Ms Niamh Keating:

I extend thanks to the Chairman and committee members for the opportunity to speak here today. I am the co-ordinator of the west Limerick primary healthcare project for Travellers. I am here today with my colleague, Ms Myra O'Brien, community health worker. Our west Limerick primary healthcare project has been operating since 2010 and it is solely funded by the Traveller health unit in the Health Service Executive, HSE. It consists of six qualified and experienced community health workers, all members of the Traveller community, and we aim to improve the health and well-being status of the Traveller community in west Limerick. Community health workers deliver peer-led health information and education to their community, helping to achieve positive outcomes with long-term effects. Today's presentation is framed within the west Limerick context, where the Traveller community experiences rural disadvantage with less access to services and service provision, limited public transport, fewer opportunities and more exclusion. Throughout this presentation I will refer to figures and statistics from the Clare baseline health assessment report, as we are currently undertaking our own baseline health survey in west Limerick.

Traveller health inequalities are well documented and addressing the root cause of health inequalities requires the understanding that health is complex and is determined by complex interactions between social and economic factors, the physical environment and individual behaviours. The primary healthcare projects operate within a social determinants of health framework, recognising that many factors affect health, including education, employment, accommodation and living conditions. In this presentation I seek to highlight the importance of the primary healthcare project structures, which are really good investments that must be properly resourced and financed.

The following are factors that greatly impact mental health. They include but are not limited to poor living conditions, poor educational attainment and discrimination. Poor living conditions have a major impact on health and specifically mental health, and they can contribute to respiratory problems while exacerbating existing health conditions. Many Travellers experience overcrowding with no safe place to live or play. Families often wait for long periods on a housing list and many Travellers experience difficulties in securing private rented accommodation.

Many Travellers leave the primary education level unable to read and write to an acceptable level. To address the mental health needs of Travellers, we must acknowledge the poor educational outcomes that many Travellers experience as a result of poor school experiences, early school leaving, reduced timetables, lower teacher expectations, a lack of culturally appropriate provision in schools and bullying. All these factors must be addressed as education determines how healthy a person will be.

Another major issue is discrimination and this has a major impact on Traveller mental health. Despite the State's recognition of Travellers as an ethnic minority group in 2017, Travellers experience significant levels of discrimination from Irish society. Discrimination and prejudice are clear but are internalised and felt by the Traveller community. In the Clare study, 94% of Travellers reported experiencing discrimination and 87% indicated they worry some or most of the time about discrimination. In the Clare study, 98% of respondents stated their Traveller identity, membership of the Traveller community and Traveller culture were important but many reported having to hide their identity in seeking and securing employment opportunities.

I will now outline some barriers and recommendations. There is a strong stigma and fear associated with accessing mental health services and many Travellers are reluctant to engage in services due to such fear.

Travellers often present in services in times of crisis seeking an immediate response. Mental health services need to understand Travellers in order to respond in a sensitively and culturally appropriate way in order to address their needs. As many as 96.4% of Travellers in the Clare baseline health study reported feeling down in the past 30 days for an average of ten days in a month. Travellers, in general, regularly attend their GPs and many speak to their GPs about their mental health issues. As many as 83% of Travellers in the Clare study reported that they had been to their GPs in the last 12 months and they do speak to their GPs about their mental health issues. Only 4.8% stated that they had attended a mental health service highlighting the exceptionally low uptake in mental health services. The lack of employment opportunities is seen as a significant negative factor that contributes to mental health issues.

I shall list five key recommendations and two need further consideration. Local authorities returning ring-fenced funding allocated for Traveller accommodation to the Exchequer is unacceptable. The education needs of Travellers must be addressed through further funding to schools and local service providers. Local funding must be made available to each of the Traveller health units. An emphasis must be placed on lifelong learning with a cradle to grave approach adopted. There is a need to develop tailored sheltered employment opportunities to provide a positive working experience for Travellers to enable onward progression into mainstream employment, and we feel that local development companies are best placed for these types of initiatives. Traveller culture and history needs to be celebrated and acknowledged. All public sector workers need to receive culturally appropriate training. We see opportunities for employment. There is a need for designated Traveller community mental health nurses who are attached to community mental health teams. We also see opportunities to expand employment opportunities within the primary healthcare project structures to include Traveller accommodation, Traveller education and Traveller employment workers.

To conclude, we commend a pilot Traveller youth mental health initiative in our region. The initiative lasts one year and is a peer-led programme that has seen the recruitment of ten young Travellers as Traveller mental health advisers aged between 18 and 25. The project aims to promote positive mental health messages that speak to and are accessible to young Travellers. We ask that further funding is allocated to this project and other similar projects throughout the country. Furthermore, we ask that the primary healthcare project structures throughout the country receive further funding. They are effective structures that have positive results and outcomes with a good return on investment.