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Commission to investigate inequalities in mental health and recommendations to bring about system change for equality

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Irish in Britain’s Green Hearts submission to the Commission on Mental Health Inequalities by the Centre for Mental Health


The Irish Community in Britain:

Research has identified high levels of mental ill health among the Irish community. Common mental disorders, including anxiety, depression and phobias, are significantly more common among Irish men (1) (2). The ‘Count Me In’ census over three years shows that the pattern of hospital admissions for Irish people with mental health problems is unlike that for other groups, being skewed towards the 50+ age group (3). It also shows that a high number of people admitted with mental health problems also have a physical disability. Suicide remains a significant issue for the Irish community in London and rates do not appear to be reducing as they are in the wider population.  Evidence shows that Irish people are less likely to be referred for help by the GP and are more likely to reach mental health services through a hospital emergency department or even the police (4).

Despite the high levels of mental ill health in the Irish community, the absence of recent research and the aggregation of census data into the overall White category renders the inequalities they experience invisible.  The failure to collect or analyse data on the Irish or aggregating it into the overall white category means a lack of relevant and contemporary evidence for policy or planning.  

Examples:

The Royal College of Psychiatrists identified the Irish as a minority ethnic group with an older population more than twice the size of the next largest (Caribbean) group, yet no commentary or recommendations were made regarding their health or health outreach programmes (RCP, 2009).

Joint Strategic Needs Assessments (JSNA’s)

Degrees of Ethnic Inclusion Report found the number of JSNAs mentioning specific health issues for the Irish are 0/52 for dementia and 8/52 for mental health. The omission of Irish from JSNA’S, excludes the community from Joint Health and Wellbeing Strategies and loses focus on prevention, commissioning of culturally sensitive services (where needed) and reduces opportunities to reduce inequalities.

Irish Travellers, who are known to experience some of the poorest mental health outcomes, are a recognised minority ethnic group under the Race Relations Act 1976 but are still excluded from most monitoring data. This further exacerbates their “invisibility” in terms of mainstream service use and provision. Despite the poor health outcomes experienced by the Gypsy and Traveller communities, the Department of Health (DoH) has made no commitment to include them as one of the 16 ethnic minority categories monitored by the NHS.

Despite recommendation by the DoH to categorise “Irish” as a separate ethnic category, this has yet to be realised. Guidance for Commissioners of Mental Health Services for people from Black and Minority Ethnic Communities (July 2014), recommend the term BME “to include all non–white, ethnic minority groups living in this country”. Categorising ethnicity in terms of skin colour means that the Irish are continuously excluded from research and development projects. Furthermore, the subsequent lack of Irish health statistics means a deficit of critical information on screening, access and treatment outcomes.

The most recent example of inequality is that of the APPG for Dementia report “Hidden no more: Dementia and disability”. Although the report recognises the impact of poverty, employment, housing, social care and community inclusion, it seriously fails to do justice to the additional barriers faced by people from minority ethnic groups including the Irish. The lack of adequate and accessible social care is a problem for all, but there is a widespread absence of culturally sensitive social care for people from different minority ethnic groups and religions.

Irish organisations representing the community are frequently excluded from consultations or decisions by policy makers.  Like other BAME groups, effort is focussed on providing services to vulnerable people with little time for chasing consultation, bidding for funding or networking with policy makers.  

Mainstream organisations, both statutory and charity frequently seek help to access, consult with or research local Irish communities. However, they rarely budget for this and expect under–resourced third sector organisations to assist them without any support costs.  

The tendency to fund larger organisations who do not have a track record (or a limited one) with Irish or other BAME communities means grassroots organisations who can reach, and are acceptable and accessible to the most vulnerable, are forced to shrink or even close.

Inequalities in access to support for mental health and inequalities in the quality of support people receive, people’s experiences of mental health services and outcomes they get:

Irish in Britain’s research within the community repeatedly demonstrates that the most significant cause of dissatisfaction and delay in accessing health services early enough is the impact of persistent cultural tropes around alcohol. People repeatedly report that the first question often asked by a doctor is “how much do you drink?” Although potentially a legitimate question, it requires sensitivity especially with older patients. Many have therefore chosen to rely on their own resources, only seeking help from family, community or Irish organisations (if any) until a crisis intervenes.

People attending mainstream services recount having to repeat themselves, being misunderstood and having their names mispronounced. While these are irritating, a number of people report having their accents mimicked or ways of speaking ridiculed. 

Although data on Travellers is not easy to access, we know that Irish Traveller women and men have high rates of anxiety and depression. The incidence of suicide among Traveller men in recent years has been high enough to invoke an investigation by the Commission for Racial Equality (5).

Another Irish community group who suffer from stigma in mental health are survivors of child abuse in Industrial Schools in Ireland. These schools were run mainly by the Roman Catholic Church and systematically abused the children in their care until the end of the scheme. Britain is home to significant numbers of survivors: 37 percent of the 1,090 witnesses who gave evidence to the Commission to Inquire into Child Abuse (1999–2009) lived in Britain. Awareness of the existence of, or needs of, survivors is low amongst British mainstream statutory services and many survivors struggle to engage with much needed health care and wraparound services.

Initiatives to address inequalities, and the impact they have had:

In response to high levels of dementia in the community, Irish in Britain has developed Cuimhne (pronounced “queevna”, the Irish word for memory), a project to promote and equip Irish community groups, clubs and cultural organisations to develop or expand their offer to Irish people with dementia and their carers providing culturally sensitive dementia friendly environments and services, reducing social isolation and promoting positive mental health. 

Cuimhne promotes community understanding and conversation about dementia, still very much a taboo topic within the Irish community.

Organisations are facilitated to capture the skills and energies of volunteers to initiate or extend enjoyable activities which are stimulating and promote social interaction and provide support and advice for family carers to enable them to cope and avoid ill–health. Organisation help maintain and improve physical health, preventing/delaying dementia, through education or activities ranging from chair exercise to walking football.

Our Cuimhne Champions Patron Mary Tilki has written an article (6) explaining how work to make BAME and local communities more dementia friendly through Community Action on Dementia in Brent has grown out of our Cuimhne work.

Practical recommendations:

The Irish community suffers from an invisibility that is compounded by a lack of up–to–date specific research into their mental health needs. Groups like Irish in Britain and its members can facilitate this much needed research, but currently lack support and funding to do so. We want to undertake research that engages with communities and allows their voices to be heard.

The Cuimhne campaign has produced positive results and reached difficult to access people and groups. The model of care that it provides is excellent, but it needs more investment and recognition. Irish in Britain would be pleased to share the Cuimhne model with other communities.

We recommend

  • A separate Irish ethnic monitoring category in mental health diagnoses and studies
  • New research into specific ethnic communities that is participatory and culturally specific
  • More support and resources for culturally sensitive programmes and campaigns led by voluntary and community sector groups that can reach hard–to–access people
  • Support from government and local authorities to enable organisations like ours to share our learning and expertise in combatting stigma and discrimination in relation to mental health
  • Funding to encourage dialogue and address stigma about mental health among Irish community in a culturally sensitive way
  • Recognition that some sections of the Irish community still need culturally sensitive services that reach out to them
  • A fairer funding field for small organisations

References

1. Sproston K, Nazroo J (eds) (2002) Ethnic minority psychiatric illness in the community (EMPIRIC) – quantitative report. London, The Stationery Office.

2.  Weich S, McManus S (2002) Common mental disorders in ethnic minority psychiatric illness in the community (EMPIRIC) – Quantitative report. London, The Stationery Office.

3. Commission for Healthcare Audit and Inspection (2007) Count Me In: results of the 2006 national census of inpatients in mental health and learning disability services in England and Wales. London, CHAI.

4. Commission for Healthcare Audit and Inspection (2007) Count Me In: results of the 2006 national census of inpatients in mental health and learning disability services in England and Wales. London, CHAI.

5. Commission for Racial Equality 2004 Gypsies and Travellers: A strategy for the CRE, 2004–07. London, CRE.

6.  Tilki M 2018: Dementia–friendly Brent: a model community” printed on page 14 and 15 of the Journal of Dementia Care Vol 26 No 3 (May/June 2018)