Ms Kate Mitchell:

I thank the Chairman and members for inviting representatives of Mental Health Reform to appear before the committee. We welcome its establishment and the attention it is giving to the important issue of mental health in the Traveller community. Mental Health Reform is the leading national coalition on mental health, with over 75 member organisations, including groups such as the Traveller Counselling Service, Exchange House and Pavee Point. We work together to drive progressive reform of mental health services and supports. In its manifesto, published in 2012, Guiding A Vision for Change, Mental Health Reform identified that community mental health services had a duty to meet the mental health needs of all members of the community, including those in the Traveller community. Mental Health Reform also highlighted that the particular challenges of some minority and marginalised groups such as members of the Traveller community led to social exclusion and increased mental health difficulties. Mental Health Reform has since published a position paper on ethnic minorities and mental health which documents the challenges such individuals, including from the Traveller community, experience in accessing appropriate mental health services and supports. Such challenges include reports of lack of quality in care, communication barriers, over-reliance on medication, negative experiences with staff, the cost of accessing supports and experiences of inequality and discrimination. Perhaps most important of all is the reported lack of understanding among professionals of individuals' social and cultural context and a sense that the mental health system has been designed to reflect the majority culture. Such a lack of understanding and appreciation of Traveller culture makes it impossible to provide mental healthcare in a way that respects that culture and fulfils Travellers' human rights to culturally sensitive care. To clarify, when we speak about cultural competence, we are referring to the attitudes, behaviours, knowledge and skills mental health services and staff need to have in order to deliver culturally responsive mental health services, while recognising that such competencies must incorporate the addressing of power imbalances and institutional discrimination.

In 2016 Mental Health Reform published, in partnership with the Mental Health Commission, guidelines for mental health services and staff on working with people from ethnic minority communities and delivering culturally sensitive care. The key recommendations outlined in the report include that staff and services respect the diverse beliefs and values of the people using the services; the provision of communication and language supports; the facilitation of family and advocate involvement in providing support and training for mental health staff, to include reflection on inherent cultural biases and the evaluation and review of the delivery of culturally sensitive services. It should include the establishment of an ethnic identifier to collect data for service utilisation, equity of access and quality of service for persons from ethnic minority groups.

I would like to highlight two key points in my opening statement, the first of which is that the experiences of social exclusion and discrimination felt by the Traveller community increase the risk of mental health difficulties. These issues must be addressed effectively if we are to improve the mental health outcomes of this community. The second point is that the lack of culturally sensitive mental health services results in the particular mental health needs of members of the Traveller community not being met. This must be addressed as a matter of priority.

With regard to social exclusion and discrimination, the all-Ireland Traveller health study, published in 2010, identified discrimination as being a major problem for all Travellers. There were significant numbers of accounts of it directly influencing mental health, leading to feelings of depression and anxiety and suicide. A report published in 2017 by the Community Foundation for Ireland identified that 77% of Travellers had experienced discrimination in the previous year. Some 43% indicated that they had encountered discrimination while accessing employment. High rates of unemployment and poverty, over-representation in prisons and experiences of unsuitable accommodation among members of the Traveller community continue to be reported. There can be no doubt but that they are compounded by cuts to Traveller services in recent years.

As outlined in Travelling with Austerity, significant cuts to Traveller infrastructure were highlighted, including cuts of more than 80% to Traveller education and Traveller accommodation and more than 70% of cuts to equality programmes. The community and voluntary services that provide essential mental health supports to Travellers at local and national levels must be acknowledged. These services, however, are often under-resourced and operate on insecure funding streams and budgets. Under human rights law, the Government is obliged to “ensure that health services are culturally appropriate and that health care staff are trained to recognise and respond to the specific needs of vulnerable or marginalised groups”. At national level, the Government’s current mental health policy, A Vision for Change, recognises that mental health services should be inclusive of all people in Irish society and should be delivered in a culturally appropriate way. This sentiment is reflected in Mental Health Commission’s quality framework. The requirement to meet the particular needs of the Traveller community has also been committed to in Connecting for Life, the national intercultural health strategy, and more recently the national Traveller and Roma inclusion strategy. While these commitments are welcome, to date there has been a severe lack of implementation and policy is far removed from what is happening in practice.

It is anticipated that the revised mental health policy, due to be published later this year, will have a greater focus on developing mental health services for particular groups of people, including those from the Traveller community. Mental Health Reform continues to hear reports that the Traveller community feel their mental health needs are being ignored, notwithstanding serious concerns about high rates of suicide and mental health difficulties within the community. Many Travellers feel there is a lack of engagement with the Traveller community and where their concerns are voiced they often fall on deaf ears. The Oireachtas Joint Committee on Future of Mental Health Care acknowledged that clearly there is a mental health crisis in the Traveller community, and that mental health services are failing Traveller people the most. In its October 2018 final report the committee recommended "that the Department of Health carry out a study to identify the causative factors [of mental health difficulties] to include a priority focus on the Traveller Community, and how they can be addressed", and that "more resources and funding should be targeted at the areas of highest need with particular attention to the Traveller Community and towards addressing suicide." There is no doubt of the need to implement in full the recommendations of the Oireachtas committee, including those pertaining to the Traveller community. There is a fundamental need to adequately address the mental health needs of the Traveller community through national policy with the voice of Travellers at the heart of the process, and to effectively resource and implement such a policy. Traveller-specific infrastructure, including local community groups and primary healthcare projects, must receive adequate investment through sustainable funding. Mental health services and supports must be developed to deliver culturally sensitive services and to ensure equity of access and quality of care among the Traveller community.