices. Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care https://www.uleth.ca/dspace/bitstream/handle/10133/3121/2012-PREVENTION-OPGRC.pdf?sequence=3

14 Canadian Community Health Survey: Ottawa 2007- 2008

15 Centre for Addiction and Mental Health (2011)Problem Gambling Policy Framework retrieved Aug 1612 from http://www.problemgambling.ca/EN/Documents/CAMH_gambling_policy_framework.pdf

16 Wiebe, J., Single, E., Falkowski-Ham, A. (2001) Measuring Gambling and Problem Gambling in Ontario. For the Canadian Centre on Substance Abuse and the Responsible Gambling Council (Ontario). Available at http://www.responsiblegambling.org/docs/research-reports/measuring-gambling-and-problem-gambling-in- ontario.pdf?sfvrsn=10

17 Williams, R.J., West, B.L., & Simpson, R.I. (2012). Prevention of Problem Gambling: A Comprehensive Review of the Evidence, and Identified Best Practices. Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care. October 1, 2012. http://hdl.handle.net/10133/3121

18 Williams, R.J., West, B.L., & Simpson, R.I. (2012). Prevention of Problem Gambling: A Comprehensive Review of the Evidence, and Identified Best Practices. Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care. October 1, 2012.

19 Cox, B.J., et al. (2005). A national survey of gambling problems in Canada. Can J Psychiatry, 50(4), 213-17.

20 Rush, B., et al.(2007). Mapping the prevalence of problem gambling and its association with treatment accessibility and proximity to gambling venues. Journal of Gambling 20,193–213

21 Volberg, R.A. (1995). Gambling and Problem Gambling in Iowa: A Replication Survey, Des Moines, IA, Iowa Department of Human Services . 22 Room, R., Turner, N.E. & Ialomiteanu, A. (1999). Community effects of the opening of the Niagara Casino. Addiction, 94 (10), 1449-1466.

23 Hann, R. G., & Nuffield, J. (2005). Local community impacts of the charity casinos. Prepared for Addiction Programs, Ontario Ministry of Health and Long-Term Care.

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24 Williams, R.J, Rehm, J and Stevens, R.M.G. (2011) The social and economic impacts of gambling. Final Report prepared for the Canadian Consortium for Gambling Research. March 11, 2011.

25 Welte, J.W., Wieczorek, W>F>, et. al (2004). The Relationship of Ecological and Geographic Factors to Gambling Pathology. Journal of Gambling Studies, Vol 20, No. 4, Winter

26 Gerstein, D.R., Volberg, R.A., Toce, M.T., Harwood R., Christiansen, E.M., Hoffmann, J., Murphy, S.A. et al. (1999). Gambling impact and behaviour study. Report to the National Gambling Impact Study Commission. National Opinion Research Centre at the University of Chicago, Chicago. Available at: http://www.norc.org/PDFs/publications/GIBSFinalReportApril1999.pdf

27 Rush, B., Veldhuizen, S. & Adlaf, E. (2007). Mapping the prevalence of problem gambling and its association with treatment accessibility and proximity to gambling venues. Journal of Gambling Issues, 20: 193–213.

28 New Zealand Ministry of Health. (2008). Raising the odds? Gambling behaviour and neighbourhood access to gambling venues in New Zealand. Wellington: Ministry of Health. Available at: http://www.moh.govt.nz/notebook/nbbooks.nsf/0/E4A9E7FBD23D181CCC25748000817D08/$file/raisi ng-the-odds-may08.pdf

29 Toronto Public Health (2012). Position Statement: Gambling and Health. http://www.toronto.ca/legdocs/mmis/2012/hl/bgrd/backgroundfile-51872.pdf

30 Toronto Public Health (2012). The Health Impacts of Gambling Expansion in Toronto: Technical Report. http://www.toronto.ca/legdocs/mmis/2012/hl/bgrd/backgroundfile-51873.pdf

31 Robin Room, Nigel E. Turner and Anca Ialomiteanu, „Community effects of the opening of the Niagara casino‟¸ Addiction, Vol. 94, No. 10, 1999, pp. 1449-1466.

32 Toronto Public Health and the Centre for Addiction and Mental Health, The Health Impacts of Gambling Expansion in Toronto: Technical Report. http://www.toronto.ca/legdocs/mmis/2012/hl/bgrd/backgroundfile- 51873.pdf

33 Barnes,S.(2013).The Real Cost of Casinos: A Health Equity Impact Assessment. Prepared for The Wellesley Institute. http://www.wellesleyinstitute.com/wp-content/uploads/2013/01/Real-Cost-of-a-Casino_Wellesley-Institute_2013.pdf

34 Canadian Partnership for Responsible Gambling (2013) Canadian Gambling Digest 2011-2012 10th edition prepared by the Responsible Gambling Council for the Canadian Partnership for Responsible Gambling. June 2013

35 Williams,R.J and Simpson,R.I. (2008) Promising Practices in the Prevention of problem gambling in Ontario: report prepared for the Ontario Problem Gambling Research Centre. Guelph Ontario November 14, 2008

36Robin Room, Nigel E. Turner and Anca Ialomiteanu, „Community effects of the opening of the Niagara casino‟¸ Addiction, Vol. 94, No. 10, 1999, pp. 1449-1466.

37Toronto Public Health and the Centre for Addiction and Mental Health, The Health Impacts of Gambling Expansion in Toronto: Technical Report. http://www.toronto.ca/legdocs/mmis/2012/hl/bgrd/backgroundfile- 51873.pdf

38 Barnes,S.(2013).The Real Cost of Casinos: A Health Equity Impact Assessment. Prepared for The Wellesley Institute. http://www.wellesleyinstitute.com/wp-content/uploads/2013/01/Real-Cost-of-a-Casino_Wellesley-Institute_2013.pdf

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Document 1

Decisions regarding gambling expansion in Ottawa and across Ontario

In March 2012, the Province of Ontario approved several changes to the operations of the Ontario Lottery and Gaming Corporation (OLG), including the development of new gaming sites in various Ontario cities. Twenty-nine potential “gaming zones” in which private sector companies would be allowed to operate a gambling facility were identified, including a zone in Ottawa.1

On October 2, 2012, the City of Ottawa‟s Finance and Economic Development Committee (FEDCO) recommended to City Council that notice be sent to OLG that the City of Ottawa be considered for a new or improved casino. At that time, staff was directed to: “provide an analysis that gives a broad picture of the potential economic benefits and impacts of a gaming facility for the City of Ottawa. As part of this analysis, staff will consult with relevant stakeholders and consult with Ottawa Public Health staff on the potential public health impacts of an expanded gaming facility in Ottawa, including providing an overview of the current mitigation measures for populations at-risk of problem gambling. The staff report will be provided to FEDCO and Council when Council reconsiders the matter once a preferred proponent has been selected by OLG.”

On October 10, 2012 City Council voted to approve that the City of Ottawa respond to the OLG Request for Interest by sending a letter from the Mayor stating that the City of Ottawa supports in principle becoming a "host city" for a gaming entertainment centre.

In November 2012, Toronto Public Health released a report on the “Health Impact of Gambling Expansion in Toronto” and a technical report written by Toronto Public Health and the Centre for Addiction and Mental Health.

In April 2013, the Peterborough Health Unit sent a letter to Premier Wynne and Ministers Sousa and Matthews, signed by Board of Health Chair, David Watton, which recommends against the continuation of the provincial OLG gambling initiative and advocates for the inclusion of mitigation strategies if expansion does proceed.

In May 2013, voted against offering Toronto as a host community for gambling expansion.

In June 2013, the Association of Local Public Health Agencies (alPHA) carried forward a resolution, calling for the Province to refrain from expanding gambling availability as a way to address budget shortfalls in Ontario and for health units

1 Centre for Addiction and Mental Health (2012) The Impact of Gambling Expansion in Ontario 25

and other partners to strengthen and develop strategies that prevent or mitigate gambling-related harm in Ontario, promote awareness and protect vulnerable populations.

In July 2013, FEDCO recommended that OLG be informed, prior to the start of the request for proposal process, that the only location acceptable to the City of Ottawa for an expanded gaming facility is the current location at the Rideau Carleton Raceway. At this same meeting, the Committee passed a motion requesting that staff conduct social impact analysis related to an expanded gaming facility at RCR based on the location and the maximum number of electronic games and table games and that staff report back to FEDCO and Council.

This motion was then referred and deferred by Council at its meeting on July 17, 2013 with the following motion, which will be debated at FEDCO on August 26, 2013:

“That the recommendations arising from the Finance and Economic Development Committee with respect to the staff report entitled, “City of Ottawa Participation in the OLG RFP Process” be replaced by the following:

1. That City Council refer the following motion to a Special Meeting of the Finance and Economic Development Committee on the City of Ottawa Participation in the OLG RFP Process to be held on August 26, 2013, for consideration and recommendation to Council at its meeting of August 28, 2013:

WHEREAS the Province of Ontario and the Ontario Lottery and Gaming Corporation (OLG) have provided multiple gaming zones within the same municipal jurisdiction in other parts of the province, including the cities of Toronto and Niagara Falls; and

WHEREAS, although the OLG informed the Mayor on May 2, 2013 that “only one gaming site would be permitted within each zone” and the OLG‟s “current mandate does not address satellite sites”, the OLG did not address the issue of providing a separate gaming zone solely for the Rideau Carleton Raceway area; and

WHEREAS there are reasons for Ottawa to have two gaming zones with separate Request for Proposal (RFP) processes under the OLG‟s Modernization of Lottery and Gaming process; and

WHEREAS remains committed to the continuation of the Rideau Carleton Raceway as a gaming facility, as evidenced by the following resolution, approved by City Council on March 10, 2011:

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City Council communicate its support in principle of the petition to the Province of Ontario by the Rideau Carleton Raceway to direct the Ontario Lottery and Gaming Corporation (OLG) to permit gaming tables at the Raceway as a two- year pilot project, subject to any required rezoning and any relevant legislation such as the Ontario Lottery and Gaming Corporation Act, 1999 and subject to the municipality receiving a flat 5% commission on slot revenues upon the introduction of gaming tables at the Rideau Carleton Raceway.

And the following motion, approved by Council on October 10, 2012:

That the City of Ottawa strongly encourages the Ontario Lottery and Gaming Corporation establish a Request for Proposal process that is fair, transparent, open and competitive and which provides all proponents, including the Rideau Carleton Raceway, an opportunity to compete within a level playing field; and

That the Ontario Lottery and Gaming Corporation consider providing an opportunity for the Rideau Carleton Raceway to be pre-qualified to take part in the final bidding process, given their strong record of success in the Ottawa region; and

WHEREAS, despite the OLG‟s referenced „Gravity Model‟, City Council believes that all private sector proponents should be given the opportunity to determine and demonstrate if and how gaming facilities can exist at the Rideau Carleton Raceway as well as at another location in the Ottawa area; and

WHEREAS City Council wishes to ensure that all proponents are given an opportunity to present their proposals to the Ontario Lottery and Gaming Corporation‟s Request for Proposal process;

THEREFORE BE IT RESOLVED THAT the Finance and Economic Development Committee recommends that City Council approve the following:

a. That the Mayor, on behalf of City Council, ask the Province of Ontario and the Ontario Lottery and Gaming Corporation to create a separate gaming zone and Request for Proposal process for the Rideau Carleton Raceway, such that the Rideau Carleton Raceway retains its current allocation of 1250 slots and the approved expansion for 21 gaming tables; and

b. That the City of Ottawa request that the Ontario Lottery and Gaming Corporation‟s Request for Proposals process for the remaining Ottawa area be undertaken only after the Province of Ontario has communicated a decision with respect to Ottawa‟s request for a separate gaming zone for the Rideau Carleton Raceway; and

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c. That, should the Province of Ontario and the Ontario Lottery and Gaming Corporation deny City Council‟s request for a separate gaming zone for the Rideau Carleton Raceway, City Council communicate its support for the retention of the existing slots facility at the Rideau Carleton Raceway, with the current allocation of 1250 slots and the approved expansion for 21 gaming tables; and

2. That City Council defer consideration of the following recommendations until such time as City Council addresses the Report arising from the Special Meeting of the Finance and Economic Development Committee to be held on August 26, 2013: a. That City Council approve that the proponent for any new or expanded gaming facility at the Rideau Carleton Raceway will: i. Be required to undertake a comprehensive Community Transportation Study (CTS) to assess the impacts to the adjacent community and propose mitigation measures as necessary as part of any potential development application for a new or expanded gaming facility, including the creation of a primary entrance to the facility from ; and ii. Fund the following as part of any potential development application: 1. Any costs to accelerate any proposed Transportation Master Plan or any other projects that are identified and deemed appropriate as a result of the CTS, including the potential timing of the O-Train extension as well as road widening projects such as Bank, Albion (south of Lester), Lester, Earl Armstrong, and the ; and 2. The cost to implement any Area Traffic Management plan, for Blossom Park and other potentially impacted neighbourhoods, required as a result of the Community Traffic Impact Study; and 3. The cost to maintain a free shuttle service to the Rideau Carleton Raceway from the nearest major transit hub with no decrease from the highest level of service provided in 2013; and 4. That the proponents of any proposed gaming facility be required to develop a transit service plan as part of their development application and that staff be directed to review the proposed transit service plan and review possible funding methods, including the potential for a targeted expansion of the Urban Transit Area, and report the results of their review to the Transit Commission and/or the appropriate Standing Committee and Council, as appropriate; and; 28

b. That City Council direct staff to begin an analysis of potential economic benefits and impacts and potential social impacts related to an expanded gaming facility at Rideau Carleton Raceway and report back to the Finance and Economic Development Committee and Council when it is complete.”

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Document 2

Health and Social Impacts Related to Problems with Gambling

Gambling is a common activity and most individuals who engage in this behaviour do so without causing harm to themselves or others. However for some, gambling behaviours can vary within a lifetime, moving back and forth between non-problematic to severely problematic. Gambling can be looked at in terms of a continuum of use, similar to alcohol and substance use, ranging from not gambling, gambling responsibly, some problems with gambling that carry a moderate risk of consequences, gambling that causes some serious social harm (problem gambling) to the most problematic form – pathological gambling. At this stage, individuals engage in “persistent and recurrent maladaptive patterns of gambling behaviour that disrupt personal, family or vocational pursuits.” As gambling behaviour becomes more problematic, so does the severity of the mental and physical health impacts as well as financial effects. i

Mental Health

People experiencing problems with gambling are more likely to have other mental health concerns. There is evidence that individuals who have developed problem gambling will have a higher incidence of mental health illnesses, such as depression, anxiety, attention deficit disorders and personality disorders.ii

At the pathological gambling stage, the most severe form of problem gambling, the individual may engage in five or more of the following behaviours:

1. Preoccupied with gambling (e.g. preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble) 2. Needs to gamble with increasing amounts of money in order to achieve the desired excitement 3. Has repeated unsuccessful efforts to control, cut back, or stop gambling 4. Is restless or irritable when attempting to cut down or stop gambling 5. Gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g. feelings of helplessness, guilt, anxiety, depression) 6. After losing money gambling, often returns another day to get even (“chasing” one’s losses) 7. Lies to family members, therapist, or others to conceal the extent of involvement with gambling 8. Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling 9. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling 10. Relies on others to provide money to relieve a desperate financial situation caused by gambling 30

Alone or in combination, these resulting behaviours can have devastating effects on the individual, their families, friends and their community.

Suicide

The link between suicide and problem gambling is a serious concern. Based on a review of previously published studies, on average, 37.9% of problem gamblers reported suicidal thoughts, and on average 20.5% of them reported attempting suicide.iii According to the Toronto Public Health analysis of the 2007-08 Canadian Community Health Survey data for Ontario, a significantly higher proportion of problem gamblers reported having thoughts of committing suicide in their lifetime compared to non- problem gamblers.

Although persons under the age of 18 are not able to gamble in casinos, youth gamble in other ways – betting money in sports pools – and experience negative health impacts. One study found that a quarter of Ontario students with gambling problems reported a suicide attempt in the past year, roughly 18 times higher than in the general school population. iv, v According to the 2009 Ontario Student Drug Use and Health Survey, youth problem gamblers are four times more likely than non-problem gamblers to have seriously considered committing suicide.vi

The risk of suicide is also higher among older adults with gambling problems. vii Additionally, spouses of problem gamblers and their children are more likely to attempt suicide than the general population. viii, , ix

Substance Misuse

Thirty-three per cent of problem gamblers in Ontario reported using alcohol or drugs while gambling in the past 12 months. As with mental health, there is research evidence that links substance use and tobacco issues to problem gambling (60.1% with co- occurring nicotine dependence and 57.5% co-occurring substance use disorder). There are well-documented health and social harms related to substance use and the concern is that co-occurring substance use with gambling has the potential to exacerbate both issues. It is for this reason that it remains important when considering the impact of expanding casino gambling availability to also consider the impact of increased availability of alcohol.

Physical Health

Issues documented in individuals and family members of problem gamblers are those associated with stress, such as high blood pressure, gastric distress and irritable bowel and the complications associated with each of these. As problem gambling behaviour escalates, the physical health problems become worse.

Financial 31

Bankruptcies have been studied more than any other impact of gambling, with the large majority of studies finding that bankruptcy increases following the introduction of casinos. x Gambling is the third most likely and fastest growing cause of bankruptcy in the western world, and one in five persons who experiences problems related to gambling will eventually file for bankruptcy. xi, xii In a Quebec study, 28 per cent of people with severe gambling problems had declared bankruptcy and one-third had debts between $75,000 and $150,000. A further 35 per cent were about to declare bankruptcy. xiii A 2002 Ontario survey found that, on average, 14 per cent of clients using credit counselling services were there as a result of problem gambling. xiv

Bankruptcy affects not only the gambler, but the family as well. xv Persons with problems gambling may have accumulated debt by gambling with their paycheques or the family savings, and may also have borrowed money from friends and relatives to try and avoid the looming financial impact to their family. Lack of finances directly affects one’s ability to provide safe, affordable housing as well as food, and can affect an individual’s relationships with family and peers. An Ontario study found that non‐gamblers do experience difficulties resulting from someone else’s gambling and the most common negative consequences were financial in nature: being manipulated into lending money (37.3%) and loans not being paid back (37.1%).xvi

Impacts to Family and Community

Similar to families who experience consequences from other addictions, the families of problem gamblers often experience devastating financial difficulties (as described above) and emotional burdens that may lead to divorce and/or suicide. xvii, xviii

Children who grow up in an environment where there are parental problems with gambling are exposed to the effects of these problems, including family conflict, financial problems and inconsistent parenting behaviours. These children may witness domestic violence, and be subject to child abuse or neglect. They may also indulge more frequently and more heavily in potentially addictive substances and activities, and appear to be at greater risk for developing addictive patterns of behaviour. The children of people with gambling problems often experience higher than average levels of mental health issues, such as symptoms of anxiety and depression. xix xx

Activities such as fraud and embezzlement have also been noted in a small percentage of problem gamblers as they seek to support their gambling actions. Most gambling- related crimes are non-violent in nature and include credit card theft, fencing of stolen goods and insurance fraud.

While the impact of problem gamblers is first and foremost on the family, the community also experiences considerable effects. Job loss and reduced work productivity can lead to the need for unemployment and social assistance benefits. The ripple effect on supporting organizations, such as charities and shelters, increases with the burden of problems created by individuals experiencing problems with gambling.xxi

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i Gambling policy framework CAMH august 2001. Diagnotic Services Manual IV and Korn,D Gibbins,R and Azmier,J 2003. Journal of Gambling Studies 19.2 ii CAMH Problem Gambling Policy Framework retrieved Aug 1612 from http://www.problemgambling.ca/EN/Documents/CAMH_gambling_policy_framework.pdf 2 Diagnostic and Statistical Manual of Mental Disorders IV : A3: Definition of pathological gambling iii Turner, N. & Ferentzy, P. 2012. Review of problem gambling and comorbid disorders and behaviours OPGRC RFA Number: FY2011-2012-03. Report submitted to the Ontario Problem Gambling Research Centre. iv Centre for Addiction and Mental Health (2011) .Gambling Policy Framework. Pan American Health Organization /World Health Organization Collaborating Centre v Cook, S., N. Turner, A. Paglia-Boak, E.M. Adlaf, and R.E. Mann (2010). Ontario Youth Gambling Report: Data from the 2009 Ontario Drug Use and Health Survey. Report prepared for the Problem Gambling Institute of Ontario vi Ottawa Public Health (2011) OSDUHS Youth Facts 2011: Gambling. City of Ottawa http://www.ottawa.ca/cs/groups/content/@webottawa/documents/pdf/mdaw/mje1/~edisp/cap223601.pdf vii Nower, L. and A. Blaszczynski, A (2008). Characteristics of problem gamblers 56 years of age or older: a statewide study of casino self-excluders. Psychology of Aging 23(3), 577-584 viii Gaudia, R. (1987). Effects of compulsive gambling on the family. Social Work, 32 (3), 254-256 ix Marshall, D. (2009). Gambling as a public health issue: The critical role of the local environment. Journal of Gambling Issues 23, 66-80. http://jgi.camh.net/doi/pdf/10.4309/jgi.2009.23.4 x (Williams et al., 2011). Williams, R. Rehm, J and Stevens, RMG (2011). The social and economic impacts of gambling. Final Report prepared for the Canadian Consortium for Gambling Research. March 11, 2011 Available at: http://www.gamblingresearch.org/content/default.php?id=4303. xi Frazer, A. 2010. Gambling and Bankruptcy. Retrieved from Condon Associates at http://www.condon.com.au/articles/gambling-and-bankruptcy

xii The National Council on Problem Gambling (2000). Problem Gamblers and Their Finances; A Guide for Treatment Professionals http://www.ncpgambling.org/files/public/problem_gamblers_finances.pdf xiii Ladouceur,R. , Dube, D and Bujold, A (1994) Prevalence of pathological gambling and related problems among college students in the Quebec metropolitan area. Canadian Journal of Psychiatry 39:289-293 xiv Rush,B. Veldhuizen, S. and Aldaf, E. (2007). Mapping the prevalence of problem gambling and its association with treatment accessibility and proximity to gambling venues. Journal of Gambling Issues, 20. 193-213.

xv The National Council on Problem Gambling (2000). Problem Gamblers and Their Finances; A Guide for Treatment Professionals http://www.ncpgambling.org/files/public/problem_gamblers_finances.pdf xvi Wiebe, J. , Mun, P. and Kauffman, N. (2006). Gambling and problem gambling in Ontario 2005. Responsible Gambling Council. Available at: http://www.responsiblegambling.org/articles/gambling and problem gambling in Ontario 2005.pdf xvii Upfold, D, (2012) Gambling and Substance Abuse: A Comparison. Retrieved August 16, 2012 from http://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/GamblingandSubstanceAbuseAComparison.a spx xviii Marshall, D. (2009). Gambling as a public health issue: The critical role of the local environment. Journal of Gambling Issues 23, 66-80.

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xix Centre for Addiction and Mental Health (2008) Problem Gambling A guide to helping professionals (p17,A Pan American Health Organization /World Health Organization Collaborating Centre. Retrieved from: http://www.problemgambling.ca/EN/Documents/2990PG_Pro_ENG.pdf xx Arlene Moscovitch (2006). Gambling with our (Kids’) Futures: Gambling as a family policy issue for The Vanier Institute http://www.vanierinstitute.ca/include/get.php?nodeid=1148 xxiResponsible Gaming Council. June, 2013. What’s the problem with problem gambling? 34

Document 3

Prevention, Outreach and Treatment Services in Ottawa: Current Programming, Best Practices and Proposed Plan

Current Prevention and Treatment Services in Ottawa

There are four Ottawa-area providers of prevention and treatment services for problems with gambling funded by the Ontario Lottery and Gaming Corporation (OLG) revenues to the Ministry of Health and Long-Term Care (MOHLTC) and distributed through the Champlain Local Health Integration Network (LHIN). Amethyst Women's Addiction Centre offers a confidential and free program to women with gambling problems residing in the Ottawa region. The program offered is a two-year outpatient program, allowing women to live at home. Centertown Community Health Centre hosts the Lifestyle Enrichment For Senior Adults (LESA) which offers in-home counselling and group support for senior adults (55+) experiencing problems related to the use of alcohol and other psychoactive drugs, and gambling Rideauwood Addiction and Family Services offers counsellor-led support groups for individuals with gambling problems and also for friends and family members of people experiencing problems with gambling. One-on-one counselling is also available on a fee-for-service basis Sandy Hill Community Health Centre delivers individual and group counselling for gambling problems, as well as an access point to the OLG self-exclusion program in collaboration with local casinos.

Other local prevention and treatment service providers, not funded through OLG revenues are: YM-YWCA offers the Youth Gambling Awareness Program and is funded directly by the MOHLTC Serenity Renewal for Families (a not-for-profit organization) provides education and counselling services to individuals, directly or indirectly, affected by addictions or mental health issues Eight Gambling Anonymous meetings and one Gam-Anon meeting are held per week in Ottawa

Ottawa residents also have access to the following province-wide services: The Ontario Problem Gambling Helpline which provides confidential and free counselling through telephone, live chat, or email, and also hosts an information website A website for both the public and health professionals offered by the Centre for Addiction and Mental Health OLG Website “Know your limit and stay within it” The Responsible Gambling Council 35

Currently prevention is done through funding by OLG to the Responsible Gaming Council that operates the Know your Limits campaign and provides some onsite support at casinos. Programming is targeted to people who gamble and depends on self- awareness and self-regulation. The OLG also currently provides problem gambling training for employees

Best Practices

Ontario has been a leader in research into problem gambling through funding by OLG to the Canadian Centre for Addiction and Mental Health. The resulting Ontario Problem Gambling Resource Centre has identified a number of promising practices to prevent and mitigate harms related to problem gambling: a range of educational and policy interventions with special emphasis on the need to keep prevention initiatives in place for a sustained period.

The literature also points to several gambling prevention best practices with the caveat: “While certain initiatives are more effective than others, there is almost nothing that is not helpful to some extent and, conversely, there is almost nothing that by itself has substantial potential to prevent harm.”1

Healthy child development initiatives and policies restricting the general availability of gambling (including the number, location and more harmful types of gambling) are estimated to have moderately-high effectiveness. Best practices demonstrating moderate effectiveness – sustained targeted educational initiatives, policies increasing the legal age for gambling, restrictions on how gambling is provided (player pre- commitment and automated, mandated intervention for at risk-gamblers) – have been estimated to have moderate effectiveness. Beyond sustained education initiatives, these other types of practices are out of the realm of control of public health, but have been advocated for by several public health agencies in Ontario and Canada.

Practices with moderate-low effectiveness that are within scope and mandate of Ottawa Public Health and its partners include: information, awareness-raising campaigns, on- site information/counselling centres, and casino self-exclusion.

Proposed Plan: Prevention, Outreach and Treatment

Prevention and Outreach

The literature and local health data reveal that: One in six Ontario adults (16.2%) experiences a problem resulting from their own or another person’s gambling. Evidence that there are approximately 13,000 people in Ottawa experiencing problems with gambling. With only about 280 accessing mental health and treatment services annually, it suggests that a significant number may not be aware of their problem and/or services to assist them and/or how to access them. 36

There are numerous other barriers that individuals face when dealing with gambling problems: desire to deal with the problem alone, stigma Many people experiencing problems with gambling do not realize they have a problem until they reach a point of significant loss There is a gap between what is offered by the OLG and the uptake in using prevention services in Ottawa.

To bridge the gap in current prevention and outreach services, OPH is recommending that six per cent of the City of Ottawa’s municipal commission from the OLG (approximately $350 K in 2013) be provided to OPH and partners on an annual, on- going basis to: Build awareness in the youth and adult population of gambling misconceptions, warning signs and safe gambling guidelines to enhance early detection and increase treatment seeking in this group Strengthen coordination efforts between primary care providers, prevention and treatment providers and OLG Responsible gaming staff to implement effective policy initiatives and increase referrals of at risk gamblers to treatment providers o Implement promising practice mitigation strategies o Ensure multicultural, multilingual outreach and treatment services are made available o Support primary care clinicians to provide screening, brief intervention services through provision of clinical tools and appropriate referrals to local resources including mental health and addiction counseling providers o Establish stronger screening and referral mechanisms between casino and addictions services for individuals exhibiting potential problem behavior o Carry out activities to monitor the extent of the health impacts of problem gambling o Collaborate with academics and treatment providers working in problem gambling for timely knowledge exchange Increase access to self exclusion in a non-casino setting and provide initial contact with a counsellor

Treatment

Local and national service providers have estimated that treatment costs for one individual with gambling problems are $7.0 K, while current funding is at approximately $2.5 K per person. This leaves a gap of $4.5 K per person. A number of strategies are being used by some to address this shortfall, including; Shortening the length of the treatment programs Providing more group treatment and less individual sessions to maximize the number of clients that a counsellor can service Combining groups that best practices suggest should be segregated, such as grouping by age or sex 37

In order to address this shortfall in funding for treatment services, OPH is recommending that OLG allocate $2.0 M on an annual, on-going basis to the Champlain LHIN to adequately address current treatment needs of Ottawa residents experiencing problems with gambling. This funding would enable treatment providers to: Screen, assess and enrol clients in a more coordinated manner Give support to family members of clients Develop plans of care for clients that are tailored to each individuals’ unique needs, which may include mental health support, individual, couples and group counselling, and referrals to other social and health care services

1 Williams, R.J., West, B.L., & Simpson, R.I. (2012). Prevention of Problem Gambling: A Comprehensive Review of the Evidence, and Identified Best Practices. Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care. October 1, 2012. http://hdl.handle.net/10133/3121 38

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10. HEALTH AND SOCIAL IMPACTS RELATED TO PROBLEMS WITH GAMBLING IN OTTAWA RÉPERCUSSIONS LIÉES AUX PROBLÈMES DU JEU SUR LA SANTÉ ET SUR LE PLAN SOCIAL À OTTAWA ACS2013-OPH-HPDP-0006 CITY WIDE

Mrs. Sherry Nigro, Manager of Health Promotion Disease Prevention spoke to a PowerPoint presentation, which served to provide the Board with some context on this report and Ottawa Public Health staff took questions from Board members. This discussion lasted approximately sixty minutes.

The Board then heard from the following public delegations, which lasted approximately forty five minutes:

Elaine; Jeff Morrison, Centretown Community Health Centre; Rawlson King, Rideau-Rockcliffe Community Resource Centre; Paul Welsh, Rideauwood Addiction and Family Services; Dallas Smith, Lifestyle Enrichment for Senior Adults (LESA) Program – Centretown Community Health Centre; Bruce Jutzi; and Robin McAndrew, Sandy Hill Community Health Centre

All seven public delegates were in favour of the report recommendations.

Following the discussion, the report recommendations were then put to the Board.

That the Board of Health for the City of Ottawa Health Unit: 1. Receive for information the Ottawa Public Health gap analysis of gambling prevention, outreach and treatment services, as outlined in this report; CARRIED

2. Approve that the Chair of the Board of Health for the City of Ottawa Health Unit write the following letters, and that the Mayor of Ottawa be provided the opportunity to co-sign these letters: a. To the Ontario Lottery and Gaming Corporation (OLG) and the Ontario Minister of Finance with a copy to the Ontario Minister of Health and Long-Term Care and Ottawa-area Members of Provincial Parliament, requesting that the OLG: 39

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i. Fully implement healthy public policies, as outlined in this report, for current and future gambling sites in Ottawa; ii. Allocate $2.0 million on an annual, on-going basis to the Champlain Local Health Integration Network, an increase from current funding of $741,000, to address the funding gap for community-based gambling treatment services in Ottawa, as outlined in this report; iii. Work with Loto-Québec and Casino Lac-Leamy to provide additional funding for the purposes of strengthening prevention, outreach and treatment of gambling-related harms in Ottawa; b. To the Ontario Minister of Health and Long-Term Care requesting that the Ministry of Health and Long-Term Care augment the Open Minds, Healthy Minds, Ontario’s Comprehensive Mental Health and Addictions Strategy by including a comprehensive approach to prevent gambling-related harm in Ontario, provide early identification and timely treatment, and protect vulnerable populations, through integrated planning and services across the Ministries assigned to the Standing Committee on Social Policy, the Ministry of Consumer Services, the OLG and local Boards of Health; c. To the Ontario Minister of Health and Long-Term Care and the President and Chief Executive Officer of Public Health Ontario requesting that studies be commissioned to evaluate the effectiveness of public policies that mitigate problems with gambling and to strengthen provincial surveillance of populations at risk of gambling-related harm;

CARRIED, as amended by the following motion:

MOTION BOH 18/04 Amendment Moved by Councillor Qadri

WHEREAS Ottawa residents have access to two gaming facilities in the Ottawa area: Rideau Carleton Raceway, which is operated by the Ontario Lottery and Gaming Corporation (OLG); and Casino de Lac-Leamy in Gatineau, which is operated by Loto-Québec; and

WHEREAS in 2012, Casino de Lac-Leamy announced an investment of $50 million in renovations to the casino with an aim to attracting more clientele, many of whom will be residents of Ottawa; and

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WHEREAS in the last three years, Loto-Québec has more than doubled its promotion of video lottery terminals (VLTs), spending $500,000, and VLTs are more likely to be associated with gambling-related harms; and

WHEREAS there exist gaps in funding of prevention, outreach and treatment of gambling-related harms in Ottawa; and

WHEREAS Loto-Québec spends approximately $30 million every year to prevent excessive gambling across the province of Québec;

THEREFORE BE IT RESOLVED that Recommendation 2 be amended, by adding 2a(iii) as follows: 2. Approve that the Chair of the Board of Health for the City of Ottawa Health Unit write the following letters, and that the Mayor of Ottawa be provided the opportunity to co-sign these letters: a. To the Ontario Lottery and Gaming Corporation (OLG) and the Ontario Minister of Finance with a copy to the Ontario Minister of Health and Long- Term Care and Ottawa-area Members of Provincial Parliament, requesting that the OLG: i. Fully implement healthy public policies, as outlined in this report, for current and future gambling sites in Ottawa; ii. Allocate $2.0 million on an annual, on-going basis to the Champlain Local Health Integration Network, an increase from current funding of $741,000, to address the funding gap for community-based gambling treatment services in Ottawa, as outlined in this report; iii. Work with Loto-Québec and Casino Lac-Leamy to provide additional funding for the purposes of strengthening prevention, outreach and treatment of gambling-related harms in Ottawa;

3. Approve Ottawa Public Health’s position against increasing access and availability of gambling in Ottawa;

CARRIED on a division of 8 YEAS to 1 NAY as follows:

YEAS (8): Councillors D. Holmes, M. Fleury, D. Chernushenko, K. Egli, K. Hobbs, and members T. Hutchinson, G. Richer, M. Keeley. NAYS (1): Councillor S. Qadri

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4. Recommend that City Council: a. Receive this report for information; and b. Approve as part of the 2014 City of Ottawa Draft Operating Budget an allocation of 6.5% of the City of Ottawa's municipal commission from the OLG on an annual, on-going basis (estimated to be approximately $350,000) to Ottawa Public Health, an increase from current funding of zero per cent, to fund gambling prevention and outreach with community partners, as outlined in this report. CARRIED