Gaming disorder: How government is tackling a new frontier in mental health crisis

Gaming is one of the biggest contributors to the Consolidated Fund. Last year, the sector paid Shs151b in taxes and fees and by the end of June this year, it is projected to contribute Shs160b in taxes. 

With 2,000 registered betting shops, the sector employs more than 10,000 Ugandans. However, this positive economic contribution is increasingly coming at the cost of the mental health of punters. 

At a plush location on the outskirts of Kampala City, a group of young men sit in a circle around a psychologist. Surrounded by lush green plants, their faces hold a host of emotions; hope and regret mainly. The sessions, which happen every Tuesday, are held in Luganda. The psychologist, hired by the National Lotteries and Gaming Regulatory Board, is helping them navigate the challenging road to recovery from gaming addiction.

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“In recovery, we go step by step. I cannot say that if you come here today, you will stop gaming immediately. The journey to recovery is progressive and long. So, be patient with yourself because restructuring your thinking will take a long time,” the psychologist tells the youths.

The young men clap for a peer who has spent two weeks without betting. The psychologist tells them that; “the betting disease is more common among men than women. I have never interacted with a woman suffering from a gaming addiction.” 

However, his charges assure him that female addicts exist although they are very few.  

The psychology of addiction

Fred Ssempala, a resident of Kirokole zone, in Tula village, Kawempe Division, is among these men. The 24-year-old bodaboda rider’s journey into the world of gaming began innocently enough but soon spiralled out of control.

“I first heard about betting on the radio. I am an Arsenal (Football Club) fan, so one day, with Shs10,000 in hand, I entered a betting hall in Bwaise. After some research, I realised I would only win Shs12,000, which did not make financial sense to me. Instead, I walked to the slot machines. I put in Shs1,000 and the machine gave me Shs12,000. I was shocked. I realised I had been wasting time and energy working yet there was free money to be made here,” he says.

At the time, Ssempala was hawking juice for a small factory in Kawempe. His means of transport was a bicycle. Encouraged by his win, he increased his bet to Shs2,000 and won Shs25,000. He was hooked. 

“I cut the time I spent hawking juice and started relaxing in the betting shop. The lure of the slot machines became so powerful that all the money I made went to betting. I began stealing stock from the factory. I even sold the bicycle and put the money in the slot machine. I lost. Eventually, the juice factory collapsed because a colleague and I had become gaming addicts,” he says. 

He turned to bodaboda riding, but besides betting all his earnings, he turned to petty theft to feed his habit. 

“I would take a passenger to one part of the City and after receiving payment, I would immediately look for a betting shop in that place. After losing the money, I would get another passenger and the cycle would repeat itself. One day I had to travel to Kayunga District to buy goats. I had Shs200,000 on me but when I reached Nakifuma in Mukono District, I went into a betting shop thinking I could win at least Shs10,000. Instead, I lost all the money,” he says.

The tipping point came when Ssempala gambled the Shs300,000 he had set aside to pay for his wife’s delivery expenses at Kawempe National Referral Hospital. The midwives abandoned his wife because he could not buy a mama kit and other medical supplies. His wife lost the baby.

Dr Benedict Akimana, a psychiatrist with Butabika National Mental Referral Hospital, says for a diagnosis of addiction to be made, one has to have impaired control.   

“Someone says they are going to play only one game but ends up playing the whole night. Secondly, a diagnosis can be made when gaming starts affecting one’s functioning because instead of going to work or school, they end up gaming. It affects children as well, especially those who are always on the smartphone, playing games. Whenever a parent takes away the phone, they get irritable, angry, and begin breaking things. Those are withdrawal symptoms,” he says.

Impact on mental health

With time, Ssempala began hating himself because of his inability to save any money.

“I got a second wife, and because of betting, I could not pay for her delivery costs in the hospital. Luckily, the baby did not die because my father-in-law stepped in to pay the bills. My wife lost weight because I did not have money for food. I always had money for the slot machine, though. She would cry every night because of my addiction. I hated myself so much. Every morning, I prayed for a trailer to run me over,” he says. 

Dr Akimana says gaming disorder can lead to serious health conditions.

“The victim can suffer stress after financial loss, anxiety if they are seeking to recover the loss, and depression if they fail to win back the money. Treating these conditions requires patience and can be lengthy. Mental health issues are emergencies, and treatment can take up to six months," he says.

The Lotteries and Gaming Act 2016 mandates the National Lotteries and Gaming Regulatory Board to protect the public from the adverse effects of gaming. Denis Mudene Ngabirano, the Board’s CEO, says they are creating awareness of the dangers of gaming through sensitisation of key stakeholders.

“We have partnered with the Mental Health Department of the Ministry of Health to train health workers about problem gambling. Previously, the department has been dealing with drug addiction and alcoholism. We have developed a training manual on responsible gambling for the village health teams, who are the first line of support for problem gamblers,” he says. 

According to the law, customers in betting shops and casinos have to be above 25 years of age. Ngabirano says the Board is working with a National Central Electronic Monitoring System, which will be leveraged into the National Identification and Registration Authority (NIRA) database to ensure operators adhere to the law on age. 

“We have an enforcement and compliance department that makes periodic spot checks in these gambling centres to ensure there are no underage gamblers. We penalise operators who are found in breach of the regulations. We also sensitise clients in the betting shops that gaming is a leisure activity and not a money-making venture. Sometimes, people bet repeatedly to recover the money they have lost,” he says. 

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Online gaming

Casino games, sports betting, pool betting, slot machine games and bingo games are the only legalised forms of gaming in Uganda. According to Ngabirano, the turnover from gaming between April to July this year is expected to be Shs3t. Of this, Shs135b has so far been collected in fees and taxes. 

“Eighty percent of the Shs3t is coming from online gaming. The reports we receive from the operators show that it is not only the youth who are betting. People in corporate offices are the most prolific gamblers. Currently, we are undertaking a review of the laws and regulations to address online gaming to collect data in real-time about how much online operators are making, how many people are gaming, how much time they are spending on these platforms, and what games they are playing,” he says. 

So far, Uganda has five registered online gaming operators. Allan Tumushabe, the managing director of Betpawa Uganda, one of the registered online operators, says the company’s systems recognise national identification numbers.

“You must have a NIN to enrol in our system. That is how we weed out minors. All our adverts have a responsible gaming message, especially about the age limit. Besides community interactions and sensitisations, we have a fully functional call centre that operates 24 hours a day, every day. We have partnerships with counsellors, who we pay on behalf of our clients. When a client needs help with avoiding the urge to game, they call the call centre and we connect them to a counsellor,” he says. 

Tumushabe adds that some gamblers are self-aware, and call the centre to deactivate their accounts if they feel they are crossing the point of no return.  

Ditching the addiction

When Ssempala became suicidal, he began blaming the government for its laxity in abolishing betting shops. 

“I was happy when betting shops were closed during the Covid-19 lockdowns. I thought I had finally ditched the habit. You can imagine my dismay when I found myself using my phone to search for online betting companies. That is when I understood that I was the problem; not the government,” he says.

One day, Ssempala noticed a poster on the wall of a betting shop. The poster had a toll-free helpline that clients could call if they noticed they were addicted to gaming.

“I called the number and the person on the line invited me to a counselling session. When I got there, my first question to the counsellor was, ‘Will I ever be free from this addiction?’ My friends had informed me that there was no cure. The counsellor asked me if I accepted that I was sick and needed help. I was so tired of trying to fight the addiction on my own so I admitted that I was sick and needed help,” he says.

It is now five months since Ssempala last placed a bet or played the slot machine. He also has a new set of friends who do not game. He got a loan to buy a new motorcycle and is now left with Shs600,000 before he can fully own it. 

“I know there is a law to regulate gaming but it does not work. The people I was with in gaming shops, playing the slot machines, were as young as 15 years. The addicts who sleep in these shops are between 19 and 23 years old. Putting the age limit at 25 years ends in the adverts. I request whoever is responsible to place more posters with helplines in the betting shops,” he adds. 

Responsible gaming 

Because the gaming sector is a huge contributor to the Consolidated Fund, and to the sports sector through its corporate social responsibility, abolishing gaming is out of the question. 

However, Jacqueline Kamakune, the corporate social responsibility and responsible gaming officer, says the National Lotteries and Gaming Regulatory Board is championing a set of initiatives that the government, operators, and other stakeholders have put together to protect the public. 

“We have counselling and treatment for problem gamblers, awareness creation and sensitisation, research and advocacy, a department for arbitration and a department to ensure operators meet their obligations. We have a toll-free helpline for problem gamblers. When they call, a psychologist first assesses the problem because some just need first-line counselling. If they are outside Kampala City, we connect them to hospitals and counsellors in their regions. If they are in Kampala, we place them in groups and engage experts to counsel them,” she says.

The Boards is also partnering with operators to create a Responsible Gaming Foundation. Responsible gambling involves one betting what they are ready to lose, knowing when to stop, and learning not to look at betting as a source of income but as a fun sport.

The board, working with Uganda Police, has taken on enforcement exercises which have seen them confiscate 3,445 illegal slot machines. 

“We have obtained a court order and have identified Luwero Industries Limited (a subsidiary of the UPDF’s National Enterprise Corporation) to help us destroy that illegal equipment. The equipment was confiscated from betting shops operated by both Ugandans and Chinese nationals. We are working closely with Uganda Communications Commission (UCC) and telecom companies to close 17 illegal online gaming sites and block mobile money transactions to these sites,” Ngabirano says.

Lessons from other countries 

Gaming addictions are not unique to Uganda. The United States of America has a massive gambling industry, with Las Vegas and Atlantic City as the most famous gambling hubs. Millions of Americans are struggling with problem gambling and to deal with it, the country has numerous state-funded programmes aimed at providing support and treatment for problem gamblers. 

Australia has one of the highest rates of gaming addiction in the world, with slot machines found in almost every pub and nightclub. However, the country has stringent regulations on the operation of slot machines, limits on the amount of money that can be gambled and mandatory breaks for players.

The United Kingdom has a well-regulated but extensive gaming industry. The country’s Gambling Commission imposes strict advertising standards to prevent the glamorising of gambling, especially to minors. 

Macau, a special administrative region of the People’s Republic of China, is known as the "gambling capital of the world." It generates more gambling revenue than any other location. The government is working closely with gambling operators to promote responsible gaming, which includes providing resources for problem gamblers and enforcing regulations that limit access to gambling for those identified as at risk.

South Africa is the largest gambling market in Africa. Despite regulations and awareness campaigns, there are growing concerns about the social impacts of gambling, particularly in poorer communities where gambling is often seen as a way out of financial difficulties.