Mr. Pablo Rojas Coppari:

I distributed a submission earlier. I presume all members of the committee have received it. Some committee members might be familiar with Migrant Rights Centre Ireland. We are a national organisation, which was established in 2001. We have approximately 17 years' experience working with migrants and their families in Ireland. Often we describe our work as being at the intersection of precarious employment and precarious immigration status. We work with many migrants who work in low-paid occupations as well as with migrants who are most at risk of vulnerability associated with legal status or lack of legal status.

As such, ours is the principal organisation working with undocumented migrants in the State. That is how we mainly would have engaged with communities in the past. We have a focus on economic migrants, but we represent people on all issues that affect all categories of migrants.

We are not a service provider in mental health service terms, but we provide employment and immigration law services. As indicated in my submission, we are associated with Médecins du Monde or Doctors of the World in a health-related project that particularly examines the socioeconomic determinants of health outcomes. It considers both physical and mental health. As such, we have been developing materials and gathering data in that regard. I also make reference to the work of Cairde, a health advocacy organisation. Members are probably familiar with its report on the mental health of minority ethnic groups. I also refer to the work of Mental Health Reform, a coalition of organisations, of which MRCI and others have been part, that considers mental health needs of migrant communities in Ireland.

I will outline the matters of concern to us but, first, I refer to the data collected as part of our project with Médecins du Monde. It highlights that the prevalence of negative mental health is similar to that among the overall population. Among migrants reporting negative mental health there is an increased sense of isolation and a lack of support. Among those who describe themselves as having very bad or bad mental health, 66% indicate a lack of support and say they do not have anyone on whom they can rely, or they have a limited number of people on whom to rely for support. As members know, mental health issues affect everyone in the population. It is important that people have access to support networks and services. Particular categories of migrants have limited access to both services and support. We cannot talk about causation, but there is a correlation between lack of support, lack of access to services and isolation and poor mental health outcomes. With migrants who declared positive mental health outcomes, the level of network support was twice as good as among other populations.

I have divided issues of concern into three categories. The first is the provision of mental health services for the broad immigrant population. It arises mainly from the report published by Cairde in 2015 which identified the following key barriers to accessing mental health services. This relates to experiences of racism and discrimination that people face when trying to access services. There are certain difficulties in terms of entitlements and financial barriers. Access to mental health services very much depends on entitlement to access HSE services. This is a function of the type of legal status a person has. Persons with precarious legal status cannot rely on services provided by the State, while undocumented persons may not access mental health services.

There are also barriers arising from language and the provision of culturally appropriate services. We have identified a lack of interpretation services and intercultural training as a barrier in accessing mental health services. This amplifies the sense of stigma and shame which might be linked with poor mental health outcomes and having the need for mental health services. This is prevalent in all cultures, but in certain ones it is more relevant.

The other points relate to specific categories of migrant with which we work. The first is the victims of human trafficking. MRCI specialises in the provision of services and representation for victims of trafficking for forced labour, although we can relate it to other forms of trafficking, including for sexual exploitation. Victims of trafficking have often experienced different traumas and may suffer from post-traumatic stress disorder. When referred to our national referral mechanism, they are provided with a health programme that is limited to physical health. There is a dedicated anti-human trafficking service within the HSE, but it does not offer counselling services or more specialised mental health services. Among the victims we support, we noted their need for mental health services. They requested such services on a number of occasions, but they were not provided with them. On a number of occasions they were referred to mainstream mental health services, which have long waiting periods which leads to re-traumatisation while they are involved in a process of reflection and recovery. On a number of occasions the lack of immigration status or financial means presented a barrier and, more often than not, their needs were not met. The mental health needs of victims of human trafficking are quite specific because of the experience of trauma and violence that could be associated with it. Certain needs are akin or similar to the needs of those who experience torture. We need to look at the provision of special counselling services for those who have undergone the experience of human trafficking.

I will ask Ms Rashimi to speak about the mental health needs of undocumented migrants. For those not familiar with the issue of irregular migration in Ireland, the MRCI survey, Ireland is Home, estimates that there are between 20,000 and 26,000 undocumented migrants in the State. There are up to a further 6,000 undocumented children. In MRCI we have developed support networks for both undocumented adults and young people.