New challenges for social work
In addition to the social challenges associated with the employment of persons with physical and mental disabilities, it will be necessary to address the issue of seniors with cognitive impairment becoming involved in internet gaming, gambling and abuse. In this context we consider it important in terms of vocational interest to define the indicators of problem gaming and gambling within the European Union. Currently, there is for example no clearly defined concept of cyberbullying, and little exploration in the area of vulnerable target groups in connection with gaming and gambling. Improving the skills and knowledge which help professionals to recognize the primary signals and early stages of addiction to gaming and gambling should form part of social-work training at universities and colleges.
A further challenge related to gambling and persons with dementia is the question of who has the competence to protect the elderly with dementia if they themselves have adult children who are compulsive gamblers. Crimes committed by seniors in the Slovak Republic are often connected with gambling problems in the family (Criminal Police of Slovakia, 2015). Family members, often a son, need money to finance their gambling, pay gambling debts and/or finance the use of intoxicants (mostly alcohol). The elderly become victims, often threatened and even physically abused by family members. As the digitally active generation grows older, we can anticipate that gaming will be a challenge, regardless of a person’s age.
Social workers are often the mediators in relationship conflicts. One of the main problems in such mediating lies in sorting out generational conflicts that are considered “normal”, and those that are seriously pathological.
For counselling services and social workers, the focus should be on those in danger of or showing signs of mental illness. For counselling services, working with and giving information to students is a high priority. The same is naturally true regarding the elderly. However, the problems of many elderly people are difficult to diagnose and help because this demographic may have few social contacts. We are likely to see increased isolation among the elderly due to the possibility of living in the digital world. It is important that counsellors do not demonize gambling and accept it as a normal recreational activity, while at the same time pointing out the warning signs and giving easy access to counselling and professional intervention.
Social workers often have limited access to subcultures. Moreover, the problems within subcultures might differ considerably from those in the majority culture, and therapy and counselling will have to consider those differences. Discussions with organizations for immigrants include raising the possibilities of suitably adapted programmes. Social workers coming from ethnic minorities will be important in such work. They will also have the advantage of being familiar with the language and culture of the ethnic minority they work with. Lack of a common language or difficulty in communication in another language is a significant obstacle in therapy and counselling.
Preventive programmes organized by the gambling industry are ineffective or even counterproductive. Online self-help tools and counselling for gamblers should be limited to those provided by independent professionals only. Results showed that when social support workers were trained and improved their knowledge on gambling types, characteristics and related risks, it impacted directly on the clients with gambling disorders; their gambling behaviour, some cognitive distortions, and misconceptions related to the economic profitability of gambling were all reduced (Tani, et al., 2021)
Social workers are frequently counsellors both to individuals and families and to others, such as teachers (Jonsson, 2003). Counselling needs to be knowledge-based and founded on the same ethical and professional standards as other social work. Because of potential conflicts of interest, counselling on moral issues is sensitive. The same is true for problems involving what individuals consider to be private issues. Examples are issues associated with emotional reactions and sexuality.
Counselling needs to relate to practice. This especially concerns personal economy and use of time for work and social interaction. It is about family problems as well as individual problems. It is about shame, depression and individual limitations and pathology. Quite often counselling needs to address a combination of problems and very often the different reactions to those problems among the family members. Family counselling is about making family members engage in fruitful interaction about the problems the family share, and sometimes about challenges which individuals in the family wish to resolve as individuals, and not together with the rest of the family.
Internet-based counselling and treatment programmes already feature among the strategies of social work. Experience with such programs in Norway is positive (Myrseth et al., 2013). Traditional programmes using self-help approaches among people with the same problem is often helpful with gaming and gambling problems (Ferentzy & Skinner, 2003; Ferentzy et al., 2003; Ferentzy et al., 2013).
With the coming demographic changes, the social work profession has a unique opportunity to improve the education and training of social workers to meet the needs and health challenges, as well as gaming and gambling disorders, of the elderly. Gerontological knowledge in social work education can help to provide effective services. There is a pressing need to upgrade the gerontological knowledge and skills of practicing social workers. Geriatrics and gerontology, as specialized fields of knowledge, have not been sufficiently integrated into formal academic training programs. There are major trends in the health care environment which impact on social work education, including technological advances, a shift from inpatient to outpatient and community care settings, the increasing diversity of the older population, and client and family participation in decision-making. These trends necessitate social work education to emphasize new content areas in gerontology and the development of new skills in clinical, case management, care coordination, and teamwork. A significant obstacle to the preparation of future social workers, which inhibits their ability to deliver the complex services needed by older adults and their families, is a serious shortage of social work faculty in gerontology (Scharlach et al. 2010, Berkman et al. 2016)
To achieve a better aged society, we should stop considering an aging population as a negative social phenomenon; instead, we should create a society where elderly people can enjoy a healthy, prosperous life through social participation and contribution. Factors that hamper the elderly from leading a healthy life include various psychological and social problems that occur in older age, as well as a higher incidence of diseases. Thus, we should recognize the importance of gerontology and geriatrics, and a reform of social, medical-care services and public health policy is necessary in order to cope with the coming aged society.
The challenge of responsible public health policies to gaming and gambling
There are various approaches to problem gambling in the field of public health, which are also used to develop responsible gambling strategies. Some strategies are used internationally to combat the occurrence of gambling problems, such as better information about odds and the costs of gambling. Such strategies operate primarily at local level, and often involve a range of stakeholders, including government, treatment agencies, local community groups, academic researchers and the gambling industry itself. There are examples of mandatory initiatives where states have required lotteries to print helpline numbers on tickets and develop ‘point of sale’ materials about problem gambling to be posted in lottery retail outlets. The public health perspective is based on policies designed to prevent and reduce the adverse social, financial and health consequences of gambling for individuals, communities and society, which are generally categorised under the umbrella term of “Harm Reduction” (Reith & ScotCen, 2006).
Universal and targeted policies and programmes addressing major modifiable protective and risk factors (e.g. social, educational and economic disparities, unemployment, ethnic discrimination) could significantly augment gambling-focused interventions. Several non-gambling risk and protective factors also underlie other mental health disorders, morbidities and harms. Addressing these shared protective and risk factors can be expected to have widespread benefits, most likely including reduced prevalence of these disorders as well as gambling-related harm, and reduction in health and social inequities. While of major importance, reducing exposure and participation via supply limitation is unlikely on its own to reduce gamblingrelated harm in the short to medium term (Abbott, 2020).
The main threat to any public health approach in this area is the potential for the gambling industry and other vested interests to oppose or subvert any policies which might reduce their profits. The complexity of the systems on which policies act means that any policy must be carefully evaluated for both intended and unintended consequences, and the independence of the evaluation prioritised and protected.
The challenge of mental illness to gaming and gambling disorders
The challenge of those with mental health disorders depends upon the type of illness involved. Schizophrenia poses a particular challenge because of the sufferer’s distorted sense of reality. Not relating to the same reality as others can result in selfdestructive behaviour, which can sometimes be harmful — and even dangerous — to others. Many games are war-games or include violent actions and role-playing, so for those who cannot separate fantasy from reality there are obvious challenges. Such games are moreover very popular.
Both of the following two examples are of young people, but nevertheless the challenges of schizophrenia are not generationally limited. The case of Anders Behring Breivik is interesting because of the dispute among professionals over his mental state. The first psychiatric commission used by the court diagnosed him as suffering from paranoid schizophrenia, whereas the second commission did not give him a psychiatric diagnosis, even if it found him to have a lack of empathy, identity problems and extreme political views (Overå & Weihe, 2016; Borchgrevink, 2014). From the point of view of the first psychiatric commission, Breivik’s gaming was an important focus-point in diagnosing him as a paranoid schizophrenic.
The second case is that of the American Adam Lanza (1992–2012), who killed 26 children and adults at Sandy Hook Elementary School in Connecticut on the 14th December, 2012. He committed suicide at the scene, and had not received any psychiatric diagnosis while alive, but information that emerged after his death seemed to indicate that he suffered from Asperger-type autism. Like Anders Behring Breivik, he played various violent computer games (Williams et al. 2008; Padilla-Walker et al. 2010; Telegraph, 2013; Overå & Weihe, 2016;).
Both of the above cases received major public attention and media coverage. As pointed out by many researchers, the computer games played by them are popular among millions of computer users who have no behavioural problems (Yee, 2009, 2007; Yeoman & Griffiths, 1996). Even if most players are young people, these games are increasingly played by older generations as well. Since the games do not require physical prowess, they may be played by all generations.
The question of criminality and violence among the mentally disordered is addressed in the “Stockholm Project Metropolitan” (Hodgins & Janson, 2012). While the majority of those with such disorders are self-destructive and pose no danger to others, there are well-known exceptions. Both Adam Lanza and Anders Behring Breivik are examples of unique individual psychopathology, and therefore we must acknowledge that people with unique pathology do exist, and that it should be of high priority to prevent such individuals from acting out their disorders.
Another question is the impact of gambling and gaming on the development of mental problems, depression and suicidal behaviour (Cambell et al., 1998, Fong, 2005; von der Heiden et al. 2019). For certain people such reactions seem to be the result of gaming and/or gambling. Lack of success in gambling and loss of money can sometimes result in depression and suicidal behaviour. Gaming is not so likely to result in financial disaster but might entail feelings of loss of status and concomitant depression. We do know that various problem gamblers have mental health disorders (Cunningham-Williams et al. 1998). However, it is still questionable if these disorders result in gambling problems or if they are themselves a result of gambling (Lynch et al., 2004).
In criminal statistics, we hardly ever find elderly people with problems of violent behaviour. They might be victims of violence, but they are rarely perpetrators. While even the elderly can act with violence, their common lack of physical ability usually prevents them from committing crimes of violence. There are however cases where elderly people have committed violent crimes involving the use of weapons, giving good reason to be observant about whether firearms or other tools of violence are readily available.
The challenge of intellectual impairments, dementia, gaming and gambling disorders
In caring for those with mental health issues, various providers describe the challenge of compulsive gambling involving slot machines. Such machines are available in many places and are a tempting pastime. In addition to the financial aspect, these machines engage users in repetitive activities which can easily become addictive and evoke strong emotional reactions when they are not available due to lack of money. For care-providers who have to deal with those frustrations, the consequences can be grave. In addition, playing tends to be time-consuming and destructive with regard to work and other social interaction.
Many people with alcohol related dementia persist in gambling, often in an uncontrolled way (Vinsontay et al. 2021, Roberts et al. 2021). Often such gambling starts with lottery games, initially played at regular intervals, but after the onset of dementia the activity gets out of control and the players cannot remember prior purchases of lottery tickets, nor do they remember to cash in if they win, or relate to their losses. Suspicion and even hostility on the part of others, often close relatives, are common reactions to gambling by the elderly with dementia.
Care-providers and health-social workers must deal with various issues involving people with dementia, and gambling sometimes forms part of those issues. For social workers, resolving such issues is mostly a question of counselling in order to find strategies to protect the person with dementia from destructive gambling, and if possible, to enable others to help them deal with the gambling.
Intellectual disorders sometimes get involved in gaming. Most computer games are simple ones of the type not involving role-playing, and therefore not requiring a high level of cognitive skills. On the other hand, some gaming activity might become compulsive and consequently affect the behaviour of the affected players in a negative way. It is important for the social capital of the mentally disabled to participate in social interaction (Meyer, 2008). Gambling and gaming are easy ways of interacting, but with considerable disadvantages as they can put the elderly at risk of consequences and challenges beyond their control.
In the case of gambling for money, the practically guaranteed consequences are draining of the individual’s finances and creation of high levels of tension and frustration. On the other hand, this type of gambling will usually stop when the affected person runs out of money. The frustration of not playing can be great and is sometimes a great challenge for those taking care of the individual.
Many games involve sex and violence, often in combination and based on role figures. Games can then gain importance because of their artificial intimate and sexual dimensions. The underlying causes of sexual urges, and in particular the sexual urges triggered by gaming, are a particularly sensitive issue.
The moral challenges of gaming and gambling in cross-cultural society
Attitudes towards gaming and gambling might differ considerably from nation to nation and within different parts of a culture. Russian attitudes might be different from those we find in Nordic countries (Kassinove et al. 1998); differences are also evident between, for example, the Chinese subculture in Australia and the mainstream culture in China itself. Several research studies document the importance of culture in gaming and gambling (Loo et al. 2008; Raylu & Oei, 2004).
Differences in attitudes potentially affect how we define addictions, excessive use and unacceptable patterns of gaming and gambling. In-depth studies of gender differences and patterns of use illuminate such attitudes and have revealed similarities between different nations and ethnic groups (Ko et al. 2005a and b). Approaches to treatment, as well as possible diagnostic tools, need to be adapted with reference to the cultural dimension (Ariyabuddhipongs & Chanchalermporn, 2007). Superstition and ideas which might seem irrational in terms of Western perceptions need to be recognized in order to understand gaming and gambling patterns in various cultures (Huang & Teng, 2009). Ethnic sub-cultures also present a challenge, because gaming and gambling practices might differ from those in the majority society. The study “Mahjong Gambling in the Chinese Australian Community in Sidney” illustrates gambling and gambling problems not visible in the rest of society. Nevertheless, within the Chinese community the problems connected with this gambling are a major challenge and concern (Zheng et al. 2010). Similar studies from other parts of the world describe the same phenomena (Papineau, 2005).