Mr. John Meehan:

I am the assistant national director in the HSE responsible for mental health strategy and planning. I also head the National Office for Suicide Prevention, which I will refer to as the NOSP. I am joined by my colleague, Dr. Siobhán Ní Bhriain, national clinical adviser and group lead for HSE mental health. On behalf of the HSE mental health services, I welcome the establishment of this committee and its focus on mental health within the Traveller community. In the context of our own health services, mental health describes a spectrum that extends from positive mental health through to severe and disabling mental illness. A strategic goal for mental health services is to promote the mental health of our entire population in collaboration with other services and agencies, including reducing loss of life by suicide. This requires a whole-population approach to mental health promotion. Over 90% of mental health needs can be successfully treated within a primary care setting with a need for less than 10% to be referred to specialist community-based mental health services. Of this number, approximately 1% are offered inpatient care and nine out of every ten of these admissions are voluntary. I offer a reminder today that our mental health services, whether provided by community-based mental health teams or within acute inpatient services, day hospitals, outpatient clinics or forensic services, are for our entire population and that includes the Traveller community.

On suicide and mental health among Travellers, it is widely accepted that there are many factors that can impact on the mental health of the Traveller community including, but not limited to, perceived stigma associated with being a Traveller and discrimination against Travellers among the general population; lower educational levels; socioeconomic conditions; inadequate accommodation; addiction; domestic violence; and inclusivity among the Traveller community as regards LGBTI+ and gender equality. Nevertheless, it remains difficult to ascertain the levels of suicide among the Traveller community. Unfortunately, the data provided by the Central Statistics Office do not capture a wide range of information, including ethnicities. This gap is just one of the barriers to improving real-time visibility of suicide incidence among many different cohorts in society. However, we can still look to qualitative studies.

The 2010 all-Ireland Traveller health study, although somewhat dated, concluded that the rate of suicide among male Travellers was 6.6 times higher than the general population. The female suicide rate was less pronounced.

In a strategic context, I would like to highlight four key drivers that inform and assist us in the HSE in improving the mental health of, and reducing suicide among, the Traveller community. First, members of the Traveller community are considered as a priority group in Connecting for Life, and feature across many objectives and actions in the strategy. They are strongly represented in 17 localised versions of Connecting for Life that are now in place across the country, many of which involve local Traveller groups and representatives on their implementation or oversight groups.

A Vision for Change reminds us that mental health services should be inclusive of all the people in Irish society and should be delivered in a culturally appropriate way. A refresh of A Vision for Change is due to be completed later this year and will propose an expansion of existing recommendations, as well as seeking to develop a framework for the implementation of cultural, diversity and gender competency that is required to respond to the needs of these particular groups. The national Traveller and Roma inclusion strategy also details HSE-specific actions which inform this work. Of particular note is the commitment to develop a national Traveller health action plan. In answer to Senator Warfield's question about the action plan, a senior manager in the HSE has been allocated to work with Travellers to complete it and it will be done by quarter 1 of 2020.

The consultation process to inform the development of the plan, led by the HSE national social inclusion office, commenced in 2018. Along with the HSE community strategy in planning mental health, the office has proposed an integrated approach to deliver key mental health and social inclusion actions under the national intercultural health strategy, which includes Connecting for Life, A Vision for Change and Healthy Ireland, alongside wider Government initiatives. The second National Intercultural Health Strategy 2018-2023 provides a comprehensive and integrated approach to addressing the many unique health and support needs experienced by the increasing numbers of HSE service users from diverse ethnic and cultural backgrounds who live in Ireland.

There have been key initiatives and developments across the HSE, nationally and locally. In 2017, the HSE committed to the recruitment of nine mental health co-ordinators for Travellers, eight of whom are currently in post. The focus of these roles is to work within the CHOs to support improved access, consistency and integration of mental health services to meet the mental health needs of Travellers. The HSE NOSP provides suicide prevention-specific funding to Exchange House, from which the committee heard last week and whose service has now established working groups in Dublin, Limerick, Sligo, Meath, Waterford, Kildare and the midlands. The NOSP has also funded the Offaly Traveller Movement and the local community healthcare organisation, CHO, to provide the local Travelling to Wellbeing mental health service. This has resulted in the production of a guide to developing a local co-ordinated multi-agency crisis response plan for the Traveller community to ensure more support for individuals and families when suicide incidences or crisis situations occur. The HSE national social inclusion office funds a wide range of Traveller mental health initiatives that are focused on both improving the mental health and reducing death by suicide of Travellers through training and education programmes but also through providing a community development approach to service access and delivery. Many of these initiatives are based in CHOs and a number are funded directly through dormant accounts.

Last week, the committee also heard from Ms Niamh Keating, from the West Limerick Primary Health Care Project for Travellers. Primary health care for Travellers projects, PHCTPs, establish local models for how Travellers could take part in developing health services. Travellers work as community health workers and this will allow primary health care to be developed based on the Traveller community’s own values and perceptions. This helps to achieve positive outcomes with long-term effects. It is just one example from an array of initiatives under way within Traveller health units across each CHO area in the HSE. These units provide support to a range of primary care projects and other initiatives for Travellers.

The Traveller health units, as discussed previously, work to enhance Traveller health status, improve the capacity of mainstream health services to respond to Traveller needs, and to respond to the social determinants that impact Traveller health. The latter issue has been mentioned by many of my colleagues.

There remain challenges across our health system in accessing Traveller populations, and in responding to their specific needs, but the HSE believes that targeted, evidenced local initiatives can make a difference. For example, projects to introduce regional Traveller mental health liaison nurses, mental health promotion programmes, Traveller cultural awareness training and programmes such as Healthy Minds, which was discussed in Cork and Kerry previously, all have promising outcomes. A wide range of local Traveller projects or action groups have nurtured constructive relationships and partnerships with HSE community health organisations in this regard.

I assure the committee and representatives here today that there remains a very firm commitment, at national and local levels, to improve the health service experiences and reduce mental health inequalities experienced by the Traveller community in Ireland. We hear, and share, the concerns about mental health and levels suicide among the community, and remain determined to work collaboratively with allpartners and stakeholders, to achieve better outcomes together and to reduce suicide and self-harm among the Traveller community and the general population. That concludes my statement.