Oireachtas Joint and Select Committees
Thursday, 6 November 2025
Committee on Key Issues affecting the Traveller Community
Health Inequalities and the Mental Health Crisis: Discussion
2:00 am
Anne Rabbitte (Fianna Fail)
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Apologies have been received from Deputies Lawlor, Ó Muirí and Barry Ward, and from Senator Flynn. All are welcome and I ask anyone attending remotely to mute themselves when not contributing so as not to pick up background noise and feedback. I also remind everybody to turn off their mobile phones.
As we are within the precincts of Leinster House, witnesses are protected by absolute privilege in respect of the presentations they make to the committee. This means they have an absolute defence against any defamation action for anything said at the meeting. However, they are expected not to abuse this privilege and it is my duty as Acting Chair to ensure it is not abused.
Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with such a direction.
Members are also reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person or entity outside of the Houses, or an official of the Houses, either by name or in such a way that makes them identifiable.
The agenda for today's meeting is engagement with the Department of Health and Exchange House to discuss health inequalities and the mental health crisis as part of the national Traveller mental health service. I welcome our guests to the committee today. I ask Ms Kerry Cuskelly to please present on behalf of Exchange House.
2:05 am
Ms Kerry Cuskelly:
I thank the Acting Chair and members of committee for the invitation to make this opening statement on behalf of Exchange House Ireland National Travellers Service. We welcome the opportunity to address the mental health and suicide crisis in the Traveller community and to propose solutions grounded in our work and existing national policy frameworks. I am joined by my colleagues Ms Cathleen McDonagh Clark and Mr. John O'Brien.
Founded in 1980, Exchange House Ireland is the largest and longest running front-line Traveller-specific service in Ireland. We are an organisation of Traveller and non-Traveller people working together to provide evidence-informed, professional, high-quality services to some of the most marginalised members of the Traveller community. Our core services include family support and crisis intervention; children and young people services; addiction, mental health and suicide prevention services; and education and training services. Staffing includes those in social work, addiction counselling, psychotherapy and play therapy, and after-school workers, access workers, youth workers, education workers, mental health workers, peer support workers and staff in community development work. We operate a duty system through which anyone can contact us for support, information or guidance.
We ask the committee to consider the mental health crisis among Travellers not as isolated clinical problems but as deeply rooted in structural, social, economic, cultural and environmental determinants. Exchange House Ireland provides our services informed by a social determinant lens. A social determinant approach emphasises that health and mental well-being are shaped by the conditions into which people are born, live, work, learn, age and die. To holistically address people's needs, we work from a multidisciplinary approach combining the expertise of peer support workers and professionals to deliver culturally appropriate wraparound trauma-informed services. Our peer support model ensures a cultural lens is applied to all interventions. Our access to a diverse professional team ensures service user issues, however complex, are addressed and not treated in isolation.
The Traveller community in Ireland is facing a suicide crisis of unprecedented scale. Preliminary and soon-to-be-published findings from a surveillance of death by possible suicide in the Traveller community will show that in comparison with rates for the population in Ireland as a whole, the rate of probable suicide among the Traveller community is ten times higher, eight times higher for Traveller men and 15 times higher for Traveller women. While mental ill-health is a factor, a key component are social determinants of health. In our work with Traveller youths to co-produce the design of a Traveller youth mental health service, we found young Travellers across Ireland have a distinct lack of hope for the future. Limited employment prospects combined with already high rates of unemployment, poor experiences within education, inadequate housing, racism and discrimination, community expectations, shame and stigma are contributing to this young population feeling hopeless.
Low levels of formal education, early school leaving and discrimination in the labour market continue to cause long-term poverty exclusion and poor mental health within the Traveller community. Constant prejudice and a lack of opportunity compound the effects of trauma, leaving many people without the skills or supports to manage emotional pain. Over time, this leads to despair, distress and, far too often, suicide. At Exchange House Ireland, we see every day how education and training can break this cycle. Learning builds confidence, strengthens identity and provides structure, belonging and purpose, which are all vital to good mental health. As a QQI-approved provider, we deliver level 4 and level 5 programmes that help learners rebuild confidence, gain recognised qualifications and progress into further education, apprenticeships or employment, which are proven protective factors for mental well-being and suicide reduction.
Across the justice system, Travellers are disproportionately represented, making up over 7% of the prison population, despite making up only 0.7% of the general population. Anecdotal figures suggest this figure rises as high as 15% in individual prisons and 35% in Oberstown. Exchange House Ireland has, for almost 20 years, been providing invaluable support within prisons and across the probation system through a variety of initiatives, including addiction counselling, psychotherapy, mental health support, social work and peer support groups. Our work within prisons, particularly in Wheatfield, Mountjoy and Dóchas, has demonstrated significant impact and garnered positive feedback from both prisoners and prison staff. With both prisoners and Travellers recognised as priority groups under the Connecting for Life national suicide prevention strategy, we advocate for greater recognition of services specifically for Travellers in the justice system.
As pointed out, causative factors in the mental health and suicide crisis in the Traveller community are embedded within the social determinants of health. Thus, solutions must take on a multiple systems approach requiring significant collaboration. Exchange House Ireland has built up a strong reputation for being a leader in successfully engaging with stakeholders across all sectors at a national, regional and local level to ensure the community's needs are met. This ranges from national advocacy and steering groups, such as the national Traveller and Roma inclusion strategy, NTRIS, to large-scale campaigns, such as the Traveller Road to Hope and Change, to multi-organisational research on culturally inclusive telephone suicide crisis supports, and individual crisis interventions through the development of culturally inclusive integrated care pathways.
We ask for the committee's consideration of the following: a costed implementable national Traveller mental health and suicide prevention action plan; embedding and scaling of Traveller-specific mental health services nationally; Traveller youth-centred culturally responsive models of mental health care; enhanced implementation of Traveller-specific crisis response capacity nationally; enhanced implementation of culturally appropriate suicide postvention supports nationally; and formalising integrated cross-sectoral partnership and referral pathways across our health, social and community services.
Travellers have the right to mental health, the right to live free from stigma and the right to access care that honours identity. Through partnership, co-creation and the centring of Travellers' lived experience, coupled with tangible action, there is opportunity to build a working, evolving model of culturally grounded high-quality mental health care that is integrated with community and aligned with national policy. We in Exchange House Ireland offer our support and genuine wish for collaboration towards this goal.
I thank members for their time. We look forward to answering their questions.
Anne Rabbitte (Fianna Fail)
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I thank the participants from Exchange House and their colleagues in the Gallery. I now ask the Department to make its contribution. Will Ms McArdle explain who is with her today?
Ms Siobhán McArdle:
I thank the Acting Chair and the wider committee for the invitation to appear here to discuss health inequalities and mental health issues among the Traveller community and other related matters. I am assistant secretary in the social care, mental health and unscheduled care division in the Department of Health. I am joined by my colleague Mr. David Leach, assistant secretary of the corporate affairs division in the Department with responsibility for Traveller health. Also here on behalf of the Department are Ms Siobhán Hargis, principal officer for mental health policy, and Ms Karen O’Connor, assistant principal officer for the drugs policy, refugee and inclusion health unit. We are also joined from the HSE by Ms Maria Bridgeman, integrated health area manager for Limerick city and north Tipperary, Ms Aileen Kitching, public health lead for social inclusion, and Mr. Tony McCusker, general manager for mental health services under access and integration in the HSE.
Improving the health and well-being of the Traveller community is a key concern for the Department of Health. Traveller health inequalities are reflective of the wider social and economic disadvantages, marginalisation and discrimination experienced by the Traveller population in Ireland. It is of pivotal importance that our national strategies and policies address the broader social determinants of health, including mental health. Statistics show that the rate of suicide among Travellers is much higher than for the general population, while Travellers have a higher rate of self-harm across all age ranges than the general population. A 2023 HSE research report showed that the risk of self-harm for Traveller men over the age of 50 was significantly higher than that for the general population. Being a member of a minority ethnic group can also be a predictor of poor health. As such, Traveller health and mental health are as much societal issues as they are specifically health issues.
The Department of Health must therefore ensure that policy interventions under our remit go beyond basic health service improvements, but also speak to, and positively impact, the broader social determinants of Traveller health. This is reflected in the national Traveller health action plan, which seeks to improve the health experiences and outcomes for Travellers. The plan, which covers the period 2022 to 2027, is co-published by the Department and the HSE. It is a landmark document that recognises the right of Travellers to the highest attainable standards of physical and mental health, as is the norm in Irish society. While Ireland has made great strides in improving health and extending life expectancy, Travellers have not benefited to the same extent.
A core element of the plan is the recognition that Traveller health and health inequalities are reflective of the wider social and economic disadvantages, marginalisation and discrimination experienced by the Traveller population. The importance of the social determinants of health is recognised in goal 3 of the national Traveller health action plan which sets out the aim to address the social determinants of Traveller health through targeted and mainstream measures.
The Department is fully committed to providing the leadership and resources to support the implementation of the plan and thereby to promote health equality for Travellers. To this end, the Department has provided the HSE with a ring-fenced budget in excess of €10 million for the provision of Traveller-specific health services, the majority of which is used to fund Traveller primary healthcare projects which work to ensure Travellers receive equitable access to mainstream healthcare services such as GP services, primary care, public health, acute hospital, mental health and community care services.
Additional resources have also been provided for drug services, including services that target Travellers affected by problematic drug and alcohol use. In addition, since the publication of the national Traveller health action plan, the Department has provided over €4 million in funding to implement initiatives under this plan. This includes specific measures to support Traveller mental health and to improve Traveller child health. I will elaborate on some of these initiatives further. The plan itself is complemented by the national Traveller and Roma inclusion strategy, NTRIS. This strategy delivers a whole-of-government response to the inequalities and disadvantages Travellers experience in Irish society. Health and well-being is a key theme of this strategy, with two strategic objectives and seven separate actions being implemented by the Department of Health and the HSE in partnership with Traveller organisations.
I will now highlight some of the Department's initiatives to improve the health and well-being of Travellers. The first is a programme to address the social determinants of Traveller health in conjunction with the Sláintecare healthy communities programme. In excess of €700,000 has been allocated over a period of two years to deliver this important programme. Projects have been selected in five locations: Bray, Cork, Athy, Waterford and Westmeath. These areas contain a higher proportion of the Traveller population. Their aim is to address the specific factors that impact on Traveller health in these communities, such as living conditions, social activities for Traveller men, school supports and access to employment. The projects were developed in partnership with local authorities and local Traveller organisations. The implementation of the projects will be supported through action research and this will then inform the development of models which can be scaled up and mainstreamed to other parts of the country.
Another departmental initiative relates to Traveller child health, brighter beginnings. To date, we have funded projects in two HSE health regions, each to the value of €250,000, with additional funding for a further two health regions announced in budget 2026. The brighter beginnings initiative reflects a life course understanding of Traveller health, that Travellers are not born with health inequalities but rather these are developed over time from childhood onwards. The initiative enables a dedicated policy focus on the early years of Traveller life to maximise the lifelong health and well-being of this group. The initiative is linked with the HSE national healthy childhood programme which is the universal programme of clinical care for all children. It will address barriers to important childhood services, such as the newborn and child health screening programmes, vaccinations and developmental checks. This is in line with goal 2 of the national Traveller health action plan to improve Travellers' equality of access, participation and outcomes in mainstream health services through a human rights-based approach.
In 2023, a further initiative was specifically supported with €500,000 from the women's health action plan. This initiative was designed to provide a culturally sensitive approach to improve healthcare services for Traveller women who are at risk of experiencing homelessness. In budget 2026, we have been able to allocate a further €120,000 to mainstream a model of care which has shown to be successful from this initiative.
I will update the committee on initiatives relating to Traveller mental health. In the Department of Health, we see it as our role to engage with other Government Departments to ensure policy interventions go beyond basic health services but also speak to and impact upon the broader social and economic context in which Travellers live. This is particularly important in the context of mental health. Working with our cross-government counterparts, the Department has developed a range of initiatives to address the inequalities in health and mental health outcomes that continue to be experienced by the Traveller community. In recent years, we have put a particular focus on the principle of co-production, which involves designing and delivering policy and services in partnership with Travellers. This is an important approach that is embedded within our whole-of-population mental health policy, Sharing the Vision. Government policies, including Sharing the Vision and Connecting for Life, set out clear commitments to improve mental health services for Travellers and the Traveller community is recognised as a priority group in both strategies. Suicide rates among the Traveller community are being addressed through cross-sectoral, collaborative work underpinned by an impactful and evidence-based policy. There has been significant engagement with Travellers and Traveller representative organisations as part of the public consultation on the new suicide reduction strategy, the successor strategy to Connecting for Life.
The national Traveller health action plan contains six actions on Traveller mental health. These are being delivered through the HSE national service plan, which funds the employment of community support workers within Traveller community projects to focus on engaging the community with existing mental health supports, identifying gaps and consulting on future service developments. These mental health-specific actions are now co-ordinated under a new national Traveller mental health implementation plan, overseen by the HSE-chaired Traveller and Roma mental health working group. The working group comprises representatives from the HSE mental health services, Traveller representative groups, lived experience representation, the Department of Health, the National Office for Suicide Prevention and local area mental health co-ordinators for Travellers. The first comprehensive report of the working group is in development and is expected to be available by the end of the year.
The working group has supported and overseen a number of important initiatives and developments since its establishment in 2024, including the funding and appointment of seven primary care support worker posts to work specifically with Travellers with mental health concerns. It supports an annual national and local campaign, Travellers Together Preventing Suicide, which seeks to create awareness and tackle stigma in relation to Traveller suicide. The programme has funded ten youth mental health first aid training courses for those working with young Travellers. In addition, nine Travellers will graduate with an NFQ level 5 qualification in understanding mental health, through funded copper art skills projects. This is an innovative approach to engaging the Traveller community, sharing knowledge and experience, and learning the skills of copper art.
As part of budget 2026, the Minister of State, Deputy Butler, announced a further €415,000 in recurrent funding to support Traveller mental health, representing another increase in funding on previous years. This funding will support various initiatives as part of the work plan of the Traveller mental health working group. More recently, at the request of the Minister of State and following consultation with Traveller representative groups, the national implementation and monitoring committee for Sharing the Vision approved the establishment of a Traveller mental health specialist group. This group will co-produce a Traveller mental health action plan for enhancing and optimising mental health supports for Travellers, and considering the needs and circumstances of the Traveller community. While it will be principally aligned with Sharing the Vision, it will consider interdependent and associated policies and strategies, with a strong focus on interdepartmental working. The group will feature representation from the Traveller community, including lived experience representatives and those involved in providing services in the community. The group is currently in the process of being established with a view to holding its first meeting in January.
In conclusion, we welcome the committee's focus today on the mental health of the Traveller community. I look forward to our discussion. I hope this meeting provides an opportunity to highlight the collaborative approach the Department of Health has adopted with the Traveller community and Traveller-led organisations, delivered with the leadership and partnership of the HSE and the community and voluntary sector. The strategies, policies and initiatives of recent years have focused on the beneficial approach of co-production and collaboration while ensuring health inequalities are addressed through cross-sectoral approaches that work to improve societal determinants of health and mental health.
The concept of mental health in all policies is one we continue to build on so that we can work with our counterparts across all areas of society to embed more positive mental health and mental health outcomes for the Traveller community. We look forward to our discussions today and the discussions on all other developments to do with Traveller health.
2:25 am
Anne Rabbitte (Fianna Fail)
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I again thank the witnesses for being here and for their contributions.
John Connolly (Galway West, Fianna Fail)
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I thank all our witnesses and those who gave contributions. I particularly compliment Ms Cuskelly on her powerful contribution. Anecdotally, we would be aware of some of the perceptions relating to the data. The witnesses have outlined today that members of the Traveller community are ten times more likely to suffer from probable suicide than the population as a whole and it is 15 times more likely for female members of the Travelling community. When we see and hear the evidence-based data they have presented, it shows how stark the challenge is here. If this was data based on a geographical location, for example, County Galway, and we saw there was an issue in County Galway, I firmly believe we would have a Government task force established to try to deal with it. However, because the Travelling community is dispersed - I am probably being generous in saying that - and possibly also because of historical discrimination, we are not dealing with this issue well enough. Health officials are here today. I believe they are both right. This is not just an issue for the Department of Health or the HSE. Unfortunately, the Department of Health needs to in some way come in and try to remedy the issues that are causing this problem. I think it will take more than one meeting of this committee to see if we can develop solutions or some way to help the with the issue. I have heard Ms McArdle outline a lot of what is being done, but it seems to be a bit here, a bit there and a bit everywhere.
Ms Cuskelly made a number of good suggestions but I would like to get some feedback on her proposal that we need Traveller-specific mental health services. Is the Department of Health considering having suitably resourced Traveller-specific mental health services in each CHO and each hospital across the country? That we have come to this point is not fully the responsibility of the Department of Health but involves a range of things as the witnesses rightly outlined. Are we looking at developing that kind of service? That is my most basic question.
Ms Siobhán McArdle:
As I mentioned, that is a very significant concern. We recognise that every death by suicide is one death too many. Our national policy, Connecting for Life, is very much embedded in an evidence-based approach across all our services to address this societal issue. Leaning into our national Traveller health action plan, it is a focus both on mainstream services as well as targeted services. It is important that our mental health services and all our health services are accessible to all who need them in a timely and accessible way. I gave details on how we are investing in more specific targeted approaches where that is required.
Our national strategy, Connecting for Life, has been our suicide strategy for a number of years. It is concluding and we are now in the process of developing a new strategy to replace that, on which we would welcome the views of the committee. Through that, we expect to see a stronger focus on those priority groups. I wish to give the Deputy assurance that, across every part and region of Ireland, we have both a national strategy, Connecting for Life, and regional plans that are driven, designed and implemented by local partners, including the HSE, An Garda Síochána, the education system, local authorities and Traveller groups, coming together to ensure that the initiatives in local areas are addressing the needs of those communities. That programme of work has been evaluated and the learning from that will be embedded in the new policy and strategy we are focusing on.
I will pass over to my colleague Mr. Leach, who will talk about broader focus on health.
Mr. David Leach:
On healthcare more generally, the Department's budget for Traveller healthcare has increased from €8.9 million in 2022 to €13.65 million this year, which represents a significant increase in investment in Traveller healthcare more generally. As Ms McArdle said, the focus is on mainstream services, primarily through the primary healthcare Traveller projects. We fund those and, through support workers, they seek to connect Travellers with mainstream health services insofar as it is possible. As Ms McArdle said in her opening statement, we also recognise that there are significant gaps in the Travelling community and we seek to address those.
The funding of projects for the social determinants of health was mentioned. There is also funding for Traveller women projects and funding for childhood projects which we will roll out over the next 12 months. We seek to link Travellers to mainstream health services. We seek to address the gaps where they are as best we can. We certainly have seen increased investment, but of course we are always advocating for more, as the Deputy can imagine.
John Connolly (Galway West, Fianna Fail)
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Is the budget that Mr. Leach mentioned for Traveller health in general and not specific to mental health?
Ms Siobhán Hargis:
On top of the funding that Mr. Leach mentioned, we have seen increased funding for Traveller mental health services, especially in recent years. Specific focus has been provided for developing the national counselling service for Travellers and wider new developments. In recent years, almost €3 million more has gone into Traveller mental health supports. That covers a range of actions and initiatives, many of which are now tracked through the national Traveller mental health working group which is chaired by the HSE.
In relation to the universal access to mental health supports but also ensuring that we have appropriate access for Travellers, there is a focus within our national policies to ensure that, while there is universal access, culturally appropriate supports are also available to Travellers and that cultural awareness and humility are built into the services we are developing. In recent years and moving into budget 2026, we have built on evidence-based supports, ensuring they are also accessible to Travellers. For example, there are many suicide crisis assessment nurses, SCANs, across the country. However, as of budget 2025, we have also funded specific posts in Portiuncula to have two SCANs for Travellers as well. It is to ensure there is universal access while also recognising culturally appropriate services within the wider mental health service.
John Connolly (Galway West, Fianna Fail)
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I appreciate that, but the answer is also similar to Ms McArdle's presentation. We are hearing about a particular service here and a particular service there. I recently asked a parliamentary question about the mental health services in the Travelling community and the answer was similar. I was advised of four national services, one of which is the Exchange House Ireland service. What budget is provided to Exchange House Ireland for the provision of that service?
Ms Kerry Cuskelly:
Off the top of my head, I cannot give a specific number. However, it is between €300,000 and €400,000. That is obviously enough to do a certain amount. It would be very feasible for the model that we have developed to be replicated on scale nationally. Some weeks ago, colleagues from the National Traveller Women's Forum appeared before the committee, including Sandra McDonagh, from the Offaly Traveller movement. Its mental health service is a success story in terms of our model because we were able to support and develop that model and one in west Cork. Those two areas are now running essentially in the way we have supported them too. We could feasibly do that at a national level. At the end of our presentation, I said that we would like to collaborate on this and I genuinely mean it because there is a workable model and there is opportunity to do it.
It connects to a number of the other recommendations in terms of the need for that integrated care pathway and the realisation of shared care, what shared care approaches actually are and what they mean, and including non-traditional mainstream services in that care pathway. For example, the majority of referrals to our mental health services for the past five or six years have been for social work, which is interesting in itself. A number of weeks back our colleagues were here discussing child protection and family support. I am a registered social worker and I have worked on the front line for many years. There is a very reasonable mistrust from the Traveller community of the social work profession. However, in Exchange House Ireland that appears to be the absolute opposite. One of the fundamental pieces of our organisation is that we have Travellers and non-Travellers on every single team at every single part of the service working together genuinely to provide the front-line service. This is what I suggest we may consider looking at.
2:35 am
John Connolly (Galway West, Fianna Fail)
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Does Ms Cuskelly believe that the services Exchange House Ireland is supplying, in the limited circumstances that it is, is a model that could be used across the country? Yes. Okay.
Anne Rabbitte (Fianna Fail)
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We will finish on that point, if that is okay.
Dessie Ellis (Dublin North-West, Sinn Fein)
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I thank Exchange House Ireland and the HSE for their input. I spent nearly two hours in St. Margaret's in Ballymun yesterday. I came away more depressed than ever. In the 26 years I have been a councillor and a TD, the area has just deteriorated. They have been abandoned and left to their own devices. That is the reality. We look at Avila and we look at St. Margaret's and we see the overcrowding and the people looking for housing. It is no wonder their mental health is out the wall. It is so bad. I came away thinking where are we going to go and how are we going to handle this. My own thoughts were that we need to assess all the official halting sites to look at what the issues are in each one of them and to take them individually. We must look at them and sort out what the main problems are, whether it is mental health, housing, a combination of addiction or whatever it is. We need to find out the depth of it in each of these sites and then try to address it. We have seen where money has not been spent by a lot of local authorities across the country. We have had promise after promise about places to be built, including in Avila. St. Margaret's was to be redeveloped. I have been at this for ten or 15 years and it still has not been done. We have had suicides. A lot of them were in the Finglas area, in Avila, and in St. Margaret's recently. It is quite depressing. I really think that when it comes to mental health, there is also a huge cultural difference for people. A Traveller who has a mental health issue would not necessarily have the same issues that a person in the wider community would have. When we are dealing with the Traveller community and mental health, we need to take into account that there is a cultural issue.
What policy changes are needed, as a priority, to address the social, economic, cultural and environmental causes of the mental health and suicide crisis among Travellers? That is a big question but we need to look at what policy changes are really needed. The suicide rates are just appalling. They are 15 times higher for Traveller women and ten times higher for Traveller men. Even on the death of a relative, a friend, a son or a daughter, what supports are available for counselling? How do we direct these people into getting help? There is a ripple effect and that is a big problem.
On the increased educational attainment, how can it be made more accessible to Travellers? We have seen where Travellers go to DEIS schools and they are missing breakfast, for example. They are facing all sorts of issues. It is absolutely crazy that people are going to DEIS schools and some of them have not even had breakfast or lunch. We cannot have people going to school without being properly fed or properly looked after. The DEIS schools have been doing a major job in this.
On the engagement with the local authorities, I know what we have heard from the witnesses, but the local authorities have to step up to the mark as well. In a lot of cases, they have not. What I have seen over the last while is quite worrying. I thought we would have been miles further down the road with a lot of the initiatives. The witnesses have mentioned a lot of initiatives there and I understand and I welcome them, but an awful lot more has to be done. One simple thing in terms of the Traveller community relates to a lot of the halting sites with caravans in them. It is a major task to even get steps up to the caravans for people with a disability. We cannot even deal with basic little things like that. It is really frustrating.
On the employment issue, whether we like it or not, there is huge discrimination out there. I know there have been initiatives by the local authorities trying to get apprentices and all these initiatives are welcome and they need to come, but there is just not enough. Not enough is being done. I will leave it at that. I just feel a bit frustrated today after what I have seen.
Anne Rabbitte (Fianna Fail)
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Does anybody want to respond to Deputy Ellis? There is time and the Deputy raised an awful lot of issues. He asked one specific question about policy if the witnesses would like to address it.
Dessie Ellis (Dublin North-West, Sinn Fein)
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With regard to the Traveller mental health plan from the specialist group that has been set up, it will be the end of 2026 before we have that. How many years have these issues been going on and yet we are only now putting together a whole action plan for people's mental health? It will go into education, justice and all these different areas and it is only going to happen by the end of 2026. Janey Mack, what has happened over the last number of years?
Ms Siobhán McArdle:
I might just step in there. The Deputy is absolutely right. The social determinants of health such as employment and housing are the issues we hear from colleagues who are from the Traveller community. The research and evidence also speaks to those issues being critically important.
On suicide prevention, and just to give hope as well, it is really important as we divide out the approach at a policy level that we look at prevention, and part of prevention is around stigma reduction. This is really important to ensure that people feel it is okay to talk about poor mental health and to know where health can come from and what health looks like. In that area of stigma reduction, we have a targeted campaign to reduce stigma associated with self harm and suicide among Travellers. We have the Traveller road to hope and change campaign, which held four events in 2024 with over 1,000 participants. That training and awareness building is really critical.
The Deputy also spoke about the need for timely intervention. As my colleague Ms Hargis said, the suicide crisis assessment nurses and those nurses in our hospital settings and general practice who respond at that time of crisis are critical for being able to hear people from that point of crisis and to provide pathways to intervention and support services. There is also postvention. When a tragedy has happened in an individual's family or community, that provision of counselling and targeted support is very much part of the range of services that are available. I recognise that these could increase and be improved upon but I can give the Deputy assurance that those are developing and are in place. I will now pass over to my colleague Mr. Leach to talk about the broader social determinants approach.
Anne Rabbitte (Fianna Fail)
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I allowed Deputy Connolly to go over by three minutes so I will treat everybody equally.
Mr. David Leach:
I thank the Acting Chair. No one could but agree with what the Deputy said there. He said an awful lot and he is speaking from evidence on the ground. I will not gainsay that at all. Everything he said was heartfelt and I take it as absolutely genuine. We are from the Department of Health but a lot of the time we spend our time talking about sickness rather than health, unfortunately. When we are talking about the reasons for all of this, a lot of them are not found in the healthcare area. Healthcare is seeking to address some of those issues but those issues are to be found elsewhere, as the Deputy said. NTRIS, the national Traveller and Roma inclusion strategy, was referenced by Ms McArdle earlier.
It has nine different themes and one of them is health and well-being. The others are equally important. We all know the value of education, employment, housing and all of those other things and the impact they have on people's healthcare. As the Deputy said, with people living in very bad conditions, is it any wonder their mental health is severely challenged? What we are trying to do in terms of healthcare through the Traveller primary healthcare projects is to work with the Traveller community, with Travellers as key workers and peer support workers for the health services, to bring people to health services in order to access mainstream health services as best they can. However, they are health services and there is no point in me trying to pretend otherwise. While we have some projects around the social determinants of health, in many cases we are scratching at the surface of a really big problem and we are seeking to tackle generations and hundreds of years of discrimination. We acknowledge that and do the best we can.
To give some hope, as it is important to have some, the national Traveller health action plan has been running since 2022. Our colleagues in the HSE are running that. There are 45 actions and 44 of them are under way. Many of them are achieving things. Perhaps later, Ms Maria Bridgeman might get an opportunity to talk about how that operates on the ground for people in communities and how those services interact with the Traveller community and the impact they have. It is important we are hopeful as well and I appreciate the Deputy's point. It is well made and properly taken. We have to be honest as well and talk about the good as much as we possibly can to give everybody hope that what we are doing has some impact.
2:45 am
Dessie Ellis (Dublin North-West, Sinn Fein)
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I was wondering about engagement with the local authorities. To give an example, we have been faced with on a good number of occasions with people in caravans and cabins on halting sites and where there is a disability or someone is very sick, we cannot get the facilities for them and the facilities are not suitable for them. Is there any sort of mechanism for engagement with local authorities, given it is very frustrating? We have a housing crisis and problem right across the board but we have very serious situations where some of the caravans people are living in are just below standard and people have very serious health issues. It is really worrying.
Anne Rabbitte (Fianna Fail)
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I will let Ms Bridgeman come in and answer that question overall later on. Is that okay? We all want the answer to that question so I will bring her in later on as I am conscious I need to move to Deputy Rice next.
Pádraig Rice (Cork South-Central, Social Democrats)
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I welcome the witnesses and thank them for the briefings and documents in advance. I have very grave concerns about the scale of human rights abuses, discrimination and racism faced by the Traveller community. It is not just concerns I have expressed. We heard from IHREC last week and it quoted from the Council of Europe Commissioner for Human Rights who said:
We must confront the injustices experienced by Roma and Travellers. The racism and discrimination we have allowed to persist on a massive scale. This is one of Europe's greatest human rights scandals ... [Traveller and Roma] voices are strong and clear, and we must finally listen to them, respect them, and act on their demands for equality and justice. The time for indifference is over.
That statement from the Council of Europe should be setting off alarm bells in the Department of Health and the HSE. It is also echoed by the UN. The Rapporteur for the Elimination of Racial Discrimination stated that Travellers suffer "the worst discrimination and poverty of any ethnic group in Europe". In particular, in regard to health we saw ten times the level of suicide and a life expectancy that is 15 years shorter for men and 11 years for women. I read through the Department's documents and they listed out lots of strategies, policies and actions but I would respectfully say they are not working. I would like to know, from the Department and the HSE, what has gone wrong and what is going to change.
Ms Siobhán McArdle:
Before I pass over to my colleague Mr. Leach, I will give the Deputy the assurance that the focus and approach of the health policies in relation to Travellers and Roma are aligned to the NTRIS, which is underpinned by the public sector equality and human rights duty. We do take very seriously that human rights-based approach. It is really important that permeates all of what we do, and those values and principles are really core to how we have embarked on that role of coproduction and codesign with those who use and access our services to ensure they are landing, and looking at being effective is very core to what we do.
Pádraig Rice (Cork South-Central, Social Democrats)
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Does Ms McArdle accept, based on the statistics, that the policies and actions pursued by the State over the past number of decades are not working, based on the health outcomes we are seeing?
Ms Siobhán McArdle:
What we have to do is look at incremental improvement. The Deputy is pointing to a piece. T there is absolutely no doubt that we have more to do in building up and strengthening our response to support both health and mental health. As the Deputy's colleagues said today, this is cross-sectoral. This is about addressing factors like housing, employment, education and financial issues that underpin this. I will pass over to my colleague.
Pádraig Rice (Cork South-Central, Social Democrats)
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I will come back in first. I agree with Ms McArdle that we need to scale up and do more. I accept that.
I welcome her opening and the clarity it provides on the spend for each project line by line in terms of the action plans, which is in sharp contrast to some of the other statements we see from the Department of Health. I chair the Oireachtas Joint Committee on Health and we often do not get clarity on how much is being spent. It is remarkable that each line in the opening statement shows us exactly how much is being spent. I would like to see that in other areas of health policy as well.
Does Ms McArdle think the Department is spending enough? What is the core recurring funding for the national Traveller health action plan? Has that increased since 2022? I am referring to recurring core funding, not once-off funding.
Mr. David Leach:
Initially, €10 million was put in place for recurring funding and that was increased by €1 million. On top of that we are now up to €13.6 million so we have gone from having €8.9 million to spend in 2022 to €13.65 million in 2025. To be clear, that is specifically for Traveller health initiatives. Obviously there are mental health initiatives and initiatives throughout the health service that benefit the Traveller community that are not counted in that.
Pádraig Rice (Cork South-Central, Social Democrats)
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To reverse some of those statistics we saw at the start, how much would the Department need to be spending?
Mr. David Leach:
I do not think anyone can answer that. What Deputy Ellis said is absolutely right. If we look at NTRIS and the hundreds of years of discrimination against one community, and Deputy Rice is absolutely right to call it out as a human rights issue, the statistics around morbidity and mortality are not something this country can be in any way proud of. I am fairly confident that all of the answers to all of that are not to be found at the Department of Health, frankly. Lots of them are to be found in different Departments and that is not to abdicate responsibility.
Pádraig Rice (Cork South-Central, Social Democrats)
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With respect, all of the other Departments will say the same. What we would hear from other Departments is maybe, It is not necessarily my problem; it is not my responsibility here" and the buck gets passed on these issues.
Mr. David Leach:
The Deputy will accept, as he said, that we have been very open and transparent about what we are spending and we have detailed it line by line. We are not seeking to say that it is enough by any stretch of the imagination. Of course in every budget cycle we seek to increase funding.
Pádraig Rice (Cork South-Central, Social Democrats)
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What I would like to know is how much Mr. Leach thinks it should be. Maybe he could analyse it and see how much of an increase in funding and services need to improve to tackle those statistics and come back to us. Maybe he could do a piece of work and write to the committee about what the budget should be to tackle these issues.
Pádraig Rice (Cork South-Central, Social Democrats)
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We are not dealing with a standard issue here.
Pádraig Rice (Cork South-Central, Social Democrats)
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That is the problem. We need to accept this is a crisis and these are not standard, proportional budget increases in line with inflation. We are dealing with a really serious crisis. We are dealing with human rights abuses on a serious scale, which are some of the worst in Europe. We need to deal with this through a very different approach from the standard budget line increases. We need to massively increase investment and tackle these issues and to do so in a very serious way.
Action 41 of the national Traveller health action plan talks about exploring the barriers to the recruitment and retention of staff in the primary healthcare for Travellers projects. What work has been done to explore those barriers to recruitment and retention of staff?
Mr. David Leach:
There is an evaluation of the primary healthcare for Travellers projects going on currently that is scheduled to finish next month. These projects are a number of years old now and have been expanded and the hope is we will have the evaluation at the end of next month that will detail the impact of those projects, including on their workforce, a path for future growth and building upon the projects and addressing any deficiencies there.
Pádraig Rice (Cork South-Central, Social Democrats)
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Will it address recruitment and retention?
Pádraig Rice (Cork South-Central, Social Democrats)
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In my remaining couple of minutes, I have some questions for Exchange House.
I thank the witnesses from Exchange House Ireland for their statement and clear call to action. They have been clear about the kinds of things that need to happen around an action plan on Traveller mental health, enhanced crisis supports and suicide prevention. I will put a similar question to them that I put to the Department of Health: how much investment or support needs to be made in order to deliver some of the things they are clearly calling for? These calls need to be heard, acted on and listened to. I wish to hear their perspective on what the Department or the HSE need to do in order to deliver some of the things they are asking for.
2:55 am
Ms Kerry Cuskelly:
To answer that briefly, it requires urgent action. I think Deputy Rice said that it is not the usual incremental action that is needed, but rather urgent action now across government and from a service and interagency perspective. For me, shared ownership is the key piece, rather than everyone suggesting, as the Deputy said, that problems lie with certain bodies or groups. It is about everyone gathering together.
To give credit to the mental health side of the Department, it has gathered together an interdepartmental group on mental health, which is a good first step. Added to that, there needs to be accountability. It cannot be just another interdepartmental group, or group in general, that discusses something and develops a plan, even with the word “action” in it, but nothing actually happens out of it. One of our recommendations with regard to the mental health action plan, which we are genuinely delighted the Minister of State, Deputy Butler, has put in place, is that it needs to have dedicated funding commitments. I cannot give the Deputy a ballpark figure on that, but the Traveller population, in terms of the overall numbers in this country, is not a huge population. However, issues faced by the community are incredibly complex and require genuine, complex and important investment. The numbers are smaller but the issues are greater and there needs to be an acknowledgement of that.
Any systems that are developed across health, education or employment need to be flexible and acknowledge that the way we address the issues are not necessarily the way we address issues for the general population writ large. I suggest that we listen to the people who do the work on the ground. We should listen to the solutions they propose and try to follow through on them with tangible actions.
One of the key pieces in the longer term is that we have an actual diverse workforce. Members of the Traveller community should be sitting here, both in the members’ seats and where I am sitting. They should be working in the Civil Service at assistant secretary level, etc. We need to have a diverse workforce that reflects the diverse culture in our country. That in and of itself will assist with the changes in policy direction but also the potential for policy to be implemented in the longer term.
It is incredibly important to acknowledge that entry into education has many different routes, but they need to be supported. My colleague, Ms Cathleen McDonagh Clark, who is the manager of our education and training service, has done Trojan work in this space over the years in supporting both young and adult Travellers to either re-enter or enter education in the first place, and to move on to mainstream jobs and education, further education and apprenticeships, which in and of itself begets hope and opportunity for families and the community in general. We have countless examples of people saying that because they saw someone else do it, they knew they could do it. We have people working in our organisation who we invest in, support and train. They then can move on to work in other jobs. It is a multilevel response, but it needs a larger amount of investment now for, hopefully, a smaller level of investment in the future.
Malcolm Noonan (Green Party)
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I thank our witnesses. Like other members, what we have been looking at and dealing with in this committee over the past number of months is the root causes of Traveller mental health, but also the systematic discrimination. Certainly, we can talk about hundreds of years of discrimination. The root cause of this current crisis lies in State policy dating back to the 1960s when the issue was around dealing with the itinerant problem. I share the concerns Deputy Ellis has raised because I know from the Traveller families with whom I am working in Kilkenny that things have gone backwards for them. It is just not moving. While one or two individuals break through, get into third level education and move on to do incredible things, the general trend is not going in the right direction. What we are discussing and dealing with today is the end of pipe of systematic discrimination and racism. That is what we have to collectively address, both in here at a political level and as a society. A whole-of-government, whole-of-society approach to this is needed. It has to be dealt with because otherwise we are going to be here again in years to come with the crisis deepening all the time.
I worked in the area of suicide prevention in the past. We developed the first county suicide prevention plan in Kilkenny. We did an immersive piece of work with the Traveller community and it was a good piece of work that led to some similar projects taking place across the country. Fundamentally - we have spoken about it in here - things like the Traveller horse project and so forth are constantly being taken away from the Traveller community. A project starts and then it stops. The stables were knocked and the community centre is gone. There is a high level of frustration with that.
As we are here today trying to find solutions, I am particularly taken by the presentation by Exchange House Ireland. It is an organisation that is doing fundamentally good work. In previous sessions we discussed social care and that diversity in the workforce and I think frontloading extra funding to Exchange House Ireland might be a good start to continue that work. If there is additional funding available, that would be a good start so that we have more Traveller representation in the workforce working with Travellers.
I wish to ask a question about the postvention issue. In some of the work we did with Kilkenny Bereavement Support services, we developed a good piece of work on postvention, that is, after a suicide event. That piece of work allowed Traveller families to have access to services in an unlimited, open-ended manner. Most bereavement support services consist of around ten sessions but these used to go out further than that. As we know, postvention is prevention. If we have good services like that which can be replicated across the country for Traveller families, it can make an immense difference. I refer to the whole challenge around the respect of the funeral and the availability of priests, which is a challenge for us all in the community now. All of those things, such as respecting the religious rights of Traveller families, particularly around a bereavement, can have a positive impact. I welcome a response on that. With modest funding, bereavement support services across the country could be funded to put in place good postvention measures to support Traveller families.
Ms Kerry Cuskelly:
I fully agree. On the postvention piece, with modest investment, there could absolutely be a huge positive outcome, specifically with regard to suicide bereavement liaison services, which exist in some parts of the country but need to be developed with the Traveller community and provided in a Traveller-specific way to support the community when it is needed. Such services need to be delivered in a broad way because families are not necessarily in one place and it may require interjurisdictional conversations, communication and space for that to happen.
It also needs to be a service co-created and accepted by the community. We have experience of that recently in Exchange House Ireland with the development of a co-created youth mental health project, which we were able to do by getting third sector funding to develop an evidence-informed service. We now have some seed funding from the HSE along with the RTÉ Toy Show Appeal to begin to implement that. That service can happen with a reasonable amount of investment. Again, however, there is no longer term commitment. Part of it is knowing that something can be developed alongside people in their own time, so we need reassurance that there will be funding next year, the year after that and so forth in order to be able to support people, build capacity, ensure the community can provide the services they need and work alongside allies and professionals who are non-Travellers. That is the key piece.
We work with other NGOs and State partners in the areas of prevention and postvention and their refrain to us often is that while they would like to offer services to the community, they are not working for whatever reason. The key piece for us is to try to develop or reconfigure a service that might exist in the mainstream but is not meeting the needs of the community for whatever reason. That needs time and it needs to be done at the pace of the community and in the way the community needs it.
We need to trust that Travellers know what they need and then we simply need to do that. This sounds simple but it is incredibly difficult in real life. My main suggestion is that we need to listen to the community and then we just need to do what they ask us.
3:05 am
Malcolm Noonan (Green Party)
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These are recommendations we should try to include in our reporting on this also. In the few seconds I have left, I want to ask two quick questions on the issue of LGBTIQ+ members of the Traveller community. I know there are healthcare supports. Are there supports in place for LGBTIQ+ members of the Traveller community? Are there awareness programmes within the Traveller community on them?
Mr. Tony McCusker:
There are local projects looking at LGBTQ+ and I know there is also a national focus. Recently we had presentation on Travellers who are intersectional with another area and who are finding it even more difficult to access services. In our feedback we are looking to develop pathways for anybody in the Traveller community who needs access to other mental health services.
I want to speak about the suicide bereavement liaison service, which Senator Noonan mentioned, and the community services we have. We are commissioning a suicide bereavement liaison service, which is being established at present. We will work with our NGO partners to employ someone in the Traveller community to lead and spearhead this. This is in recognition of the importance of postvention support with families. We are focusing on suicide prevention through the regional offices throughout the country and they help to develop the community response plans. Taking on board Senator Noonan's point, it did come up in the research that LGBTQI+ is something we do need to focus on for this year.
Ms Kerry Cuskelly:
To respond to the question on the LGBTQ Traveller and Roma population, Exchange House Ireland has been delighted to support a national action group for LGBTQ Travellers and Roma with a number of NGO partners for a number of years at this point. Again, as my colleague Mr. McCusker has mentioned, the point of the group is to ensure the unique and intersectional needs of the community are accepted, understood and acknowledged. I know the group, which meets regularly in our building, is looking to try to support the development of direct service provision to Travellers and Roma who identify as LGBTQ, with the express point being to end the signposting cycle so that people receive the services they need, as opposed to being sent from one person or service to another. There are spaces that exist but, again, with no funding. Essentially spaces such as these have convened because of an urgent need for the community.
Malcolm Noonan (Green Party)
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With regard to general early years healthcare, newborns and vaccination, which were mentioned, are there breastfeeding supports for Traveller women? Are there support programmes for Traveller women on the healthcare side of it?
Mr. David Leach:
The brighter beginnings programme, which was rolled out this year in two health regions, includes breastfeeding supports. It recognises that, as Ms McArdle said in her opening statement, people are not born with a poor health outcome. It is about seeking to address childhood issues. It has received funding and there is another €500,000 for next year to roll it out to two further health regions. It is hoped that in the following year the last two health regions will be covered to address some of these issues.
Anne Rabbitte (Fianna Fail)
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I will now move on to Deputy Cullinane.
Anne Rabbitte (Fianna Fail)
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Oh no, sorry, I am thinking of your colleague. Apologies.
Maurice Quinlivan (Limerick City, Sinn Fein)
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You are grand. It is fine. I was going to give you a bye on it.
I thank the witnesses for their presentations, which I found very useful. I had read them before the meeting started. I welcome the people in the Gallery from Exchange House and Pavee Point, who are here to witness the work we are trying to do in the committee, as we try to do every week. I have a couple of questions but I want to start by expressing not surprise but shock at the suicide rates for Travellers. It comes as no surprise but it is shocking to hear it is ten times the national average and 15 times the average for females. It is absolutely shocking. Some of the language we use ourselves could be wrong, when we speak about incremental improvements. When we are talking about figures like this, as one of my colleagues said to me, we need some sort of direct and decisive intervention to see what we can do to arrest them.
My first question is for Exchange House and it is about the models in Offaly, west Cork and Dublin that were mentioned in the opening statement. I ask the witnesses to expand briefly on what these services do. I know this was also mentioned in the opening statement but if Exchange House had the funding ready, where would it go next if it could?
Mr. John O'Brien:
No, they are still there but they are independent of us. We have a multidisciplinary team of five, comprising a social worker, a family support worker, a psychotherapist, a peer support worker and a community development worker. This gives us a broad scope of professions and people within the service. The majority of presentations, at just over 50%, are accommodation related. They are not mental health presentations but they encompass supporting all aspects of a person's life. A huge amount of advocacy work is done as well. It all comes from a model of relationship-based services that support people in one aspect of their lives to allow them to deal with issues that have a significant amount of stigma or a significant amount of trauma attached to them.
This, by and large, is the approach in terms of the professions and the model that is there. We apply a trauma-informed lens to all aspects of the service. We talk about having a model whereby everything is under one roof, including education, youth, a family support service and a crisis intervention service. This allows us to access other areas of care and support in a person's life which we feel are critical. This is the scalable model we are speaking about. It does not necessarily need to be delivered by us but it can definitely be replicated.
Maurice Quinlivan (Limerick City, Sinn Fein)
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The Department of Health's opening statement spoke about the National Traveller Health Action Plan 2022-2027. Has there been a temperature check in terms of how successful this has been to date? If so, are there key metrics the witnesses can share with us? Mr. Leach said there are 42 actions in the plan and 42 are under way. I ask him to correct me if I am wrong.
Mr. David Leach:
I will ask my colleague Ms Bridgeman to pitch in on this. There are 45 actions and 44 of these have commenced. Three are completed, 28 are in progress, nine are in the earlier stages of progress and four are at a preliminary stage. From 2022 to 2027, in fairness to the team looking after it, there is a plan for each CHO, which is important. It is all done in partnership, supporting mainstream services to facilitate Traveller inclusion. Travellers are included at national level and local level. I will now hand over to Ms Bridgeman to speak about the on-the-ground experience.
Ms Maria Bridgeman:
I thank the committee for this opportunity. The Traveller health action plan has been significant for us. We have a Traveller health implementation group. In each of the former community health areas we have developed an action plan to deliver on the specific actions. We also have Connecting for Life, which connects to the overall plan. It is very important in the discussions today to acknowledge the 350 Traveller community healthcare project workers, who work with all of this day in, day out. At the end of the day, they are the most important people in all of this. As has been said already, we need to listen to what Travellers want and what they say to us.
We also need to acknowledge and accept the barriers these people face in accessing our mainstream services. The action plan focuses on how we support them and overcome the barriers. As Mr. Leach said earlier, there is a review of all those projects that will help to determine how they will be sustained and supported going into the future. We appreciate the funding we have received since the plan was launched across the country. Approximately 31 projects are in place. Each area is doing projects that are somewhat different to meet the needs of that area.
Education was mentioned earlier. In the mid-west in particular, we have supported people to develop in education. One member commenced a master's degree in sociology, while others have received other educational attainments. They are the people who really matter because they are the people who can either bring their families and communities to mainstream services or tell us where we need to target specific services to help them. When we recently got funding in the mid-west, we were able to start up an additional project in east Limerick. We were able to enhance the project in Nenagh as well. The east Limerick project with our Ballyhoura partners involved a suicide prevention and positive mental health education programme. There was significant attendance of men at that. We are also working with Exchange House in delivering a counselling service in north Tipperary. They are some of our projects. It is important to say that recently this year, we got our community mental health teams to engage with the five primary healthcare projects so that they could hear directly from people in the Traveller community about what makes it difficult for them to access the services. Our services can then change or at least adapt to support the need of the Traveller community. Fear is certainly one of the barriers.
3:15 am
Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank Ms Bridgeman but I am running out of time.
Anne Rabbitte (Fianna Fail)
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The Deputy is okay. I think Ms Cuskelly would like to give him a response as well.
Ms Kerry Cuskelly:
In very practical terms, where we would like to be able to see things move forward next is for us to be able to support the service we provide to exist nationally. It does not have to be us running it, as Mr. O'Brien said. We are not very precious about that piece. We are happy to provide a service directly nationally or support services and people locally to do that but we need to do it by ensuring mainstream services reach out as well as the community being able to receive a service it needs. We have a workable model and would like to be able to support it so it can exist nationally.
Maurice Quinlivan (Limerick City, Sinn Fein)
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Going back to the action plan, I spoke about a temperature check. Mr. Leach spoke about 45 actions, 44 of which are on the way. Could we get a written report on that?
Maurice Quinlivan (Limerick City, Sinn Fein)
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Under part five it addresses the social detriments of health through targeted and mainstream measures. Mr. Leach mentioned drug and alcohol use being prevalent in the Traveller community. What specific measures are being taken to address that? I speak as a director of the local drug and alcohol forum in the mid-west region. What measures are we taking to limit the misuse of substances in the Traveller community? Have there been any specific or measurable tangible outcomes of that?
Maurice Quinlivan (Limerick City, Sinn Fein)
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Surely if witnesses are coming to the committee, somebody would have expected a question on substance abuse. It is disappointing. We are talking about mental health and dual diagnosis.
Ms Siobhán McArdle:
Dual diagnosis is a really important specialised service for people struggling with addiction and mental health issues concurrently. All of our mental health services are attuned to addiction issues but when somebody has more significant issues, we know that dual diagnosis services, which are multidisciplinary teams that work with our local community mental health teams, are really important. Over the past number of years, we have put in funding for specialist dual diagnosis teams around the country with a focus in Dublin on youth dual diagnosis services. Regarding the data on the other locations involving dual diagnosis, I might pass over to Ms Bridgeman, who has on-the-ground experience.
Ms Maria Bridgeman:
We commenced our dual diagnosis teams earlier this year. It will be a game changer when it gets going completely because it is dealing with people who have addiction and mental health issues. We also have a focus on addiction in social inclusion. We have an excellent social inclusion team. While it is a mainstream team, it is very mindful of ensuring there is access for those other groups.
Ms Kerry Cuskelly:
Exchange House has worked in partnership with the Irish Prison Service and the Probation Service for over 18 years, albeit without any service-level agreement or funding attached. However, we have worked with them for many years. We deliver weekly social work and addiction clinics in a number of prisons, including one for women in the Dóchas Centre. The clinics provide emotional and practical support, advocacy relating to Tusla, support with accommodation and social welfare, individual counselling, EMDR trauma therapy, relapse prevention work and culturally specific group work. We have two part-time addiction counsellors funded through our local drugs task force, which is gratefully received. One of our addiction counsellors supported and co-developed the first Traveller-led crack cocaine recovery programme, which is called the crack cocaine health-led approach programme and has been rolled out a number of times in the Dóchas Centre. We will continue to do that. On the ground, because of Exchange House no wrong door policy, we will work with everybody no matter what issue they present with, be it mental health, addiction, etc.
Maurice Quinlivan (Limerick City, Sinn Fein)
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We are opening the new service in Limerick, which we hope will be a game changer in the region not just for Travellers but for everybody.
Anne Rabbitte (Fianna Fail)
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I think the committee should visit one of these 31 projects to get an on-the-ground opportunity to see them in operation within the communities. Perhaps there might be a timely opportunity there.
Tony McCormack (Offaly, Fianna Fail)
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I thank the witnesses for coming in today, for their opening statements and for sharing their experiences of what is happening around the country. We think about all the other groups that have appeared before us. Mental health and particularly suicide are significant issues in the Traveller community. If we listen to advocates or people who speak for the Traveller community, I am thinking of the actor John Connors, a great man who advocates for the Traveller community when he is on the airwaves. He talks about his life and what has happened in his family. Between his direct family, cousins, aunties and uncles, over 30 people have died by suicide. It is a horrific thing to say in modern-day Ireland that a particular community has such a prolific rate of suicide. How much would the Traveller-specific mental health service that is proposed cost and how long would it take to embed it into all the communities right across the country?
Ms Kerry Cuskelly:
How long is a piece of string is the first reply, without being glib. In the grand scheme of things, I do not think the investment would be huge in terms of the overall health budget. As we said, one of our main pieces of funding for the mental health service because of its beginnings in the suicide prevention field is through the National Office for Suicide Prevention, which is the region of €300,000 or €400,000. That is for a very specific piece of work within the Dublin region with a very small team.
If we multiply that across the country to align with the health regions, we will have the bones of something to work from and we could then consider how to develop it outwards because obviously that is a specific suicide prevention service. If we were looking at youth mental health, general adult mental health and supporting people in a more specialised way, and if we were talking about the dual-diagnosis piece, that would all create a need for slightly more funding to build capacity. In the grand scheme of things, if we are looking at a health region approach, having six regions and having a team of, say, five in each region, that is a reasonable investment.
On how long it would take to implement, genuinely we have to come back to what the local Traveller community needs, what services they actually need first, and primarily how they need those. We have to be able to spend the time to invest in capacity building, training and education so that we can genuinely and meaningfully employ members of the Traveller community to provide services to their own community. We should have Traveller social workers right across the community on mental health teams. We should have Traveller occupational therapists, nurses, doctors and psychiatrists, etc. That should be the case in order to provide culturally appropriate services alongside non-Travellers. That is obviously a longer term plan but it is something we should aim towards. As a cross-departmental piece that is a longer-term aim. In the shorter term, we could at least consider, every two years, adding a region and looking at supporting capacity building and embedding, etc.
3:25 am
Tony McCormack (Offaly, Fianna Fail)
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I agree that it is a cross-departmental process.
Anne Rabbitte (Fianna Fail)
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Ms McArdle wants to answer that question as well and that is the vision.
Ms Siobhán McArdle:
We are going to share the vision now. First, I wish to note that the national mental health policy is a stepped policy. We look at the population level, at prevention and at developing mental health literacy and awareness. The measures that some of our NGO colleagues are doing are about working with communities and with the primary healthcare projects to raise awareness because it is really important for people to talk about their health and well-being. Coming in at the level of primary care when people are experiencing difficulty is important. All of those measures like counselling and access to culturally appropriate and specific counselling are really important. The next layer is the specialist community mental health teams. It is important that we have pathways into those. We do not propose that it might be appropriate to have specialist separate Traveller mental health services all the way up but we need our services to be culturally attuned. We need the Traveller community to be part of the discussion on how we design and implement those services. We are delighted that we have a Traveller health action plan to support that work and ensure our policy is fit for purpose.
Second, it is important to say that our Connecting for Life suicide policy is underpinned by evidence. This means that in order to intervene effectively to prevent or reduce suicide we need to know the factors that cause it and what will work best. In 2025, the National Office of Suicide Prevention funded a national monitoring system for deaths by suicide. That is really critical in helping us to learn and understand the factors that underpin suicide and how to do the right things to intervene to prevent. We know that postvention, which we have spoken about today, is a critical part of it because we know that families and communities who are affected by suicide are more likely to be at risk. It is really critical that our counselling services, our resource offices for suicide prevention and our partners, like Exchange House, are on the ground and available to communities who are struggling with this issue.
Tony McCormack (Offaly, Fianna Fail)
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I agree that we definitely need, as was said by some of my colleagues here, a cross-departmental process because without that it is not going to happen. Rather than go through all the processes and taking time, we need to have this done an awful lot of quicker than what would normally happen within Departments because, as I said, it is an awful indictment of this country that we have a specific ethnic minority who suffer more from mental health issues than any other sector in society.
Mr. John O'Brien:
On the surveillance piece, it is something that we have gathered since 2023. It is another piece of work that we have been doing without a formal agreement or service level agreement. Our partners in the National Office for Suicide Prevention have been extremely helpful with that. To paint a picture for the Deputy, we are still at a preliminary level of analysing the data. Based on the whole Traveller population, the suicide rate was 97 deaths per 100,000. That is a male suicide rate of 130 per 100,000 and a female rate of 66 per 100,000, compared with ten among the general population. So what needs to come from today's discussion is absolute urgency. I think Deputy Rice said that this is not a standard issue. This is far from a standard issue. We saw how we were able to respond when Covid hit and a number of fantastic Traveller groups have started out of that. In Deputy Quinlivan's constituency in Limerick, there is the Limerick Traveller Network. That network started up as a group of women who wanted to provide supports to their community and it is now a funded group that is about to become its own independent organisation. Yes, we have statistics but they represent people's lives. There is a whole piece around that which urgently requires the leadership of this committee to bring Departments and sectors together to work on housing, employment and justice - right across the board.
Dessie Ellis (Dublin North-West, Sinn Fein)
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We are talking about services that are provided Monday to Friday from 9 a.m. to 5 p.m. but there are no services on weekends. Is that lack of services being looked at in some way? It needs to be addressed because people's mental health on weekends is worse than any other day of the week, in my experience.
Mr. Tony McCusker:
With the HSE mental health services, and especially with the working group that Mr. O'Brien and I are on, we have sampled to see what is the difficulty in the Traveller community accessing mental health services. I think the Deputy tapped into it, but years of historic institutional abuse have made the Traveller community wary of statutory services and the HSE. We are looking at a two-pronged approach. First, how can we make our services more appropriate and more culturally appropriate, and how can we have further reach into the community? Second, how do we bridge that gap and enable and empower our community development workers, and the very strong community networks that Travellers have, to navigate the systems to get to where they need to be?
We are looking at the expansion of core services across the weekend. We are looking at developing a crisis response model of care, which would involve setting up crisis response teams and Solace cafés into which people can drop and to which GPs can refer people. We are also investing in suicide crisis assessment nurses who will work with GPs and see anybody who is experiencing a mental health crisis. We have employed two suicide crisis assessment nurses specifically for the Traveller community. We have funding for another two this year and that number is building into, I think, 16 nationally. We would expect those Traveller-specific nurses to work with the other suicide crisis assessment nurses in the SCAN service to provide a bit of governance where a Traveller presents outside that area.
Anne Rabbitte (Fianna Fail)
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Before the Deputy finishes, I wish to remind him that I interrupted him earlier and he ran out of time.
Anne Rabbitte (Fianna Fail)
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Ms Bridgeman was going to answer, for the benefit of all of us here, a very specific and pertinent question on housing that arises every single week. How do local teams integrate with local authorities?
Ms Maria Bridgeman:
It is a mixed view or practice around the country. Certainly in the mid-west we have a really good relationship with local authorities. While we do not necessarily have any specific programmes going with them in relation to Travellers specifically, from time to time if there are pieces of work that we need to work on together we actually do that. I acknowledge that there is cross-departmental and cross-partnership work that needs to be enhanced and developed further in terms of responsive services for Traveller groups. We have, certainly in the mid-west, a very good relationship with our local authority. They would provide support or we would go to them at different times if there was a particular need for somebody around a health reason or whatever. That is there.
3:35 am
Anne Rabbitte (Fianna Fail)
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I have not asked any questions and I would like to use a bit of my time to ask questions that might not have been asked. I recognise that we have a Minister of State responsible - my good friend Deputy Butler. I think it is openly known we are good friends. I say that in total transparency. There are the Minister of State, Deputy Butler, the Minister for Health, Deputy Carroll MacNeill, who has primary care, and the Minister of State, Deputy Murnane O'Connor, who is responsible for drugs policy. Ms McArdle gave a very clear answer. We have a ring-fenced budget for primary care of €10 million, which is going up to €13 million. The base is €10 million. How much from the Department is ring-fenced for Traveller mental health? How much is ring-fenced from the drugs budget of the Minister of State with responsibility for drugs, specifically for Traveller mental health? It is a black and white question.
Anne Rabbitte (Fianna Fail)
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How much is specifically for Travellers' mental health?
Anne Rabbitte (Fianna Fail)
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The co-mobility piece sits with Deputy Butler.
Ms Siobhán McArdle:
The dual diagnosis. In terms of our core overall, I think close to €6 million per annum goes specifically to Traveller initiatives. If one looks at the staff funded, for instance the Traveller mental health co-ordinators in every CHO, that staffing has an associated cost. It is a part of our budget that is very specifically to support and address Traveller mental health.
Anne Rabbitte (Fianna Fail)
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I am sorry to cut across. I feel I am getting two different answers. The first answer Ms Hargis gave was €1.4 million because Deputy Butler added to it this year specifically for Traveller mental health. There is €13 million sitting beside her with Mr. Leach with €10 million in the base. Then, Ms McArdle said €6 million. I am just trying to follow the money that is specifically for Traveller mental health.
Ms Siobhán Hargis:
It might be easier for us to come back with a table to set it out. Some of the money I cited is the new development money since 2023 and there is also historical money in the base, for example for the co-ordinators. There is newer money. There is a phasing over many years. Dual diagnosis teams are funded through Deputy Butler's mental health budget but on occasion in some teams there is matching of money through social inclusion. It might be useful to set it out in a table.
Anne Rabbitte (Fianna Fail)
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It would be great if the witnesses could provide it. I have no doubt there are people looking in who would like to see a breakdown of the money. I got a clear answer on primary so I do not need to go there again. How much of that money is then disbursed to NGOs? If I was to ask Ms Cuskelly about her SLA in relation to the funding her organisation received, is the SLA predominantly with the mental health team, with primary care or with drugs? Who is funding her organisation? Are there different arrangements?
Ms Kerry Cuskelly:
We have many different funding arrangements because we provide services across the lifespan. For mental health-specific, our funding comes in the main through the national office for suicide prevention. The core I referred to a number of times, between €300,000 and €400,000, is for the core team.
Ms Kerry Cuskelly:
This year, we are very grateful and delighted that we got a commitment of €100,000 for the start of the implementation of our national youth mental health service. We have adverts for two jobs going out today to begin that process. We will implement it in three regions from next year on, the idea being that it moves outside of the Dublin region because we provide most of our services within the Dublin region. The key piece is that is a specific amount for one year. The commitment or reassurance that that will continue longer term is one piece but also the amount needed will grow per year and also if we are going to provide a service on a wider scale than three specific regions. The core is between €300,00 and €400,000 and there is the addition of the €100,000 from Deputy Butler for the youth mental health piece.
Anne Rabbitte (Fianna Fail)
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How many NGOs specifically related to Traveller mental health do we support? It is through the HSE. How many does the HSE fund?
Mr. David Leach:
The 31 primary healthcare Traveller projects are all section 39 organisations. The majority of the funding goes through NGOs and HSE staff.
Anne Rabbitte (Fianna Fail)
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That answers that. Are those projects permanent? Are they in the base?
Anne Rabbitte (Fianna Fail)
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My next question relates to expansion. There is a need for standardisation of expansion. How does the Department or the HSE advertise? There are 31 projects. Why did they not put something at the centre to ensure standardisation of delivery across youth and, for example, breastfeeding, which Senator Noonan brought up? How do we capture the data and standardise across the entire country?
Mr. David Leach:
-----projects. The aim is to look across them, see what they do and set a framework for measuring them. We love measuring and counting stuff. It is very important that we have national standards but, as has been said many times, we have to do this in partnership with local communities and the people involved. What will work in one place will not necessarily work somewhere else. The Cathaoirleach Gníomhach will know from her own experience in delivery of healthcare that there are often pockets of excellence and we would love to see them replicated. I hope that richness will come out and we will be able to do that. I also hope we will not be imposing solutions that are inappropriate in communities who may feel there is a better way for them to do something. It will not be a case of one size fits all. The evaluation is due to us in December. That will provide us with a framework and we can then measure that and see the impact.
Anne Rabbitte (Fianna Fail)
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We would love to see what good looks like. I think that is what the committee is craving.
Ms Kerry Cuskelly:
On the development of services, we rely fully on philanthropic, outside-of-State supports to develop the evidence so that we know what we would like to provide as a service and forward to the implementation. This specific piece will look at the youth mental health project. We developed that because we were very lucky to receive "The Late Late Toy Show" appeal funding so we could develop a co-created, very practical service to be implemented with Traveller youths and their families. With that evidence, we now have the commitment for funding to implement it. Funding also needs to be ring-fenced for the genuine development of evidence-informed services, which my colleague referred to.
Anne Rabbitte (Fianna Fail)
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On Traveller women's health, under the previous Minister, Stephen Donnelly, €37 million was ring-fenced for the development of women's health nationally. To see that €500,000 was left aside for Traveller women's health seems disproportionate. That is just a comment. From a policy point of view, we all understand co-production, co-design, co-involvement and across-government. Sometimes, when you interchange that language, it does not become very clear other than it is only the Department of Health involved. That is my take - the co-production. In respect of co-production, when the Department is developing or expanding its policy, how does it include more? Where does it go? Who does it include in the co-production? That was part of the opening statement.
Ms Siobhán McArdle:
To give an example of our strategy on Connecting for Life, which we have just concluded, we are evaluating and developing the next strategy, which will be due out shortly. Co-production involves getting the voices of those who have been involved in or received those services to tell us how they are working. It is about the voices of the lived and living experience and those who access services telling us what better would look like.
We have undertaken a very large public consultation. That is going out very broadly to the population at large. In fact, we had one of the largest response rates with nearly 2,000 people responding. That is a mix of individuals and organisations. We also held targeted discussions, supported by partners who will facilitate discussions with people who are affected by suicide or if they are in priority or minority populations. We engaged with the Traveller community in the evaluation. All of those voices come together and we have an expert panel and we reference all of these words. When we draft a policy, we look for feedback on that as well. With any policy, we ensure we have regular evaluations. Implementing it is important in partnership and having points in time where we stop, measure, reflect and then adapt that approach to ensure it is delivering.
3:45 am
Anne Rabbitte (Fianna Fail)
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Is it done via a roadshow or how is it done? How are the voices collected? Does the Department go to every one of the regional health authorities? Does it go to every county? Literacy is a problem within the Travelling community. How do we communicate with them and ensure their voices are heard?
Ms Siobhán Hargis:
With Connecting for Life, there were a number of written responses so we made sure we had a very accessible, public campaign. We had a number of written responses. We then held a number of in-person events in Dublin but we also held online events as well to which we invited stakeholders. We also asked NGOs and charity partners to invite their own members to attend these meetings as well. It was not just the CEO or the administration of an NGO but they brought representatives they work with as well.
We specifically reached out and targeted groups to ensure we got as broad a scope as possible as part of that consultation. We will use the feedback from those to help develop the policy. It is important to state that level of engagement should not just be at the start of the policy but as the policy is stood up and implemented as well. We should ensure the voice of lived and living experience is part of implementation structures. For example, under Sharing the Vision, the establishment of a reference group of lived experience ensures that policy implementation is overseen from a lived experience and coproduction viewpoint as well.
Pádraig Rice (Cork South-Central, Social Democrats)
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I will pick up on a couple of points. The point about LGBT Travellers that Senator Noonan raised is important. There is a national action group for LGBT Travellers and Roma rights. To declare an interest here, I used to work with LGBT Ireland, which is one of the organisations involved. That action group has done a number of important things, including producing some really solid research unveiling inequality and the experiences of LGBTI Travellers For those who have not looked at, I encourage them to look at that research because in it, they can directly hear the voices of LGBT Travellers and their own experiences. It is worth looking at. It also does other things and publications like a calendar. I encourage people to put up those calendars for a bit of representation and visibility for the community and it attends Prides. It might be a session we look at in the future about that intersectional approach.
On the prison point that Exchange House mentioned, I visited Cork Prison last week. I met with the governor and toured the prison. I was quite impressed by some of the work they are doing with Travellers. Some of the Travellers in prison did some literacy work and produced their own publication about their own culture as well work on literacy. It was an interesting initiative and they had their own resource room. The experiences of Travellers in prison might be something we look at in the future and explore further. We have heard about issues on access to services and we need to remember there are no hard to reach people; there are hard to reach services. That is a refrain we should have when thinking about services and accessing those.
Anne Rabbitte (Fianna Fail)
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SCAN nurses were mentioned. The recruitment has started but they are not in place in Portiuncula yet? For clarity, they are not in place?
Anne Rabbitte (Fianna Fail)
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Are they only being recruited at the moment?
Anne Rabbitte (Fianna Fail)
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Finally, is there anything the witnesses would like to add that they have not had the opportunity to add? I am conscious there are two people sitting here who have not spoken. Ms Kitching and Ms McDonagh Clark have not spoken. They have taken the time to be here so if there is anything they would like to contribute so we can hear their voices as well, I would appreciate it.
Ms Cathleen McDonagh Clark:
I am a member of the Travelling community and I am passionate about education. It opens doors. I am passionate about my community. There are an awful lot of strong, intelligent people out there. We must remember that education and intelligence are two different things. Those people are out there; they are just waiting to be asked. This is a vision. This is our opening message. Exchange House Ireland is a QQI accredited education and training centre, working in the heart of the Traveller community. We deliver nationally recognised programmes that help people progress into employment, apprenticeships and further education, supporting successful integration into the mainstream. We do not work through segregation. We create quality programmes that make sure people get back into the mainstream.
We have huge ambition and strong access to the community but limited tutor resources. This limits how many people we can reach and it is the learners who feel the most impact. With proper investment, anybody can deliver a quality service that changes lives and it is a win for everybody: the person, society and the community. Our approach is trauma-informed, person-centred and universal design for learning, UDL, practice and principles. We provide wraparound supports for learners facing homelessness, financial stress, mental health or any kind of health challenges. We are trusted within the community. Learners come to us because they feel safe, supported and believed in. Every programme aims at progression and employability, helping people to take the next step forward.
Our next step is that we are developing a QQI level 5 employability and progression skills programme. We are lucky enough that we have been able to re-engage with QQI. It is very important that we create programmes that are of a national standard and can provide access to help learners build confidence, skills and qualifications that open doors to work and further study. It will bridge the gap between community education and mainstream opportunities. Investment matters because funding Traveller education is not a cost; it is a long-term saving. When people gain skills and confidence, they move into work, reduce welfare dependency and strengthen their communities.
On the human story and why we do this, we asked a group of learners yesterday what jobs would they like to do. They said security, construction and driving. Then we hauled them up and we asked what is your dream job? They said politician, to manage a football team and be a solicitor. There is a difference. That is what education does. It opens doors to dreams. Our learners do not lack ambition; they lack opportunity. With investment, we can turn those dreams into real futures.
As a closing message, we are proud to deliver quality education where people are at in the heart of the Traveller community. Funding education at community level, with the aim of supporting learners to progress into mainstream, is key to long-term inclusion and success. Funding Traveller education at ground level is where it works best. With the right resources, we can continue and empower people, strengthen communities and build a generation that sees education not as a barrier but a bridge to opportunity. That is where my passion lies.
Mental health is not something that grows in isolation. Ultimately, it is a cry for help. It is stress-driven. If a stitch in time saves nine, we need to invest but we also need to have the Traveller community at the heart of all we do. That is how it will work and that is a great role model for a Traveller. I have worked in Exchange House for the past 20 years. I am a senior manager of education. I have driven the service and the vision. This all comes from the people we work with. They are the ones who guide us.
Anne Rabbitte (Fianna Fail)
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I thank Ms McDonagh Clark very much for her contribution. We really appreciate it.
Ms Aileen Kitching:
I thank the Chair and the Deputies. We have talked about social determinants of health. So much of what we experience as health and health outcomes is influenced by those determinants, perhaps by 50% or 60%, much more than what we do in our hospitals and healthcare facilities. That is why we need a whole-of-government approach to this. When we talk about social determinants, we talk about education, housing, overcrowding, precarious employment and discrimination. It is not just a whole-of-government approach, it is a whole-of-society approach we need as well. It should not just be alarm bells for the HSE and the Department. The health inequalities and mental health inequalities that are experienced by the Traveller community should be raising alarm bells for all of us.
To address it, we need mainstream measures and targeted measures. We need both or what Michael Marmot calls "proportionate universalism" where we have universal measures for everybody but also measures that are proportionate to the level of disadvantage, so they are extra targeted measures.
That is what we are trying to do through implementing the Traveller health action plan. There are things in it for mainstream services that we reckon need to improve and be more culturally sensitive and accessible. There is lots we can do to support services to be more inclusive. We need some targeted measures where mainstream services cannot deliver or cannot deliver initially and then we can have a targeted measure with a view to mainstreaming services eventually. However, we also need to measure what we are doing and that is where we are very challenged at the moment in being able to capture what we are doing. We know there are health inequalities with measurable differences in outcomes for Travellers in our society and we know they are unfair, systematic and avoidable but we cannot necessarily quantify them. A lot of the information we have is from previous studies such as the all-Ireland Traveller health study or surveys or pieces of research that are done so we need to be able to systematically measure access, participation and outcomes in all of our health services in a standardised way so we have something that is directly comparable for service to service and then we can see how we are doing. That is one of the challenges we face at the moment.
To come back to the question about working with local authorities, in public health in the HSE we have worked with the local authorities and we did a lot during Covid. Covid, as an emergency, gave us more of the clout to do that and to call them to the table. We were asking people who were living on halting sites to isolate when they had no space to isolate; to follow hand hygiene measures when they did not have running water and not to leave their homes when they did not have refrigeration. There were families on the roadside in Galway, where I was working, who did not have safe, clean running water, did not have access to proper sanitation and needed a whole different level of support during the pandemic. That is where our primary healthcare projects came in. They are the backbone of what we do in the health service. They enable so much of what we do. They are the voice of the community and it goes back to nothing about me without me. It is about partnership work. That is what is so important to bring forward. We talked about coproduction but it is the partnership working; it is that kind of respectful dialogue, the sharing of ideas and the listening, and then developing things together. Some of our services are really good at doing that. We see it in the national screening service. It has a mainstream approach in that it has an equity lens on everything and then it has specific targeted projects with Travellers and with other minority ethnic groups. It has community champions projects, it works directly on specific issues to improve uptake of our national screening programmes, for example, and our immunisation colleagues do similar work. It is really focused work but also mainstreaming.
3:55 am
Anne Rabbitte (Fianna Fail)
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Am I not glad I asked the two ladies to speak? I am conscious of the time and of the witnesses giving so much of their time. We are here over two hours. We have asked a lot of questions and we got a lot of very valuable feedback. It is also important as politicians, and for myself, to see that the budgets are growing but it is about collaboration, co-operation and the direction of it. At the same time, we also have to have a vision on how to step forward.
I just ducked into the Chair today thanks to the support of my colleagues. I thank everyone who has been in the Gallery, the cameras do not see them, from Pavee Point and Exchange House and the contributors today. Deputy Connolly said at the start that there might need to be a follow-up on this. We should do that but I thank all those who have contributed today.