(Transcript from World News Australia Radio)
Gambling researchers say heavy financial losses are likely to be one of the most important causes of suicides among problem gamblers.
Problem gamblers often have substance-abuse problems and other mental-health issues, but debt has been identified as the factor most likely to push them over the edge.
The release of coronial statistics in Victoria highlights the links between problem gambling and suicide, and poker machines have been identified as one of the contributors.
"I don't think I'll ever set foot in another RSL or club for the rest of my life. Every time I hear the music of the poker machines, it just ... it brings me back to just that really horrible workplace and just all those sad people."
Sydney woman Cassie Byrnes reflects on a time in her life she is glad is well past.
While studying for her degree, she worked in a number of poker-machine venues where, day after day, shift after shift, she saw the same faces sitting at the poker machines for hours on end.
What disturbed her most was the failure of her former employers to do what Australian law says they should do: ensure patrons drink and gamble responsibly.
It is known in the hospitality industry as RSA and RSG, the compulsory certificate training in the Responsible Serving of Alcohol and the Responsible Service of Gambling.
Cassie Byrnes says the venues did not take the RSG requirements seriously.
In fact, she says, she witnessed the opposite.
Ms Byrnes says someone who did do the right thing on his first day on the job almost got sacked over his response to a regular gambler who went to him saying she was completely out of cash.
"Fresh out of RSG school, he said, 'Well, maybe you should go home, or is there someone that I can get you to, like, get you some help?' And the person training him then went and told senior management, and, within like the space of just 30 seconds, I could see like the duty manager marching down through the hallways of the poker machines and like took him into a back room, and he just got an absolute grilling. It's just not allowed. Like ... like, he almost lost his job."
Victoria's State Coroner Judge Ian Gray has released a report showing 128 people took their own lives in Victoria in the past decade because of a gambling addiction.
One of those victims was Tracy Smith's sister Julie,* who gambled on the pokies for more than 10 years at gaming venues around Ballarat.
Tracy Smith says her late sister's bank statements show she would make multiple ATM withdrawals on any one night.
It has left her wondering what, if anything, the staff at the venues did as her sister frittered away as much as $900 a week over more than a decade.
Ms Smith suspects the inaction Cassie Byrnes witnessed will continue in gaming venues until one of them is successfully sued.
"Unless it actually comes down that there's actually a written legislation law that there are repercussions ... If it can be demonstrated that they actually allowed behaviour to exist that was actually outside what they see as responsible gambling, that they could be held accountable ... "
Tracy Smith is also angry at the banks and pay-day lenders who kept providing her sister with credit.
"This has obviously been a problem for 10, 15 years, so it's like, well, what was the final straw? Now it might be the loans that she actually had outstanding from the pay-day lenders. And they charge like 40 or 50 per cent interest. And that is a fundamental problem, that they take advantage of someone who has this desperation, and it just adds to the pressure."
Tracy Smith can only speculate about what caused her sister_K to commit suicide, but some gambling researchers believe they know why so many problem gamblers do it.
The National Council on Problem Gambling in the United States says one in five problem gamblers attempt suicide, and it says high levels of debt are the final straw.
But Dr Rene Pols, a pyschiatrist from Flinders University in Adelaide, says determining if there is a direct causal link between gambling addiction and suicide is difficult.
He says most problem gamblers have other mental-health and substance-abuse issues as well.
"Is the gambling actually causing the mental-health problem, or is the mental-health problem causing the gambling? And then, is the mental-health problem and/or the gambling the cause of the suicidal thoughts and feelings? All that I'm aware of is that so many of our problem gamblers become absolutely at the end of their tether and at rock bottom when they lose large amounts of money that they can ill afford again and again and again. And suicide certainly is a way out for some, and suicidal thoughts and feelings are extremely common."
Another Flinders University psychiatrist, Dr Conrad Newman, agrees establishing if there is a causal link is complicated.
"I think what we have difficulty determining at the end of the day is what's the last straw. And what's the last straw for one person might be different for another person. But I think, for most people who become suicidal, significant loss is one of the key factors in their life, and I think people who are problem gamblers lose a number of things. Not only financially, but they lose relationships, they lose credibility, they lose employment and a number of things that contribute to the deterioration in their mood."
At least one researcher says poker machines, themselves, are actually designed to be addictive.
Cultural anthropologist Dr Natasha Schull is the author of "Addiction by Design: Machine Gambling in Las Vegas".
Her book draws on research from years of observing problem gamblers in Las Vegas and from interviews with designers of poker machines.
Dr Schull told America's 60 Minutes program why she believes the machines themselves can get gamblers hooked.
"What addiction really has to do is with the speed of rewards, and these machines, they're packing 1200 hands per hour into play. You're being exposed ... you could see that as being exposed to a higher dose. Another core aspect of their addictiveness is their continuous nature. You're not interrupted by anything. You're not waiting for the horses to run. You're not waiting for the guy next to you to choose his card to put down. There is no roulette wheel spinning. It's just you and the machine. It's a continuous flow without interruption."
Tracy Smith says speaking out about her sister's death has helped her work through her own grief.
And she welcomes the Victorian coroner's decision to release the suicide statistics.
"I thought, 'At last, at least they're coming out and actually creating conversation.' But it's a tiny percentage of what the reality is, because most people who have a gambling addiction aren't open about it. That's part of the illness, they're very secretive. So they're saying 128 deaths in 10 years. Well, you could almost multiply that by, you know, at least ... you know, a huge amount."
Anti-gambling activists and media organisations have spent years trying to get access to these coronial statistics.
They have requested access to a national database known as the National Coronial Information System.
It contains information about deaths reported to Australian coroners since July 2000.
The Victorian Department of Justice manages the database, based at the Coronial Services Centre in Melbourne.
It is understood the Victorian figures only came to be released after a journalist made a personal approach to the Victorian coroner.
Psychiatrist Conrad Newman suggests more open disclosure of the coronial statistics might be worthwhile.
"I know there is a whole debate around that, because there is a large debate about publishing a suicide toll, much like the road toll, and I think that a number of professions are ... have differing views on that. I think there hasn't been a consensus around that. But I think visibility into the problem, I think, is always important."
The former Gillard Government promised mandatory pre-commitment technology for poker machines to get the support of Independent MP Andrew Wilkie.
But it did not make good on its promise after heavy opposition from Clubs Australia, which says only a minority of poker-machine players are problem gamblers.
Cassie Byrnes, the former pokie-venue worker, says Australia should approach pokies the same way it cracked down on access to firearms after the Port Arthur massacre.
Her solution is simple: reduce the number of poker machines in Australia.
"If we just have less poker machines at less venues, you get less younger people forming habits. Because most of it ... I see a lot of friends who just have a punt, you know, on the dogs or, you know, the pokies -- put 20 dollars in and then walk away -- but, because (in) most venues in New South Wales, you're constantly surrounded by them, therefore you're going to use them. It's exactly like the gun-control debate. Yeah, that's exactly it. Or if a numbers issue is the game they're playing, then clubs should pay more taxes for each machine they have.