The Gandara Center is a mental health clinic in the North End of Springfield, where daytime TV plays continuously in the waiting room.
Gandara therapists like Crystal Aviles Del Valle mostly serve clients on public assistance. She said that before MGM opened, only a few of her patients gambled regularly. Now, she estimates 85 percent do.
Del Valle thinks her clients use gambling as a coping mechanism for stress or depression.
"So [patients say], 'Instead of maybe going out shopping, now I go to the casino,'" she said.
And in some cases, clients may have replaced substance abuse with gambling.
That's not to say Del Valle's clients have a gambling addiction at this point. The official diagnosis requires a full year of problematic behavior. Nevertheless, she said her patients may not recognize an encroaching problem."Obviously, if it's not impairing their functioning, it's fine," she said. "But [it could be a problem] once they start telling me they lost a lot of money, in words like, 'I need to get back to kind of make the amount of money that I lost.' I had a client that told me, 'I went to the casino, and I went at night, and it was the other day in the morning, and I had no idea how many hours had passed, and I was still at the casino.'"
Other counselors at the Gandara Center say gambling is up among their patients, too — but the state does not yet have official data on gambling trends.
"It's really difficult to judge whether or not we're seeing an increase in the prevalence of problem gambling in and around Springfield," said Mark Vander Linden, Director of Research and Responsible Gaming for the Massachusetts Gaming Commission.
"It's not surprising that with any new type of gambling, you get people that are interested, and trying it out and seeing how it goes," he said. "And then what's also very typical is that once the casino is there for a while, the novelty of it is gone."No matter how many people are gambling, Gandara administrator Lara Quiles said almost no patients are asking to be treated for it. And she said that unlike with substance abuse, it's hard for counselors to know exactly when gambling becomes problematic.
"Typically, when a person is struggling with substance, we can see other signs, perhaps — physical signs, deterioration in mental health," Quiles said. "But with gambling, it takes more time."
To help identify the signs, Quiles said about a third of the clinic's approximately 30 counselors have attended training sessions run by the Massachusetts Council on Compulsive Gambling. Across the state, 11 clinicians have become newly certified in gambling treatment since MGM opened, according to the Council. That brings the total number to 135, including 60 in western Massachusetts.
Another effort to prevent problem gambling is the GameSense program, which operates on the MGM floor. Staff members — known as "advisors" — are supposed to teach customers how to play the games, how the odds favor the house and how to get help if they're developing problems.
Since the casino opened, GameSense staff have recorded more than 65,000 interactions with MGM customers, but only about 10,000 were related to problem gambling. The majority were brief and casual, like a simple hello.
"I think a lot of those simple interactions can and do build into kind of a more trusted relationship," Vander Linden said.
Based on a few recent visits to the casino, the GameSense office is less popular than many other areas.
The office was empty of customers, while the nearby "rewards center" was full.
Staff members did occasionally walk around the casino, but did not talk much to the people absorbed by slot machines or table games. And the GameSense office is not easy to find. It's situated near the parking garage entrance, but set off to the side of the casino floor.
"We are hoping to better the signage," said Marlene Warner, executive director of the Massachusetts Council on Compulsive Gambling, which oversees GameSense. "The signage is on a lot of the electronic screens, but not the overhead signs."
One role of the GameSense staff is to help some customers sign up for "self-exclusion." That's a voluntary agreement that says the person is not allowed to gamble at Massachusetts casinos.
As of late February, the gaming commission said about 400 people are on the state's self-exclusion list. At the MGM casino, 125 signed up — and 10 more arranged to sign up offsite, but nearby.
Marlene Warner, executive director of the Massachusetts Council on Compulsive Gambling, said her organization is trying to make it easier for people to sign up for self-exclusion away from the casino. She'd really like to designate therapists to do that in their offices, but the gaming commission has yet to set up that system.
"It seems pretty ideal, and a no-brainer, that that individual [therapist] would then be trained to put that person on a self-exclusion list, instead of them having to make a separate phone call, and separate effort," Warner said.
State law requires the Department of Public Health to address gambling issues, too. The casino legislation even created a revenue stream. An estimated $15 to 20 million a year, taken from casino revenue, is meant to go into a Public Health Trust Fund once all the resort casinos in Massachusetts are operational.
Victor Ortiz, who runs the department's problem gambling services division, said he doesn't know how much money is in that fund now, and he hasn't tried to access it. He said his team has launched 12 initiatives to help prevent gambling problems, but only two of those are in western Massachusetts — and it's not clear how visible they've been.
"We just completed a public awareness campaign that's targeting men of color with a history of substance misuse," Ortiz said.
That campaign, he said, included posters on Springfield-area buses, and pamphlets delivered to Springfield clinics, including the Gandara Center.But Gandara's clinical director said she hasn't seen any pamphlets — and neither has the head of the Public Health Institute of Western Massachusetts, which monitors the health impacts of the casino.
Ortiz said the state is also launching in Springfield what's called an "ambassador program" — a peer support model for problem gambling that he said will be based at the Gandara Center.
"They're just beginning to launch it off, and it should be launched off in the next couple of weeks or so," Ortiz said.
But that's news to Gandara's clinical director, who said the Springfield clinic has no plans to host an ambassador program.
As for the city's role in all this, Springfield health commissioner Helen Caulton-Harris said she's been talking to community members, and hasn't heard of an increase in gambling problems.
"So there has not been any public health challenges that have come to the forefront," Caulton-Harris said. "However, that does not mean they do not exist. We also don't have the individual in place who we would want to gather that information for us at this time."
Caulton-Harris said her department plans to hire someone to oversee gambling issues. Last August, before the casino opened, she said that hire was imminent. But six months later, the position remained unfilled.
This report comes from the New England News Collaborative: Eight public media companies, including The Public's Radio, coming together to tell the story of a changing region, with support from the Corporation for Public Broadcasting.
Disclosure: MGM has purchased underwriting from New England Public Radio publicizing the company's non-gambling activities. The NEPR newsroom operates independently of the station's development department, and editorial decisions are made without regard to any funding relationships.