Gambling and hidden practices in Danish forensic psychiatry

Background

This is the first study to examine gambling within medium-secure forensic psychiatric care in Denmark. The aim is to understand how prevalent gambling is, as well as how patients and staff experience and understand gambling and financial management, thereby providing insight into how gambling practices intersect with ward life, clinical relations, and recovery processes.

Methods

A cross-sectional survey was conducted across 19 hospital units in two major Danish health regions. In addition, semi-structured interviews with patients and staff members were conducted to explore participants’ perspectives on gambling, money management, and the institutional conditions that shape these practices.

Results

Gambling problems were significantly more prevalent among forensic psychiatric patients than in the normative sample. Gambling was linked to attempts at self-regulation, family involvement, and, in some cases, other addictions. Staff perspectives varied, ranging from viewing gambling as harmless recreation to identifying it as a clinical concern associated with impulsivity, mood instability, or conflict. Throughout the interviews, financial autonomy emerged as a key domain. Hidden economies, such as informal loans and undisclosed debts, existed outside of institutional visibility, complicating therapeutic alliances and limiting staff’s ability to intervene without eroding trust.

Conclusions

Gambling has emerged as an ordinary yet disruptive aspect of ward life, shaping autonomy and clinical relations while also creating secrecy at the wards. The discussion suggests that clearer expectations, routine investigation, and responsive financial support could help address gambling-related harm without eroding trust. Such measures may help strengthen recovery processes, but their effectiveness will depend on how well they are integrated into the relational fabric of secure care.

Key messages

• This first qualitative study shows how gambling in forensic psychiatry shapes autonomy, trust, and recovery, while hidden debts and secrecy complicate care and increase vulnerability.

• Routine, non-stigmatizing enquiry about gambling and financial strain could reduce hidden harm, strengthen therapeutic alliances, and support recovery in secure psychiatric care.