SUICIDE RATES are more than six times higher in Traveller men than in the general population, according to the All Ireland Traveller Health Study, released last month.

And there is a disproportionate number of Travellers in psychiatric units around the State.

There are also high levels of anxiety and depression within the community and, anecdotally, high numbers of Travellers on antidepressants. Substance abuse is a problem and young men in particular struggle with issues of identity when mainstream society has a rooted level of prejudice against them. Sexual identity issues in such a traditional culture also add to the pressure.

Clearly, there is a need for mental health services in the community but, according to Thomas McCann, manager of the Traveller Counselling Service (TCS), the need can not be filled by the mainstream; Traveller-specific mental health services must be developed all around the State.

McCann established the TCS in Phibsborough in north Dublin in 2008, with the help of a €5,000 grant from Social Entrepreneurs Ireland. He had been working on Traveller issues for over 20 years and recognised the need. His aim was to provide counselling initially on a pilot basis in the greater Dublin area.

By the time most Travellers with mental health problems reach mainstream services they are in crisis, McCann says. Though they may or may not have been aware of mental health services, for example at a local health clinic, they have not accessed them.

One of the key issues preventing access has been the relationship between the services and the Traveller community. There was an expectation that, if a need was identified and the service was provided, people would automatically use the service, he says, but that has not been the case. Trust is an issue, but it is more about the sense of distance, both physical and metaphorical, between the Traveller community and the service.

“Services provided are generally outside the Traveller community; whereas within the majority, community services are seen as being provided from within. We need to acknowledge that,” he says.

“If you sit in the office waiting for people to come, they are not going to come, no matter how good the service is . . . because of that distance and because of that relationship and the historic, traditional kinds of cultural differences.”

Those cultural differences could include how a service provider reacts if someone doesn’t turn up for an appointment, if they turn up at a different time or don’t follow up on medication.

“All of that can be due to the cultural background the people are coming from and we need to understand that one size doesn’t fit all,” he says. The “nomadic mindset” of Travellers needs to be considered.

TCS learned early that it needed to reach out to the community, McCann says. In the first year there was a high rate of calls, and 150 appointments were made with the five experienced counsellors the service hired in, but only one-third of appointments were kept. The fear of coming in was too much for some, McCann says, and accessibility was an issue. If you were coming from somewhere such as Bray to Phibsborough, it would take a three-and-a-half-hour round trip.

“For someone to do that, particularly if they have children, or to walk off a site without people saying ‘Where are you going every week for three or four hours?’ was very difficult,” he says.

Stigma around mental health within the Traveller community is also a barrier. There is a fear that other people will talk about the family – a fear of letting the family down. “There would be a shame around it,” says McCann, “an internal stigma”.

The TCS has been trying to change that. It offers outreach counselling in Bray once a week. It has also piloted a service in Portlaoise and hopes to have outreach services in Tallaght and Blanchardstown by the end of the year, although not in existing Traveller centres because users would not want to bump into family members while attending.

Working in partnership with local addiction centres and charities such as Crosscare, it hopes to utilise their local facilities to provide counselling as cheaply as possible. It has also given support to similar new Traveller counselling centres being established in Galway, Cork and Limerick.

“We would like to see counselling available for Travellers in every local area,” McCann says.

Crucially, TCS has also started visiting Traveller sites to talk to residents about mental health. Addiction and suicide have been the big issues, along with depression, McCann says. The response to the talks has been good.

“Once the discussion happens, people really engage with it, that’s my experience and the same experience applies in the counselling service. When Travellers come in, they really talk about the issues and that has been very different from private practice, where it might take people a long time to get to the issue.”

In the long term, culturally inclusive mental health services, not just for Travellers, but for other minorities in Ireland, should be provided as part of A Vision for Change, the Government's mental health strategy.

To that end, McCann will meet Minister of State with responsibility for Mental Health, John Moloney, later this month. He hopes to convince him of the benefits of committing funding to inclusive services for Travellers.

Just looking at the numbers of Travellers in psychiatric units and on antidepressants shows the cost of not providing the services, McCann says.

“Providing the services would have an immediate benefit for Travellers and their families . . . but in the long term, it is society as a whole that would benefit.”