Written submission from Friends, Families and Travellers (MHM0061)

Gypsy, Roma and Traveller men and boys face some of the greatest challenges around mental health of all men and boys in the United Kingdom. Gypsy, Roma and Traveller men and boys can experience severe stigma when disclosing information about their mental health. When coupled with high levels of discrimination, major barriers to employment and education and mental health services largely designed and commissioned for the ‘Gorja’ (non Traveller person) population, this can create the perfect storm for members of these communities.

Key issues

• Chronic exclusion across the social determinants of health places Gypsy, Roma and Traveller men and boys at higher risk of experiencing poor mental health.
• High levels of stigma and gendered expectations make it difficult for Gypsy and Traveller men to speak about mental health and therefore to seek help.
• Young Gypsies and Travellers often miss out on chances to learn about mental health or sources of support when experiencing poor mental health.
• Groups within Gypsy, Roma and Traveller communities such as Gay, Bisexual and Transgender men and boys, as well as men and boys in contact with the criminal justice system face double exclusion.
• Many Gypsies and Travellers experience bereavement and untreated trauma from grief.

Introduction

Among Gypsy, Roma and Traveller communities, mental health is rarely discussed openly, or even admitted privately. Even the term ‘mental health’ is often shied away from, with people preferring to refer to ‘bad nerves’.  For many people within the Gypsy and Traveller communities the term “mental health” comes with connotations of being crazy or linked with madness, on the more extreme end of poor mental health, rather than issues such as depression, stress and anxiety[1].

As the health and social care system does not routinely collect disaggregated data on Gypsy, Roma and Traveller communities, it is difficult to provide a precise overview of incidences and prevalence of poor mental health and the uptake of services in these communities. However, data collected within academic studies, by voluntary sector organisations and as part of the All Ireland Traveller Health Survey found that:

• Gypsies and Travellers are nearly three times more likely to be anxious than others, and just over twice as likely to be depressed[2].
• The suicide rate for Traveller men is seven times higher than for settled men Traveller men[3].
• Between 2005 and 2012, 43% of advocacy organisation Roma Support Group’s beneficiaries were suffering from mental health problems including depression, personality disorders, suicidal tendencies, self-abuse or dependency/misuse of drugs[4].
• Suicide within the Irish Traveller community is thought to be the cause of 11% of all deaths[5].

In addition, we know anecdotally that members of the liveaboard boater community often experience high prevalence of poor mental health. Anecdotal evidence suggests that there may be an overrepresentation of alcohol misuse and depression amongst this group, with issues around isolation adding to anxiety[6]. However, little evidence has been collected on this and boaters rarely feature in any documentation within the health and social care system. There is a clear need to gather more evidence on this.

Gypsy, Roma and Traveller communities

Several different groups fall under the banner of ‘Gypsy, Roma and Traveller’. These include Romany Gypsies, Irish Travellers, Scottish Gypsies and Travellers, Welsh Gypsies and Travellers, New Travellers, Boaters and Travelling Showpeople.

Although only Romany Gypsy and Irish Traveller communities have been established as distinct ethnic groups through case law, Roma communities, Scottish Gypsies and Travellers and Welsh Gypsies and Travellers would meet the same criteria and therefore should be considered as members of protected characteristic groups.

Whilst New Travellers, Boaters and Travelling Showpeople are not considered to be ethnic groups, many members of these communities experience similar levels of disadvantage as ethnic Gypsies and Travellers. Many families within New Traveller or Travelling Showpeople communities have been on the road for three or more generations and may one day be considered to be distinct ethnic groups.

Why are Gypsy, Roma and Traveller men and boys at higher risk of poor mental health?

1. Chronic exclusion across the social determinants of health places Gypsy, Roma and Traveller men and boys at higher risk of experiencing poor mental health.

It is well known that poor mental health often originates or is influenced by external factors and there are a range of issues that influence whether or not an individual will be vulnerable. Many men and boys from Gypsy, Roma and Traveller communities experience exclusion and inequalities across the wider social determinants of health, including accommodation, education, employment and social inclusion.

Discrimination

In 2018, the Equality and Human Rights Commission carried out research on social attitudes which found that 44% of the British public surveyed openly expressed negative feelings towards Gypsies, Roma and Travellers, more than any other protected characteristic group[7]. The way that high levels of discrimination affects the health and wellbeing of Gypsies and Travellers is not only limited to self-perception and feelings of being exclusion, but extends to how Gypsies and Travellers experience healthcare and mental health services as well as vulnerability to hate crime and hostility.

It is difficult to measure the impact on children and young people of growing up in an environment where members of their communities experience such high levels of hatred and hostility, but doubtlessly this can and will be incredibly damaging.

Accommodation

“I was happy if I was in a caravan....freedom and all that....you know, fresh air.” 

Male Gypsy or Traveller[8]

Lack of secure and long-term accommodation has long been cited as a key factor in causing poor mental health amongst Gypsies and Travellers. Living roadside, on unauthorised and temporary encampments, with no facilities, no access to health care, experiencing barriers to accessing benefits or employment, and facing constant evictions and encounters with the police and hostility from locals can be a situation that goes on for years with no let up. While the vast majority of Traveller caravans are on authorised sites that have planning permission, there are around 3000 caravans on unauthorised sites, largely as a result of local authorities’ failure to identify land where Travellers can live[9].

The long-term effect on mental health for people in these circumstances cannot be underestimated.  Pressure on the male members of families in these living conditions will centre on being unable to provide for the family, worries about children’s safety, fears of discrimination or hostility from local people, heightened emotions when confronted by the police or bailiffs, and stress around having to hitch up caravans and tow on and off or constantly having to move on and find new places to pitch up.

Figures from the 2011 Census showed that around three quarters of Gypsies and Travellers now live in bricks and mortar accommodation[10]. Many Gypsies and Travellers choose to settle for health or education reasons, or because there are no pitches available due to lack of provision from local authorities. Many housed Travellers that Shelter consulted in their 2008 study, recalled the shock of moving into settled accommodation. The stress and anxiety resulting from a complete change in lifestyle and feelings of isolation commonly cause mental health problems[11].

Within the liveaboard boating community without home moorings, the pressure from having to move every two weeks in order to comply with Canal and River Trust guidelines can have a major impact upon the mental health of some boaters, particularly single men who have recently experienced relationship breakdown. Men within this group can be particularly susceptible to poor mental health, including issues surrounding depression, social anxiety and isolation, from coping with feelings as a result of relationship breakdown and often treated with alcohol and/or substance misuse.

Male boaters who have experienced relationship breakdown and have chosen to live on the canal as a result may find it difficult to cope. Failure to comply with river guidelines can mean that men are drawn into enforcement procedures, which can further exacerbate any pre-existing mental health issues or problems around self-medication. On top of this, it can be difficult to maintain employment, and missed appointments can mean that benefits are cut off.

“I haven’t really adjusted to it (living a house). I lived on site for 15 years but feel isolated now. I spend a lot of time back on site and where my eldest son lives.”

Male New Traveller[12]

Education

Evidence released as part of the Race Disparity Audit indicates that pupils from Gypsy, Roma and Traveller communities had the lowest average GCSE score of any ethnic group in 2016/7[13]. Further to this, pupils from Gypsy, Roma and Traveller communities have the highest ‘overall absence’ and ‘persistent absence’ rates of any ethnic group[14].              

As a result of missed opportunities in education, boys and young men from Gypsy, Roma and Traveller communities may miss out on universal efforts to educate young people on mental health, how poor mental health can be eased or prevented and where to go to for support. In the context of high levels of stigma around mental health in Gypsy and Traveller communities, this leaves many young men afraid of admitting they are unwell or engaging with services.

Many young Gypsy and Traveller men are unaware of what mental health means and associate negative connotations and terminology with it. Young Travellers involved with a 2015 report by Pavee Point  expressed negative perceptions about mental health and felt that words like ‘psycho’, ‘mad’ and ‘loser’ were explanations for mental health generally. One participant stated that a person with mental health struggles would be “someone you don’t talk to”[15].

Young Gypsy and Traveller men and boys can experience high levels of discrimination and racist bullying within a school setting, meaning young Gypsies and Travellers will try not to disclose their identity or where they live (if on a site). The bullying can come from teachers and staff as well as other pupils. Continued verbal or physical abuse clearly has an impact upon mental health and can affect self-esteem and confidence. A study carried out by The Children’s Society found that 63% of Gypsy, Roma and Traveller children had been bullied verbally or physically whilst in school, because of their ethnicity[16].

We recently held a focus group with young Romany Gypsy people to discuss education and employment issues. One young man in the group described how he had been bullied throughout school for being behind as he was the main carer for his mother and had missed a lot of school. The young man attended school from the age of eight years to 16 years of age but was consistently bullied for being a Traveller. This had an ongoing effect on his mental health and self-worth. In the end, he lashed out at one of his perpetrators and left the school before taking any exams.

He then went on to attend college, in another area so he could get “as far away as possible from the other kids.” He managed to complete entry level exams but felt he did not get enough support from staff. He then did some weeks on the mechanics course, then switched to another course. However, he was soon being bullied again and left the college after one and a half years, feeling frustrated and depressed with the whole experience.

“I was more grown up than any of them; they were like kids. I had more actual experience of life than they did. I went there to try and work and learn but it was like being back in a playground.”[17]

2. High levels of stigma and gendered expectations make it difficult for Gypsy and Traveller men to speak about mental health and therefore to seek help.

“You’ve got to be tough and get on with it. My family is there like, but you’ve got to help yourself.”

Male Irish Traveller[18]

Men and boys in Gypsy and Traveller communities can often feel pressurised to appear “strong” and “in control”. This can make it very difficult for Gypsy and Traveller men to admit mental health problems. This can be difficult and feel shameful because it can be seen as a sign of weakness and may threaten mens’ traditional role as providers for the family[19].

Within Gypsy and Traveller communities, there is a strong preference for self-employment. In fact, Gypsies and Travellers are twice as likely to be self-employed compared to the majority population in England and Wales[20]. Recent changes in the law around cold calling and scrap metal collection can make it difficult for some Gypsy and Traveller men to make a living. The increasing popularity of websites used to verify tradesmen can also leave Gypsy and Traveller men more susceptible to discrimination if their ethnicities can be identified because of their address or lack of address on their profiles.

In addition, whilst many employers are increasingly aware of how to support the mental health of men within their companies, men from Gypsy and Traveller communities who are self-employed will not be able to access this type of support.

“There’s still a lot of stigma around mental health, and so people talk in terms of stress. And I think… what we’ve found from the health needs assessment was high levels of stress really around money and employment.”

Stake holder in focus group[21]

3. Young Gypsies and Travellers often miss chances to learn about mental health or sources of support.

“I didn’t have a clue about what depression was or did, that was until it hit me. Growing up, we always spoke about depression as a cause for a suicide. I didn’t think mental health illnesses were as serious as a physical illness. I don’t think anybody in my family did when I was growing up, and especially in a family of Irish Travellers”.[22]

‘Mental health’ is a term not often discussed by Gypsy and Traveller men. The term “bad nerves” is often used to describe poor mental health as a result of stigma around the term “mental health”.

The lack of disaggregation of data collected by the health system in relation to Gypsy, Roma and Traveller communities means it is difficult to determine uptake of mental health services and support. However, anecdotally, we know that many members of Gypsy, Roma and Traveller communities find it difficult to access support or don’t feel that the support offered by mental health services are for them.

Men and boys from Gypsy and Traveller communities can often prefer to deal with problems they are experiencing by themselves or within the extended family. Members of Gypsy and Traveller communities often pride themselves on their independence and strength and may see accessing mental health services as a sign of weakness.

Men may be fearful that if others find out that they are receiving help for their mental health, they might be marginalised or judged. Stigma about mental health among Roma men is further heightened by language barriers and the difficulties of translating terminology[23]. 

Many Gypsy and Traveller men and boys can feel that health professionals in mental health services will lack understanding of their culture or way of life. In addition to this, issues surrounding low literacy amongst many members of Gypsy and Traveller communities means that information about mental health and support for poor mental health is likely to inaccessible for many Gypsy and Traveller children and young men.

4. Groups within Gypsy, Roma and Traveller communities such as gay, bisexual and transgender men and boys, as well as men and boys in contact with the criminal justice system can face double exclusion.

Gay, bisexual and transgender men and boys

“By the age of 19 — sometimes much younger — most Travellers are married. I know other gay Travellers who have married girls just to escape suspicion. That’s not who I am, I don’t want to break a young girl’s heart. I couldn’t marry someone, then sneak off with men behind her back. An older member of my community is gay and has never married or had a partner. He’s in his fifties and was beaten up for many years. I went to see him a while ago and we went out for some food. He’s an alcoholic and I don’t want to end up like him. I want to find a partner and get married one day.”

Patrick Connors, Attitude Magazine[24]

A number of participants in a 2005 study felt that the difficulties in discussing sexuality openly was a contributing factor to the high rates of suicide in the Traveller community[25]. There is anecdotal evidence from within Gypsy and Traveller communities to suggest that some gay, bisexual and transgender Gypsies and Travellers may contemplate suicide or take their own lives because they felt they could not talk to anyone about their sexuality.

Gay and transgender Gypsy and Traveller men and boys may face a ‘double discrimination’ where they may be afraid of facing discrimination from within their own communities if they reveal their sexuality or gender identity, but also fear discrimination from the settled community for their ethnicity. This can understandably cause great conflicting pressures on men and boys and as a result have a detrimental impact on their mental health.

Men and boys in contact with the criminal justice system

‘My son was 13 when he died…  The governor told me I couldn’t go to the funeral because I came from ‘the Travelling community’ and would abscond.’

Irish Traveller inmate[26]

Evidence shared as part of the Lammy Review indicates that Gypsy, Roma and Traveller men are estimated to account for 5% of male prisoners[27]. Despite the fact that Gypsy, Roma and Traveller communities are represented in prison more than women and the severity of health inequalities faced by these communities, no specific standards have been issued to improve the health and wellbeing of Gypsies, Roma and Travellers in prison. In the absence of a specific and targeted approach to improve the physical and mental health of Gypsy, Roma and Traveller men (both within and outside of prison), members of these communities will continue to fall between the cracks.

Separation from the extended family and the support network it provides, long periods indoors when used to being outside, alongside exposure to discrimination within prison can have a major impact on Gypsy and Traveller men and boys. We held a focus group inside a prison with men from the Romany Gypsy community to discuss mental health within the criminal justice system. A number of participants in the group told us how they were not permitted to visit dying relatives or attend family funerals. When asking prison staff why one man could not attend his father’s funeral he was told it was because he was a Gypsy and that there will be a lot of family at the funeral so it posed a ‘security risk’. No further explanation was given and the man was not permitted to attend. This was a scenario many of the men had experienced.

The men also described how bad the discrimination they face for being Gypsy or Traveller inside prison is; from staff members especially, and how this has a hugely detrimental effect on their mental health. Several men within the group discussion had experiences of other Gypsy men, especially young men, becoming so depressed they had attempted to commit suicide by hanging themselves[28] .

“When I went to healthcare about feeling depressed, they said I was overegging it to get released quick. We need to be believed.”

Romany Gypsy man in focus group

Figures from the Prisoners’ Reform Trust suggest that around 26% of Irish Traveller prisoners suffer from bad mental health[29]. In addition, research presented as part of the Lammy Review found that, “Gypsy, Roma and Traveller prisoners were more likely than non-Gypsy, Roma and Traveller prisoners to report needing support across a range of problems but were less likely to say that they had actually received such support. For example, in 2014, 27% of Gypsy, Roma and Traveller prisoners reported feeling depressed or suicidal on arrival (compared with 15%). However, they were less likely to report receiving information about what support was available for this (35% compared with 44)”’[30].
 

5. Many Gypsies and Travellers experience bereavement and untreated trauma from grief.

“The majority of Travellers I know who are committing suicide......most of the ones I know are after a death. I think that could be a lot of the cause of the suicide as well, when nobody is getting to say what they feel, and keep it to themselves, and that’s why you get a suicide that follows a death.”[31]

Families within Gypsy and Traveller communities can often be very close knit, so bereavements can hit hard and affect many people. Particularly among men poor mental health issues around grief, depression, stress and loss are often not talked about, meaning that any such feelings resulting from deaths among family members can often be kept inside and hidden.

Unresolved grief from multiple bereavements can have long-term health implications including depression, anxiety and increases in risk taking behaviours such as alcohol and substance misuse[32]. In perhaps the largest study of its kind which focusses on liveaboard boaters, Greenfields and Lowe highlight that “the demographics of boat dwellers (whilst including a percentage of young couples and women) tended towards middle aged and older males (often single) and anecdotal evidence (coupled with indications from self-reported health conditions) suggested that there may be an overrepresentation of alcohol misuse and depression amongst this latter group.” Undoubtedly, unresolved grief from relationship breakdown is one key contributor to instances of poor mental health and in some case alcohol or substance abuse in liveaboard boater communities[33].

In addition, the research authors reported, “several respondents during qualitative interviewers referred to divorced men who might have drunk or had substance misuse issues prior to becoming a boater/Traveller but which then became more of an issue once ‘no wife to keep them on the straight and narrow’ or ‘marriage broke up, can’t afford to buy or rent a house so get a boat if you’re a man who has hung about in boats when married, or is a bit practical - nobody to think about but himself.. and then heavy drinking is normalized amongst a lot of Boaters”[34].

Solutions

Solutions to the issues we have outlined in this submission must come from both within and outside from Gypsy, Roma and Traveller communities. Initiatives such as the ‘One Call Away’ helpline set up by members of the Romany Gypsy community provide a good example of ways in which Gypsies and Travellers are striving to identify solutions to the problems they are facing. In recent years, the example being set by high profile people from the Gypsy community such as Tyson Fury in discussing his battle with poor mental health represents a positive step, particularly for men and young boys.

Actions within Gypsy, Roma and Traveller communities to improve mental health must be matched by actions within the government to ensure that Gypsy, Roma and Traveller men and boys can receive the support they need with their mental health, when they need it. Below are some recommendations that should be implemented to support men and young boys from the Gypsy and Traveller communities:

• Commissioners should seek to support communities and voluntary sector organisations to develop projects and services which take an asset based and peer-led approach to better mental health in Gypsy, Roma and Traveller communities.
• Service providers should move beyond a ‘door open’ approach to engage in Gypsy, Roma and Traveller communities and instead aim to co-produce culturally appropriate services with community members, using assertive outreach to build trust.
• The Department of Health and Social Care should commission pilot projects which aim to support the mental health of gay and transgender men and boys who are experiencing ‘double discrimination’ because of their ethnicity, sexual orientation and gender identity.
• The Department of Health and Social Care should create standards to improve the mental health of Gypsy, Roma and Traveller men and boys in the criminal justice system.
• NHS England should include Gypsy, Roma and Traveller communities as ethnicities in the NHS Data Dictionary, so that we develop an improved knowledge of health issues faced by Gypsy, Roma and Traveller communities and uptake of services.
• The upcoming ‘Prevention is Better Than Cure’ Cross-Government Green Paper should contain commitments which recognise and challenge the unique inequalities experienced by Gypsy, Roma and Traveller men and boys across the social determinants of health.
• The government should commission more services to support mental health prevention, diagnosis and support for self-employed people.

About us

Friends, Families and Travellers is a leading national charity that works on behalf of all Gypsies, Roma and Travellers regardless of ethnicity, culture or background.

fft@gypsy-traveller.org | www.gypsy-traveller.org | Twitter: @GypsyTravellers | Facebook: @FriendsFamiliesandTravellers | +44 (0) 1273 234 777

March 2019