A qualitative study of the perceptions of mental health among the Traveller community in Ireland

Inequality in Health Care and the Experiences of Women From the Irish Traveller Community

OBJECTIVE

To explore the health care experiences of women from the Irish Traveller community, which is an indigenous ethnic minority group in Ireland and Great Britain.

DESIGN

A descriptive qualitative methodology underpinned by naturalistic inquiry was adopted.

SETTING

Halting sites where the participating Traveller women permanently reside.

PARTICIPANTS

The sample consisted of 24 women from the Traveller community in Ireland.

INTERVENTION/MEASUREMENT

Data were collected via two focus group interviews using semi-structured interviews. Inductive content analysis was used to analyze the data.

RESULTS

Three overarching themes emerged: Conceptualizing What It Means to Be in Receipt of Health Care; Respecting Ethnic Customs Around Death and Dying; and Strategies for Enhancing Cultural Competence. Women from the Traveller community experienced many challenges when requiring health care services. Some recalled a health care environment that lacked compassion and was discriminatory toward them. A lack of dignity and privacy afforded to women during the "passing" of a loved one was an important finding in this study.

CONCLUSION

Strategies to improve Traveller women's access to and engagement with health services are urgently required. These include cultural awareness training for health care providers and visual aids for Travellers accessing health services.

Using an Intersectional Approach to Explore the Lived Mental Health Experiences of Traveller Men Affected by Suicide in Ireland

Rates of suicide are seven times higher among Traveller men, an Indigenous ethnic minority group in Ireland, compared with non-Traveller men. Several factors are implicated, including racism, social exclusion, discrimination, inadequate accommodation, unemployment, and lower educational attainment. Systemic and cultural barriers inhibit Traveller men from seeking support. This study addresses a gap in the literature by exploring the lived mental health experiences of Traveller men affected by suicide. Semi-structured interviews (n = 13; aged 19-50) were conducted with Traveller men affected by suicide. Interviews were recorded and transcribed verbatim. Thematic content analysis was used to analyze the data, which yielded three broad themes. Theme 1, "key determinants of Traveller men's mental health," describes the impact on Traveller men of issues relating to accommodation/homelessness, education, and unemployment, as well as frequent exposure to prejudice, discrimination, and racism. Theme 2, "contemporary Traveller masculinities," considers how Traveller masculinities were shaped by a patrilineal tradition and by historical/ongoing tensions related to their ethnicity. Theme 3, "navigating support seeking and coping with distress," encapsulates both resistant and proactive approaches used by participants to manage their mental health. The intersection of structural inequalities, internalized racism, Traveller masculinities, and strong historical associations between stigma and mental health/suicide within the Traveller community lies at the heart of the heavy burden of suicide carried by Traveller men. Findings provide a deeper understanding of the sources of distress and pathways to resilience/recovery among Traveller men affected by suicide and can inform the development of more gender- and culturally appropriate suicide prevention interventions.

Can routine data be used to estimate the mental health service use of children and young people living on Gypsy and Traveller sites in Wales? A feasibility study

INTRODUCTION

Gypsies and Travellers have poorer physical and mental health than the general population, but little is known about mental health service use by Gypsy and Traveller children and young people. Finding this group in routine electronic health data is challenging, due to limited recording of ethnicity. We assessed the feasibility of using geographical markers combined with linked routine datasets to estimate the mental health service use of children and young people living on Traveller sites.

METHODS

Welsh Government supplied a list of Traveller site postcodes included in Caravan Counts between 2012 and 2020. Using spatial filtering with data from the Adolescent Mental Health Data Platform (ADP) at Swansea University's SAIL Databank, we created a cohort of Traveller site residents aged 11-25 years old, 2010-2019. ADP algorithms were used to describe health service use, and to estimate incidence and prevalence of common mental disorders (CMD) and self-harm.

RESULTS

Our study found a subgroup of young Gypsies and Travellers (n = 802). We found no significant differences between our cohort and the general population for rates of CMD or self-harm. The rate of non-attendance for psychiatric outpatient follow-up appointments was significantly higher in our cohort. Rates were higher (but not statistically significant) among Gypsies and Travellers for measures suggesting less well-managed care, including emergency department attendance and prescribed CMD medication without follow-up. The small size of the cohort resulted in imprecise estimates with wide confidence intervals, compared with those for the general population.

CONCLUSIONS

Gypsies and Travellers are under-represented in routine health datasets, even using geographical markers, which find only those resident in authorised traveller sites. Routine data is increasingly relied upon for needs assessment and service planning, which has policy and practice implications for this underserved group. To address health inequalities effort is required to ensure that health datasets accurately capture ethnicity.

Presentations of self-harm and suicide-related ideation among the Irish Traveller indigenous population to hospital emergency departments: evidence from the National Clinical Programme for self-harm

PURPOSE

Previous research has examined the suicide risk of the Irish Traveller population, but less is known about self-harm and suicidal ideation among this ethnic minority group, which are established risk factors for suicide. The aim of the current study was to compare the presentation-based self-harm and suicide-related ideation of Traveller to non-Traveller patients and describe any ethnic disparities in the aftercare of their presentation.

METHODS

Data were obtained from the service improvement database of an Irish dedicated national programme for the assessment of those presenting to emergency departments (EDs) due to self-harm and suicide-related ideation. Presentation data from 24 EDs were analysed and Poisson regression was used to assess the age-sex-adjusted relative risk of hospital-presenting self-harm and suicide-related ideation.

RESULTS

24,473 presentations were recorded with 3% of the presentations made by Irish Travellers. Female Traveller patients had 3·04 (95% CI 2·51-3·68) higher risk for suicide-related ideation and 3·85 (95% CI 3·37-4·41) for self-harm, compared to white Irish female patients. Male Traveller patients had 4·46 (95% CI 3·86-5·16) higher risk for suicide-related ideation and 5·43 (95% CI 4·75-6·21) higher rates for self-harm. The highest rate ratios for self-harm were observed among older Traveller patients [male: 9·23 (95% CI 5·93-14·39); female: 6·79 (95% CI 4·37-10·57)]. A higher proportion of Traveller patients requested no next of kin involvement, compared to other ethnicities.

CONCLUSIONS

Given that Irish Travellers are at higher risk of self-harm and suicide-related ideation presentations compared to other ethnic groups, EDs should be viewed as an important suicide intervention point.

Case series: Psychosocial challenges of female youth within the Irish Travelling community

BACKGROUND

The Irish Travelling community are an ethnic minority group known for their distinct identity, traditions and language. Although this group has its roots in Ireland, they are marginalised and discriminated against by every part of Irish society. Irish Travellers are a group who are vulnerable to exclusion and experience health, economic and educational inequalities. Young female Irish Travellers in Ireland are highly susceptible to mental illnesses which makes the engagement of this ethnic group by healthcare services important.

AIMS

To review the cases of three female adolescents from the Irish Travelling community living in Ireland with a focus on their psycho-social difficulties. Complete a literature review, to complement and inform the three cases reviewed, on the socio-cultural and mental health challenges which effect adolescent females in the Irish Travelling community.

METHODS

Case series with literature search and review of relevant published articles using a keyword search of databases PubMed, PsycINFO and HSE protocols and reports. Hand searching of relevant references utilised. Informed signed consent obtained from each patient attending child and adolescent services in Ireland. Signed parental consent also obtained. Written consent obtained due to the use of patient history and assessments in the case series.

RESULTS

Adolescent females within the Irish Travelling community encounter particular difficulties within the moral constraints and expectations of this community. They encounter specific issues including mental illness, sexual stigma, domestic violence and limitations to the role of women. The three cases outlined give representative examples of the challenges faced by adolescent females within the Travelling community.

CONCLUSIONS

Psychiatric services need to be aware of this vulnerable group and focus on the recognition of their needs within the context of their community.