Dr. Brian Keogh:

I thank the Chairman. I am an assistant professor in mental health nursing at the school of nursing and midwifery in Trinity College Dublin. In my statement I will draw from work that was completed in Carlow and Kilkenny during 2018 when we evaluated the role of the mental health liaison nurse, a post introduced to support Travellers who were experiencing mental health difficulties.

Travellers are not a homogenous group and care must be taken not to apply stereotypes and make assumptions about their needs or abilities. An individualised approach is required and approaches that are sensitive, non-judgmental, unrushed and respectful will assist towards meaningful engagement. The importance of relationships, the development of trust, privacy and confidentiality should not be understated. Recovery-orientated approaches should underpin all services and interactions with Travellers. Meaningful involvement of Travellers in the design and delivery of services is essential.

Cultural competence training should be mandatory for mental health service providers who are in close contact with Travellers on a regular basis.

Any strategy to support the mental health of Travellers needs to consider the social determinants of health and how they can impact negatively on the mental health of Travellers. For those who are vulnerable to developing mental health difficulties, strategies need to assist Travellers to recognise mental distress and develop self-help strategies, including help seeking strategies, to manage their distress and prevent it from worsening. For those in receipt of treatment from mental health services, strategies to assist Travellers to remain in contact with the services and adhere to treatment plans, where appropriate, need to be developed. Traveller health projects already in existence are in a prime position to promote positive mental health, but they need to be supported to do so. For Travellers who are in receipt of care from mental health services, service providers need to understand why Travellers might be vulnerable to disengaging from the services. Traditional ways of informing people about appointments or medications, etc. may not be useful for Travellers for a variety of reasons. Interventions need to be tailored to meet individual needs and take into consideration issues such as literacy levels and others that might impact on their engagement with services. There are also opportunities for mental health services to work closely with Traveller health projects in engaging with the Traveller community and addressing some of the barriers between Travellers and mental health services such as stigma.

In 2018 my colleagues and I evaluated the role of a Traveller mental health liaison nurse in Carlow and Kilkenny. The liaison nurse works within the primary care system and supports Traveller community health projects in a number of ways such as by educating Travellers, liaising with other professionals and community organisations and facilitating access to primary care services, or re-engagement with mental health services, when necessary. She also provides a follow-up and reminder service. This model of mental health service provision supports existing services, including the traditional mental health services, and was evaluated positively by key stakeholders, including Travellers. Some of this success can be attributed to the relationship the liaison nurse has built up with the Traveller community and her use of wellness and recovery oriented strategies to support individual Travellers who are experiencing distress. In addition, her comprehensive knowledge of community resources is instrumental in helping Travellers to access the assistance they require. Furthermore, she has forged relationships and worked closely with other agencies such as social workers and substance misuse services in facilitating access and helping professionals to understand the specific needs of Travellers.

Stigma and social exclusion are major problems for members of the Traveller community. In addition, mental health difficulties are stigmatised, leading to a lack of openness about mental distress and a reluctance to engage with the services, where necessary. Educational supports and good relationships with healthcare providers will go some way towards breaking down some of the barriers, while Traveller community health projects are in a good position to do this in partnership with mainstream organisations.

Suicide is a significant issue among members of the Traveller community. Travellers have been identified as a priority group within the national suicide prevention strategy. The introduction of the liaison nurse in Carlow and Kilkenny and the Traveller community health projects respond to some of the strategic goals of the national suicide prevention strategy such as supporting the community's capacity to prevent and respond to suicidal behaviour. A gendered response is necessary in the Traveller community. Traveller men are particularly hard to access and reluctant to engage with mental health services. Possibly the most effective strategy to reduce the incidence of suicide is tackling social exclusion, in particular, unemployment and the lack of a meaningful occupation that Traveller men often experience.

LGBTQ+ Travellers face the potential for discrimination within their community which tends to have strong conservative and religious values. There are many resources for LGBTQ+ people throughout the country and raising awareness of these supports as an avenue for open and confidential discussions about sexuality may encourage access to them byTravellers, especially young people. Traveller health projects may facilitate a sharing of information on the services and supports available.