Ms Maria Carnicer:

I thank the committee for the opportunity to speak here today. Exchange House Ireland National Traveller Service is an organisation of Travellers and non-Travellers who work together to provide culturally competent front-line services to some of the most marginalised Travellers in Ireland. We have had 3,399 service provisions so far this year, ranging from drop-in crisis intervention to social work involvement for accommodation, family support and advocacy, addiction counselling, suicide intervention and trauma related therapy. In the past four months, 23% of first-time contacts to Exchange House Ireland have been from outside County Dublin. Referrals come from mainstream services such as Pieta House, medical centres, psychiatric facilities, Traveller health units, statutory organisations such as Tusla and the Probation Service, concerned family and friends and individuals.

Many of those who have addressed this committee today have highlighted the social determinants of good mental health, including access to safe living conditions, adequate housing, educational opportunities and meaningful engagement in work and society. We are well aware that because Travellers are seriously marginalised and face regular discrimination at an individual and societal level, through no fault of their own they will experience poorer mental health as a result of the lack of opportunities in these key areas. As part of the service at Exchange House Ireland, we use certain measurement tools and the lived experience of service users to co-create culturally meaningful and therapeutically sound plans to address their presenting issues. We work collaboratively to explore the person's current living conditions and social and family relationships, as well as the environment in which he or she grew up, especially as it relates to experiences of traumatic events. In developing support plans with service users, we are always mindful of culturally informed practices and evidence-informed interventions.

In this regard, the research from the adverse childhood experiences, ACEs, study conducted between 1995 and 1997, which demonstrated an association of adverse childhood experiences or traumas with health and social problems across lifespan, informs our practice. The traumatic experiences fall into three specific categories: abuse, neglect and household dysfunction, which can include mental illness, domestic violence, separation and divorce, incarceration of a family member and chronic underemployment. The long-term experience of any of the adverse childhood experiences not only affects brain development, including one's ability to develop empathy and trust, but also impacts on physical health, doubling the risk of heart disease and cancer, increasing the likelihood of becoming alcoholic by 700% and increasing the risk of attempted suicide by 1,200%. The greater the number of adverse childhood experiences, the more likely a person is to experience disrupted brain development, social, emotional and cognitive impairment, increased likelihood of engaging in risk-taking behaviours, development of diseases and ultimately an early and untimely death. Adverse childhood experiences cause the production of toxic stress, which activates the stress response system known as the fight, flight or freeze response. With prolonged or repeated exposure to trauma, a child's window of tolerance or zone of optimal arousal begins to narrow, causing him or her either to remain constantly on high alert, experiencing danger and responding with anger, violence and impulsivity or defensiveness, or to respond by shutting down when emotionally overwhelmed or triggered.

Our goal at Exchange House Ireland is to reduce the number of adverse effects where possible, or to reduce the impact of adversity by responding with specialised therapeutic interventions for trauma and suicide such as eye movement desensitisation and reprocessing, EMDR, therapy and contextual-conceptual therapy, CCT. These interventions are unique to Exchange House Ireland and offer what we believe to be the best opportunities for healing when delivered by compassionate and culturally aware team members. EMDR, developed by Francine Shapiro, is a trauma informed therapy that enables people to recover from the symptoms and emotional distress caused by disturbing life events. Some 90% of individuals seeking services from Exchange House Ireland present with trauma. The all-Ireland Traveller health study noted that suicide continues to be a complex and major health problem for Irish Travellers, who experience suicide rates six times higher than the general population. Traditional counselling approaches and medications may help the suicidal person in the short term but these approaches often do not reach the person deeply enough to end his or her suffering. Contextual-conceptual therapy is a new and innovative approach to suicide therapy. Developed by Seattle-based suicidologist Fredric Matteson, CCT identifies that feeling suicidal is not a mental illness but an attempt to create a life without the intense emotional pain. Lack of meaningful engagement in society, poor housing conditions, reduced timetables in educational settings, discrimination, incarceration, substance misuse and violence all contribute to feeling suicidal and we must tackle all of these factors to make meaningful change in the death rates.

While the multidisciplinary front-line team at Exchange House Ireland offers the optimal means of addressing the complex needs of Travellers, we must recognise that with our current capacity, replicating this level of service and responding to the significant number of requests from outside the greater Dublin area is not possible at present. As a result, Irish Travellers are further marginalised and suffer because of their geographical location. Exchange House Ireland would like to collaborate in the development of culturally competent, trauma informed multidisciplinary service hubs across Ireland and seeks the support of the committee to realise this vision. This should be done in partnership with the organisations on a local and national level. We would like to see service delivery that is the same as is offered in Dublin, with oversight in clinical quality as well as necessary training in therapeutic best practices and cultural awareness. To live in an Ireland where Travellers are fully valued as a distinct ethnic minority, receiving equitable treatment and access to all supports and services without barriers, is the vision of Exchange House Ireland. It must be realised within the mental health sphere if we are to make a substantive difference in the lives of Travellers.