Mr. Patrick Reilly:

Pavee Point is delighted to have the opportunity to present to the committee. I compliment my colleagues from the other Traveller organisations for highlighting the issues affecting our community. Given the limited time we have and the complexity of the issues we wish to highlight, we will focus specifically on the key issues and the strategic recommendations.

All members of the joint committee have received a copy of our submission, which sets out some key issues and recommendations for Travellers with regard to mental health. To date, Travellers have been invisible in mental health policy and service provision. The well-established findings of the all-Ireland Traveller health study reveal the extent of the Traveller mental health crisis and identify the Traveller community as a high-risk group in relation to suicide and poor mental health, including frequent mental distress. The Traveller population experiences a higher burden of mental illness and suicide than the non-Traveller population. The suicide rate among Travellers is six times higher than the rate among the general population. Suicide accounts for approximately 11% of all Traveller deaths. I ask the members of the joint committee to take a moment to reflect on the fact that one in ten Travellers dies by suicide. We have moved beyond crisis point.

As the mental health worker in Pavee Point, I engage on a daily basis with Travellers who are experiencing crises of this nature. As a Traveller man, I see directly the impact that suicide and poor mental health are having on our community. To put this in perspective, suicide is so common in our community that it is part of everyday reality. When I was at a Traveller funeral two years ago, someone said to me that suicide has become so common that we do not make a wonder of it anymore. That is the level we are at. We are tired of the status quo. Traveller organisations alone cannot take the burden of addressing these issues. We have done our part in responding to the crisis by developing local responses within existing budgets which are already under-resourced. Traveller health has not received any new dedicated funding since 2008, although we acknowledge the once-off funding from the HSE from the Dormant Accounts Fund 2017-2019 action plan mental health initiative for Travellers. Nine HSE mental health service co-ordinators for Travellers have been appointed, but just eight of them are in their positions at present. If we are serious about having better outcomes, we need a long-term plan that is focused, strategic and resourced.

I ask members of the committee to bear in mind that the Traveller mental health crisis is arising in the broader context of widening Traveller health inequalities. We do not think such inequalities have been prioritised or supported at senior management level in the Department of Health. It is clear from the recent draft of the national Traveller health action plan, which was circulated by the HSE earlier this year, that the Department has absolved itself of any responsibility for Traveller health. This is further evidenced by the Department's refusal to re-establish the Traveller health advisory committee, which has not met since 2012 despite the support of the Minister, Deputy Harris. This is an unsustainable solution to a protracted crisis. A well-resourced and co-ordinated strategic national response with all key stakeholders, including the Department of Health , is urgently required. Traveller organisations, health units and primary health care projects are ready, willing and able to play a part in identifying the issues and developing appropriate responses.

It is in this context that we are making our recommendations. The national Traveller health action plan should be published as a matter of urgency and an independent implementation body, with ring-fenced budgets to drive delivery and implementation, should be established. Sláintecare recommends that there should be access to universal GP care within five years. We recommend that Travellers should be prioritised and fast-tracked in this process. Furthermore, we recommend that all Travellers employed in primary healthcare projects should be entitled to retain their medical cards with immediate effect. The service that the employees in question have given to the State, when taken with the level of health inequality among the Traveller population, which is similar to disability, means that this entitlement should be extended to community service programmes and community employment schemes. This would involve approximately 300 medical cards across the country.

Traveller-specific health infrastructure, including Traveller health units and primary healthcare projects, should be protected. Increased resources should be allocated for their expansion and development. A clear budget should be allocated and protected to address Traveller health inequalities at national level. Dedicated resources should be provided to support Traveller mental health. A standardised ethnic identifier, consistent with the national census and inclusive of the Roma population, should be implemented as a matter of priority across all routine data and administrative systems, including mental health services, to monitor equality of access, participation and outcomes across suicide prevention and mental health services for Travellers, the Roma population and other priority groups. It is essential for the application of an ethnic identifier to take place within a human rights framework. Finally, the recommendations of the Joint Committee on the Future of Mental Health Care should be implemented without further delay.