Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-27T08:28:48.211Z Has data issue: false hasContentIssue false
  • English
  • Français

Experience of discrimination and engagement with mental health and other services by Travellers in Ireland: findings from the All Ireland Traveller Health Study (AITHS)

Published online by Cambridge University Press:  27 August 2020

B. Quirke Open the ORCID record for B. Quirke [Opens in a new window] ,
M. Heinen ,
P. Fitzpatrick ,
S. McKey ,
K. M. Malone Open the ORCID record for K. M. Malone [Opens in a new window]  and
C. Kelleher
B. Quirke*
Affiliation:
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
M. Heinen
Affiliation:
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
P. Fitzpatrick
Affiliation:
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital, Dublin, Ireland
S. McKey
Affiliation:
Department of Psychiatry, Psychotherapy and Mental Health Research, St. Vincent’s University Hospital and University College Dublin, Dublin, Ireland
K. M. Malone
Affiliation:
Department of Psychiatry, Psychotherapy and Mental Health Research, St. Vincent’s University Hospital and University College Dublin, Dublin, Ireland
C. Kelleher
Affiliation:
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital, Dublin, Ireland
*
*Address for correspondence: B. Quirke, RGN RM PGDip, Senior Researcher, School of Public Health, Physiotherapy and Sports Science, Woodview House, University College Dublin, Bellfield, Dublin 4, Ireland. (Email: brigid.quirke@ucd.ie)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Irish Travellers are an indigenous ethnic minority population in Ireland, with poor life expectancy. This study aims to identify factors associated with reported discrimination and how this affects their experiences of accessing and quality of health services, including mental health.

Methods:

The All Ireland Traveller Health Study was a cross-sectional census study in 2010. All Traveller families completed a survey questionnaire (n = 6540), and at random an adult selected from the family completed either a health status (health status study = 1547) or health services utilisation survey (HSU = 1576). Experience of discrimination (EOD) from the census was analysed in relation to HSU data on services used in the previous 12 months and reported experiences of access and quality of that health service. Census variables were analysed in relation to EOD and perceived discrimination (PD).

Results:

In the final models, EOD and PD were significantly associated with socio-demographic, socio-cultural and living conditions. The multivariate odds of reporting EOD ranged from OR 1.84 to 2.13 and were significant for those reporting worse opportunities in accessing health services, mental health (p = 0.001), hospitals (p < 0.001) and public health nurses (p < 0.001). The multivariate odds of reporting EOD ranged from OR 1.95 to 2.71 and remained significant for those who reported they had poorer experiences than others when using health services, quality of experience (OR 2.18, p =< 0.001), trust in providers (OR 1.95, p =< 0.001) and appropriate information (OR 2.71, p =< 0.001).

Conclusions:

Travellers experience high levels of discrimination which negatively affects their engagement with health services. Culturally competent services need to be developed.

Keywords

Discriminationmental healthethnic health inequalitieshealth care qualitycultural competency
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 39 , Issue 2: Themed Issue: Psychiatric Anthropology , June 2022 , pp. 185 - 195
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abdalla, S, Quirke, B, Fitzpatrick, P, Daly, L, Kelleher, CC (2010). All Ireland Traveller Health Study: Our Geels. Technical Report 2: Demography & Vital Statistics. Department of Health and Children, Dublin. (https://assets.gov.ie/18862/9a9cb0f00071438dbaf49370ce6062c4.pdf) Accessed 15 December 2019.Google Scholar
All Ireland Traveller Health Study Team (2010). Our Geels: Summary of findings. Department of Health and Children, Dublin. (https://assets.gov.ie/18859/d5237d611916463189ecc1f9ea83279d.pdf) Accessed 15 December 2019.Google Scholar
Ben, J, Cormack, D, Harris, R, Paradies, Y (2017). Racism and health service utilisation: a systematic review and meta-analysis. PLoS ONE 12, 1–22, e0189900. (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189900) Accessed 17 October 2019.CrossRefGoogle ScholarPubMed
Benjamins, MR, Middleton, M (2019). Perceived discrimination in medical settings and perceived quality of care: a population-based study in Chicago. PLoS ONE 14, e0215976. (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215976) Accessed 1 November 2019.10.1371/journal.pone.0215976CrossRefGoogle ScholarPubMed
Boilson, A, Craven, F, Drummond, A, Fitz-Simon, N, Staines, A, Kelleher, C (2007). Insight ’07 – Health and Social Services in Ireland – a survey of consumer satisfaction. Health Service Executive: Dublin.Google Scholar
Cemlyn, S, Greenfields, M, Burnett, S, Matthews, Z, Whitwell, C. (2009). Inequalities Experienced by Gypsy and Traveller Communities: a Review. Equality and Human Rights Commission: London.Google Scholar
Central Statistics Office (2017). Census of Population 2016 - Profile 8, Irish Travellers, Ethnicity and Religion. Central Statistics Office (CSO): Dublin Ireland.Google Scholar
Cheng, M. H. (2007). Aboriginal workers key to indigenous health in Australia. Lancet 370, 1533–1536.CrossRefGoogle ScholarPubMed
Cross, TL, Bazron, BJ, Dennis, KW, Isaacs, MR (1989). A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Towards a Culturally Competent System of Care, Vol 1. Georgetown University Child Development Centre: Washington, DC. (https://files.eric.ed.gov/fulltext/ED330171.pdf) Accessed November 2019.Google Scholar
Department of Health UK (2005). Delivering Race Equality in Mental Health Care – an action plan for reform inside and outside services. Department of Health: London. (http://research.bmh.manchester.ac.uk/ReACH/resources/keypaper4.pdf) Accessed 20 January 2020.Google Scholar
Dovidio, JF, Penner, LA, Albrecht, TL, Norton, WE, Gaertner, SL, Shelton, JN. (2008). Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Social Science and Medicine 67, 478–486.10.1016/j.socscimed.2008.03.019CrossRefGoogle ScholarPubMed
Dudgeon, P, Milroy, H, Walker, R. (Eds.) (2014). Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, 2nd edn., Commonwealth of Australia: Canberra. (https://research-repository.uwa.edu.au/en/publications/working-together-aboriginal-and-torres-strait-islander-mental-hea-2) Accessed 10 September 2019.Google Scholar
Equality and Human Rights Commission (2016). England’s most disadvantaged groups: Gypsies, Travellers and Roma. Is England Fairer? Review spotlight report, Equality and Human Rights Commission (https://www.equalityhumanrights.com/sites/default/files/is-england-fairer-2016-most-disadvantaged-groups-gypsies-travellers-roma.pdf) Accessed 2017.Google Scholar
Francis, G. (2013). Developing the cultural competence of health professionals working with gypsy travellers. Journal of Psychological Issues in Organizational Culture 3, 64–77.CrossRefGoogle Scholar
Gee, GC. (2002). A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. American Journal of Public Health 92, 615–623.10.2105/AJPH.92.4.615CrossRefGoogle ScholarPubMed
Government of Ireland (2016). Equal Status Acts (2002 and 2015). Government Publications: Dublin, Ireland.Google Scholar
Goward, P, Repper, J, Appleton, L, Hagan, T (2006). Crossing boundaries: identifying and meeting the mental health needs of Gypsies and Travellers, Journal of Mental Health 15, 315–327.CrossRefGoogle Scholar
Gracey, M, King, M (2009). Indigenous health part 1: determinants and disease patterns. Lancet 374, 65–75.CrossRefGoogle ScholarPubMed
Hamid, N, Daly, L, Fitzpatrick, P, Kelleher, CC (2011). All Ireland Traveller Health Study Technical Repot 2: The Birth Cohort Study Follow Up. Department of Health and Children: Dublin. (https://assets.gov.ie/18869/93209ad9ade043e3a28d0fbc64813540.pdf) Accessed 15 December 2019.Google Scholar
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205–228.CrossRefGoogle ScholarPubMed
Harris, R, Cormack, D, Tobias, M, Yeh, LC, Talamaivao, N, Minster, J et al. (2012). Self-reported experience of Racial Discrimination and Health Care Use in New Zealand: results from the 2006/07 New Zealand Health Survey. American Journal of Public Health 102, 1012–1019.CrossRefGoogle ScholarPubMed
Helleiner, J (2000). Irish Travellers: Racism and the Politics of Culture. University of Toronto Press: Toronto, Canada.Google Scholar
Jenkinson, C, Coulter, A, Bruster, S (2002). The Picker Patient Experience questionnaire: development and validation using data from in-patient surveys in five countries. International Journal Quality Health Care 14, 353–358.CrossRefGoogle ScholarPubMed
Karlsen, S (2007). Ethnic inequalities in health: the impact of racism. Better Health Briefing 3, Race Equality Foundation, Communities and Local Government. UK. (https://raceequalityfoundation.org.uk/wp-content/uploads/2018/03/health-brief3.pdf) Accessed 20 August 2019.Google Scholar
Kelleher, C, Quirke, B (2014). ‘Where are our costumes?’ The All Ireland Traveller Health Study – our Geels 2007–2011. In Hard to Survey Populations (eds. Tourangeau, R, Edwards, B, Johnston, TP, Wolter, KM, Bates, N), pp. 201–222. Cambridge University Press: UK.CrossRefGoogle Scholar
King, M, Smith, A, Gracey, M (2009). Indigenous health part 2: the underlying causes of the health gap. Lancet 374, 76–85.CrossRefGoogle ScholarPubMed
Krieger, N, Smith, K, Naishadham, D, Hartman, C, Barbeau, EM (2005). Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Social Science and Medicine 61, 1576–1596.CrossRefGoogle ScholarPubMed
Macpherson, W (1999). “The Stephen Lawrence Inquiry: Report of an Inquiry by Sir William Macpherson of Cluny”, Cmd 4262-I, The Stationary Office, London. Google Scholar
Mac Gréil, M (1996). Prejudice in Ireland Revisited: Based on a National Survey of Intergroup Attitudes in the Republic of Ireland, Dublin: Survey Unit, St. Patrick’s College, Maynooth, National University of Ireland, Maynooth. Google Scholar
Mac Gréil, M (2010). Emancipation of the Travelling People. Survey Unit, St. Patrick’s College, Maynooth, National University of Ireland, Maynooth, Ireland.Google Scholar
Malone, KM, McGuinness, SG, Cleary, E, Jefferies, J, Owens, C, Kelleher, CC (2017). Lived Lives: A Pavee Perspective. An arts-science community intervention around suicide in an indigenous ethnic minority, Wellcome Open Research 2017, (https://wellcomeopenresearch.org/articles/2-27/v1) Accessed 20 October 2019.Google Scholar
Marrone, S (2007). Understanding barriers to health care: a review of disparities in health care services among indigenous populations. International Journal of Circumpolar Health 66, 188–198.CrossRefGoogle ScholarPubMed
Matthews, Z (2008). The Health of Gypsies and Travellers in the UK: Better Health Briefing Paper 12. Race Equality Foundation: London. (https://raceequalityfoundation.org.uk/wp-content/uploads/2018/03/health-brief12.pdf) Accessed September 2019.Google Scholar
McGinnity, F, Grotti, R, Kenny, O and Russell, H (2017). Who experiences discrimination in Ireland? Evidence from the QNHS Equality Modules. Irish Human Rights and Equality Commission and Economic and Social Research Institute. ESRI Dublin: Ireland.CrossRefGoogle Scholar
McGorrian, C, Frazer, K, Daly, L, Moore, RG, Turner, J, Sweeney, MR, et al. (2012). The health care experiences of Travellers compared to the general population: the All-Ireland Traveller Health Study. Journal of Health Services Research Policy 17, 173–180.Google Scholar
McGorrian, C, Hamid, NA, Fitzpatrick, P, Daly, L, Malone, KM, Kelleher, C (2013). Frequent mental distress (FMD) in Irish Travellers: discrimination and bereavement negatively influence mental health in the All Ireland Traveller Health Study. Transcultural Psychiatry 50, 559–578.CrossRefGoogle ScholarPubMed
McLoughlin, A, Gould, S, Malone, KM (2015). Global trends in teenage suicide: 2003-2014. QJM: An International Journal of Medicine 108, 765–780.10.1093/qjmed/hcv026CrossRefGoogle ScholarPubMed
Moore, RG, Turner, J, Nic Charthaigh, R, Quirke, B, Hamid, NA, Kelleher, CC et al. (2010). All Ireland Traveller Health Study: Our Geels. Technical Report 3: Part A. Qualitative studies. Department of Health and Children, Dublin. (https://assets.gov.ie/18871/9a1eb4b20e4f40fb88a77916c6641ac7.pdf) Accessed 15 December 2019.Google Scholar
O’Mahony, J (2017). Traveller Community National Survey, Prepared by: Behaviour & Attitudes for: The National Traveller Data Steering Group and the Community Foundation of Ireland. (https://www.communityfoundation.ie/insights/news/national-traveller-survey-funded-by-the-community-foundation-for-ireland). Accessed 7 November 2019.Google Scholar
O Shea, G (2011). Suicide amongst members of the travelling community. Critical Social Thinking: Policy and Practice 3, 55–69.Google Scholar
Paradies, Y, Ben, J, Denson, N, Elias, A, Priest, N, Pieterse, A, et al. (2015). Racism as a determinant of health: a systematic review and meta-analysis. PLoS One 10, 1–48:e0138511. (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138511) Accessed August 2019.CrossRefGoogle ScholarPubMed
Pascoe, EA, Smart Richman, L (2009). Perceived discrimination and health: a meta-analytic review. Psychological Bulletin 135, 531–554.CrossRefGoogle ScholarPubMed
Pavee Point (2006). A Review of Travellers’ Health using Primary Care as a Model of Good Practice. Pavee Point Primary Healthcare for Travellers Project. Pavee Point Travellers’ Centre: Dublin, Ireland.Google Scholar
Pavee Point (2008). Traveller Cultural Rights – The Right to respect for Traveller Culture and Way of Life. Pavee Point Travellers’ Centre: Dublin, Ireland.Google Scholar
Perez, D, Sribney, WM, Rodriguez, MA (2009). Perceived discrimination and self-reported quality of care among Latinos in the United States. Journal of General Internal Medicine 3, 548–554.CrossRefGoogle Scholar
Peters, J, Parry, G, Cleemput, P, Moore, J, Cooper, C, Walters, S (2009). Health and use of health services: a comparison between Gypsies and Travellers and other ethnic groups. Ethnic Health 14, 359–377.CrossRefGoogle ScholarPubMed
Quirke, B, Fay, R (2001). Mainstreaming equality: travellers access to the health services – challenges and recommendations. Journal of Health Gain, Traveller Health 5, 30–32, the Office for Health Gain, Dublin.Google Scholar
Shepherd, SM, Willis-Esqueda, C, Newton, D, Sivasubramaniam, D, Paradies, Y (2019). The challenge of cultural competence in the workplace: perspectives of healthcare providers, BMC Health Services Research 19, 1–11. (https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-019-3959-7) Accessed 6 January 2020.CrossRefGoogle ScholarPubMed
Smart, H, Titterton, M (2003). A literature review of the health of Gypsy/Traveller families in Scotland: the challenges for health promotion. Health Education 103, 156–165.CrossRefGoogle Scholar
Smedley, BD, Stith, AY, Nelson, AR, eds. (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academy Press: Washington, DC.Google Scholar
Sorkin, DH, Ngo-Metzger, Q, De Alba, I (2010). Racial/ethnic discrimination in health care: impact on perceived quality of care. Journal of General Internal Medicine 25, 390–396.CrossRefGoogle ScholarPubMed
Staines, A, Sweeney, MR, Nic Charthaigh, R, Staines, D, Quirke, B, and Kelleher, CC (2010). All Ireland Traveller Health Study: Our Geels. Technical Report 3: Part B. Health Provider studies. Department of Health and Children, Dublin. (https://assets.gov.ie/18873/f19f7300ce304f6b8e695a1e6d9ddfd7.pdf) Accessed 15 December 2019.Google Scholar
The Equality Authority (2006). Traveller Ethnicity: An Equality Authority Report. The Equality Authority: Dublin.Google Scholar
The Health Service Executive (2008). The National Intercultural Health Strategy 2007-2012, Health Service Executive: Dublin.Google Scholar
The Joint Commissioning Panel for Mental Health (2018). Guidance for Commissioners of Mental Health Services for People from Black and Minority Ethnic Communities. (https://www.jcpmh.info/wp-content/uploads/jcpmh-bme-guide.pdf) Accessed October 2019.Google Scholar
The Royal College of Psychiatrists (2018). Position statement on Racism and mental health: PS01/18. The Royal College of Psychiatrists, UK. (https://www.rcpsych.ac.uk/pdf/PS01_18a.pdf) Accessed November 2019.Google Scholar
Treise, C, Shepherd, G. (2006). Developing mental health services for Gypsy Travellers: an exploratory study. Clinical Psychology Forum 163, 16–19.Google Scholar
Van Cleemput, P, Parry, G, Thomas, K, Peters, J and Cooper, C (2007). Health-related beliefs and experiences of Gypsies and Travellers: a qualitative study. Journal of Epidemiology and Community Health 61, 205–2.CrossRefGoogle ScholarPubMed
Van Hout, MC, Hearne, E. (2017). The changing landscape of Irish Traveller alcohol and drug use. Drugs: Education, Prevention and Policy 24, 220–222.Google Scholar
Walker, M (2008). Suicide amongst the Irish Traveller Community 2000-2006. Stationary Office: Dublin.Google Scholar
Wallace, S, Nazroo, J, Becares, L (2016). Cumulative effect of racial discrimination on the mental health of ethnic minorities in the United Kingdom. American Journal of Public Health 106, 1294–1300.10.2105/AJPH.2016.303121CrossRefGoogle ScholarPubMed
Walter, M, Saggers, S (2007). Poverty and social class. In Social Determinants of Indigenous Health (eds. Carson, B, Dunbar, T, Chenhall, R, Bailie, R). Allen & Unwin: Sydney.Google Scholar
Watson, D, Kenny, O, McGinnity, F (2017). A Social Portrait of Travellers in Ireland. Economic Social Research Institute Dublin Ireland: Dublin.CrossRefGoogle Scholar
Williams, D.R, Mohammed, S.A (2009). Discrimination and racial disparities in health: evidence and needed research, Journal of Behavioural Medicine 32, 20–47.CrossRefGoogle ScholarPubMed