Mr. Patrick Reilly:

I am the mental health worker in Pavee Point. I am also an Irish Traveller. Pavee Point Traveller and Roma centre has been working to challenge racism and promote Traveller and Roma inclusion in Ireland since 1985. The organisation works from a community development perspective and promotes the realisation of human rights and equality for Travellers and Roma in Ireland. The organisation is comprised of Travellers, Roma and members of the majority population who work together in partnership to address the needs of Travellers and Roma as minority ethnic groups experiencing exclusion, marginalisation and racism. Working for social justice, solidarity and human rights, the central aim of Pavee Point is to contribute to improvement in the quality of life and living circumstances of Travellers and Roma. This includes targeted resources and recruitment to ensure access to effective, equitable and respectful quality mental health care and services.

I and my colleague, Ms Brigid Quirke, are delighted to have the opportunity to make this presentation to the committee. While we thank the committee for including Travellers and Roma in its discussion today, we would like to note that we have been invisible thus far. We urge the committee to take our recommendations on board and ensure that we are explicitly included in the committee's final report.

We welcome the commitment of the Minister for Health, Deputy Harris, to re-establishing the Traveller health advisory committee and the development of the new Traveller health action plan based on the findings of the all-Ireland Traveller health study. We urge the committee to prioritise these actions and ring-fence a budget for their implementation as a matter of urgency.

Given the limited time and the complexities of the issues we wish to highlight, we will focus explicitly on Travellers today. However, we would encourage the committee to examine the mental health needs of the Roma community at a later stage in its deliberations. We have copies of the national Roma needs assessment for members' consideration and our Roma colleagues would welcome further discussion on the mental health findings and key recommendations.

There are approximately 40,000 Travellers in Ireland, accounting for less than 1% of the total population. Were the entire population of Travellers to sit in Croke Park, it would fill less than half the stadium. Our recommendations here are practical, feasible and, if implemented, could have a real impact on Traveller's health. Last year Traveller ethnicity was officially acknowledged by the State. Travellers throughout the country celebrated and welcomed this announcement. However, the harsh reality is that Travellers still experience challenges which include discrimination, exclusion, poverty, poor quality of education, lack of employment opportunities, and lack of accommodation which leads to overcrowding which is seven times higher than the settled population. Added to this, there are approximately 2,000 Travellers on the roadside without basic facilities, which means no toilets, running water or electricity. These are members' constituents and the people that they represent. In 2018, this is something that we expect in a developing country, not a rich, developed nation like our country. Traveller health inequalities are well-documented, with the all-Ireland Traveller health study findings indicating that Traveller health is comparable with the levels found in the settled population of the 1940s. This means that Traveller men are living 15 years less than settled men and Traveller women are living 11 years less than settled women. The mortality rates among Traveller men is four times higher.

The rate of mortality of Traveller women is three times higher than that of women in the settled community, and that of infants, or children under one year of age, is four times higher. The evidence indicates that Travellers are dying at much higher rates at all ages and across genders, with 97% of Travellers not living to their 65th birthday. Coupled with the experience of discrimination on a daily basis, this leads to poor mental health. Travellers have worse mental health outcomes than any other group in the country, which is why they have been prioritised in policy documents such as Connecting for Life and A Vision For Change. However, they have experienced no change on the ground. The all-Ireland Traveller health study found that 60% of Travellers reported their mental health in the preceding 30 days as not good, compared with 20% of the settled population.

The rate of suicide among Travellers is six times higher than among the settled population and accounts for approximately 11% of all Traveller deaths. Last year, I attended the funeral of a Traveller man who had committed suicide and there spoke to another Traveller who pointed out that we no longer make any wonder of it when a Traveller commits suicide because it is so common in our community. That would rightly be totally unacceptable in any other community and mine should be no different. If we had access to the same resources and services as the settled population, the outcomes would be better. We can do better for Travellers and they deserve that.

To do so, we must address the issues experienced by Travellers when engaging with services, including acknowledging that they are sometimes treated with a lack of respect and dignity, by which over 40% of Travellers were concerned. Over 50% of Travellers worried about experiencing unfair treatment and had concerns about the quality of care they received, and 40% of Travellers experienced direct discrimination in accessing health services. Some 70% of service providers agreed with those findings and suggested that Travellers receive substandard services because of their ethnicity. We are not making this up. These are findings from the all-Ireland Traveller health study.

As noted in our submission, Traveller health has not received any new moneys since 2008. We welcome the launch of the current policy on Travellers, the national Traveller and Roma inclusion strategy 2017-2021. It was developed by Traveller organisations in partnership with the Department of Justice and Equality and we have widely endorsed it. However, no recommendations can be implemented without a budget and there is no budget attached to the strategy, which adds to the ongoing frustration for Travellers as there is little evidence of progress. The Traveller primary health care projects funded by the HSE are of benefit to Travellers. The study states that 83% of Travellers receive their health information from these projects, which are a lifeline for my community. They must be resourced and seen as an investment by the State.

Active Traveller consultation, participation and proofing of any further development of services, policies and strategies is required, and this must be must be resourced, monitored and evaluated. The committee has received our detailed submission which includes clear recommendations regarding access, recruitment and funding. However, in the interests of brevity, we wish to highlight two overarching recommendations. In terms of ensuring a robust, evidence-informed service, we must prioritise the implementation of the ethnic identifier across all primary mental health services to monitor equality of access, participation and outcomes to suicide prevention and mental health services for Travellers, Roma and other priority groups. As regards working in partnership with Travellers, nothing should be done about us without us. There must be an engagement and effort to work in partnership with Traveller organisations and primary health care Traveller projects comprising peer-led, culturally appropriate projects to develop and deliver a positive mental health awareness and suicide prevention campaign. These structures have existed for at least 15 years, with 30 projects operating nationally. Ten such projects are ongoing in community health care organisation, CHO, areas 6, 7, and 9, in which I work, and I was disappointed to be in the Gallery a few weeks ago while the chief officers giving evidence failed to acknowledge Travellers and-or the work of these projects which they fund and operate in partnership with us.

We urge the committee to recommend strongly the implementation and resourcing of the national Traveller and Roma inclusion strategy without delay. The re-establishment of the Traveller health advisory committee is crucial and must be implemented as a matter of urgency. Travellers are dying and we cannot understand the lack of progress on the ground. The question that must be addressed is whether the reason for the lack of progress is political.

I thank the committee for the opportunity to attend and for listening to our presentation. We would welcome any questions or matters for clarification and we invite members to visit Pavee Point and our primary health care project.